[🇧🇩] Healthcare Industry in Bangladesh

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Why we need a referral system in healthcare

The healthcare system in Bangladesh is plagued with so many problems that some fundamental issues are often overlooked. The absence of a strong referral system in healthcare is one of such issues, which has created a series of problems affecting patients, doctors, and the overall efficiency of the

thefinancialexpress.com.bd

Why we need a referral system in healthcare

Shiabur Rahman
Published :
Aug 15, 2025 00:43
Updated :
Aug 15, 2025 00:43

The healthcare system in Bangladesh is plagued with so many problems that some fundamental issues are often overlooked. The absence of a strong referral system in healthcare is one of such issues, which has created a series of problems affecting patients, doctors, and the overall efficiency of the health sector.

In most countries, particularly those with well-organised healthcare systems, have a strong referral mechanism in which patients first consult general practitioners or GPs in their community - be it rural or urban areas. The GPs assess their conditions, offer primary treatment, and refer them to appropriate specialists, if necessary. This referral system ensures that patients receive the right treatment at the right time and reduces unnecessary expenses. Bangladesh should have such a system in place as a former colony of Britain, a good example of a well-organised GP-driven referral system that directs patients to start with primary care, because the foundation of Bangladesh's healthcare system was established during British rule. However, the present scenario in Bangladesh is far away from that system. Patients here usually bypass GPs, heading straight to specialist doctors of their choice due to the absence of the referral system. Most of the patients believe that specialists will solve their problems more effectively, no matter whether their condition actually requires consulting such specialists. This approach leads patients to misjudging their conditions and ending up visiting the wrong type of specialist. For example, someone with a common skin rash may rush to a highly reputed dermatologist without realising that a GP could have diagnosed and treated the issue in a fraction of the time.

This approach often causes an unnecessary burden of expenditure on patients, who have to meet a major portion of the medical expenses from their own pocket unlike the citizens of most countries. According to a World Bank report, Bangladesh's out-of-pocket expenditure on health per capita at purchasing power parity was the 8th highest among 45 least developed countries in 2021.

Specialist consultations, diagnostic tests, and treatments, which can sometimes be avoided with the guidance of GPs, generally involve higher fees compared to primary care services.

Choosing specialist doctors first also creates a huge burden of patients on "celebrity doctors", who are nationwide recognised for their expertise in particular fields. The excessive concentration of patients on a small group of doctors limits access for those who genuinely need their expertise. These doctors face overwhelming patient queues, making it difficult for them to spare adequate time for each case. Patients have to wait for hours, sometimes days, to secure an appointment, only to find that their issue does not require such specialised care. Such wastage of time sometimes heightens the risk for those encountering life-threatening conditions.

The absence of a referral system also leads to an inefficient use of medical resources. Without the system, specialist doctors spend a significant amount of time handling cases that could easily be managed at the primary care level. This inefficiency lowers the quality of care and delays in specialist treatment for serious conditions can have critical consequences.

The health scenario in Bangladesh would be changed drastically if the country is able to establish a well-designed referral system. Developing such a system would be hard, but not impossible. The existing network of community clinics and upazila health complexes could serve as the foundation for this system. But for that these facilities would have to be equipped with qualified doctors trained in general practice, along with sufficient medical supplies and diagnostic tools to handle common ailments. Besides, a campaign would also be necessary to make people understand that consulting a GP first is not a compromise in care but a smart, efficient step toward proper treatment.​

 

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Healthcare is a right, not a commodity

The crisis in Bangladesh's healthcare system is a known fact. It is being felt daily by millions of people who are forced to wait for hours in overcrowded public hospitals, struggle to afford exorbitant fees in private clinics or face the cruel choice between treatment and survival. The state of ou

thefinancialexpress.com.bd

Healthcare is a right, not a commodity

MIR MOSTAFIZUR RAHAMAN
Published :
Aug 19, 2025 00:12
Updated :
Aug 19, 2025 00:12

The crisis in Bangladesh's healthcare system is a known fact. It is being felt daily by millions of people who are forced to wait for hours in overcrowded public hospitals, struggle to afford exorbitant fees in private clinics or face the cruel choice between treatment and survival. The state of our hospitals today is not just a reflection of weak infrastructure and understaffed wards, but a broader indictment of failed policies and neglected priorities.

Government hospitals, meant to be the backbone of public healthcare, are crippled by dilapidated infrastructure, insufficient medical staff, lack of modern equipment, and an overwhelming patient load. Many lack essential medicines, diagnostic facilities, or even proper sanitation. The result is predictable: citizens who can better-off avoid these institutions altogether. Ironically, this flight from the public sector includes not just the wealthy, but even sections of the middle and lower-middle classes, who increasingly see no alternative but to seek treatment in private hospitals.

But here lies the cruel paradox: in the private sector, healthcare has been transformed into a commodity. Profit motives, disregard for regulations, and an absence of ethical safeguards mean that patients are often treated less as human beings in need of healing and more as customers purchasing a product. Here, life-saving services are packaged like consumer goods-sold at high prices and marketed through advertisements, promotions, and flashy claims of "world-class" facilities.

This crisis is not simply a matter of hospitals, beds, or doctors. It is the direct result of the country's failed health policy. Bangladesh's Constitution guarantees access to healthcare as a basic right. Yet, in practice, this guarantee remains confined to paper, a hollow promise that fails millions who depend on it.

There are cases where due to their inability to pay the treatment bill, parents had to flee hospitals leaving their children in the ICU.

Questions have been raised if hospitals have no responsibility beyond demanding bills? Is there no space in our healthcare system for empathy? Should poor patients always be treated as liabilities unless they can pay? At what point does a system built to heal transform into a mechanism that alienates the very people it should serve?

Healthcare in Bangladesh has now become stratified along lines of class, creating a cruel form of social segregation. The wealthy fly abroad for treatment or turn to expensive, large-scale private hospitals in Dhaka. The middle class-often the most vulnerable-take loans, sell property, or exhaust life savings just to afford operations or critical care. And the poor? They endure untreated illnesses, resort to unqualified practitioners, or, in the worst cases, abandon their loved ones in hospital corridors.

This is not merely an economic disparity; it is a form of social injustice. It is the erosion of the very idea that life has equal value, regardless of income or status. When the ability to access healthcare depends on how much money one has, society fractures into tiers of humanity-where the lives of the poor become expendable, and the wealthy are protected by privilege.

Underlying this crisis is the abysmally low budgetary allocation to healthcare. In the 2024-25 fiscal year, Bangladesh devoted only 5.4 percent of its national budget to the health sector. Experts widely agree this is far below what is required for a country of more than 170 million people. To make matters worse, even this inadequate allocation fails to translate into effective services because of widespread corruption, inefficiency, and resource mismanagement. Funds are siphoned off, equipment procurement is riddled with irregularities, and accountability remains elusive.

As a result, the gap between demand and supply grows wider every year. The private sector fills this vacuum, but without proper oversight, it is driven almost entirely by profit motives. Across the country, new hospitals and clinics emerge, not as centers of healing, but as businesses competing through "packages," "special deals," or glamorous advertising campaigns. The tragedy is that this commercialisation takes place in a sector that should, by its very nature, place life and dignity above all else.

The current situation cannot be allowed to persist. Healthcare must be reclaimed as a fundamental public good rather than a market-driven service. Several steps are urgently needed.

First, private hospitals must be brought under a strict regulatory framework. Standardised rates for admission, ICU charges, diagnostic services, and essential treatments must be set and enforced. A mandatory quota for poor patients, ensuring access to free or heavily subsidized care, should be part of licensing requirements. Transparency in billing, along with strong monitoring mechanisms, is essential to prevent exploitation.

Second, public hospitals must be strengthened. This means not only increasing budgetary allocations but also ensuring those funds are properly spent. Investments in infrastructure, training, and technology are vital. Equally important is creating an environment that promotes professionalism, ethics, and accountability among healthcare workers. Doctors and nurses must be incentivised to stay in the public system rather than migrate to private practice or abroad.

Third, healthcare must reach rural Bangladesh. The concentration of advanced facilities in urban areas leaves the majority of the population underserved. Strengthening community clinics, upgrading district hospitals, and ensuring consistent availability of medicines can create a more equitable distribution of services.

Fourth, civil society must be engaged. NGOs, charitable organizations, and corporate social responsibility (CSR) programs can play a vital role in bridging gaps. However, their contributions must complement, not replace, the responsibility of the state. A dedicated health fund for poor patients, managed transparently and independently, could provide immediate relief for those unable to afford critical treatment.

One of the most pressing questions we face is whether healthcare for the poor will remain dependent solely on sympathy and charity. While acts of compassion from individuals or institutions are valuable, they are not a substitute for systemic change. A humane society cannot allow the health of its most vulnerable citizens to depend on chance generosity or the goodwill of strangers.

Instead, healthcare must be recognized and enforced as a fundamental right. Just as access to education or protection from violence is considered non-negotiable, access to medical treatment must be guaranteed for all, irrespective of income or social position. This requires political will, legal safeguards, and a social commitment to equity.

If Bangladesh is to move forward as a just and inclusive society, it must confront the inequalities that plague its healthcare system. The story of the mother forced to leave her child behind should serve not only as a moment of grief, but as a catalyst for reform. No one should ever be placed in such an impossible situation.

The future demands that we reimagine healthcare not as a bill to be paid, but as a shared responsibility and a moral obligation. In this vision, hospitals are not businesses but sanctuaries of healing. Doctors and nurses are not service providers chasing profits, but professionals guided by ethics and compassion. And the state, rather than shirking its duties, stands firmly as the guarantor of health for all.

This is not an impossible dream. Many countries with fewer resources than Bangladesh have made remarkable progress in creating inclusive healthcare systems through strong policies, effective regulation, and social mobilization. What is required is the courage to place human lives above financial interests, and the determination to turn constitutional promises into lived realities.

Bangladesh stands at a crossroads. It can continue down the path of commercialisation and inequality, where healthcare remains a privilege of the wealthy and a torment for the poor. Or it can take decisive steps to reclaim healthcare as a basic right, accessible to all without discrimination.

The choice should be clear. Healthcare cannot remain a luxury item or a cruel lottery of fate. It must be the most basic assurance of citizenship-one that affirms the equal worth of every life. For the millions who struggle to afford treatment, and for the dignity of an entire nation, the time to act is now.​