Health Systems Reforms in Bangladesh: An Analysis of the Last Three Decades

We identify health sector reforms implemented in Bangladesh over the past 30 years and examine their impact on health system outcomes. Studies were included if they identified health sector reforms implemented in Bangladesh, focused on reforms affecting health system outcomes, were published between 1991 and 2023 in English or French, and were full-text peer-reviewed articles, literature reviews, book chapters, grey literature or reports. Twenty-four studies were included. Over the past three decades, Bangladesh’s health system has been transformed to improve outcomes, with crucial funding from development partners. Sector-wide approaches and subsequent reforms have improved services, tackling issues such as shortages of professionals, financial constraints and barriers to access. Improvements were made in staffing levels, but disparities between rural and urban areas persisted. Although financial reforms stimulated funding, achieving universal health coverage through direct payments proved challenging. Monitoring and evaluation capabilities have improved, but issues such as inadequate drug supply and high out-of-pocket expenditure require ongoing attention to enhance Bangladesh’s health system. Reforms such as sector-wide approaches have improved health system performance, but persistent problems underline the need for sustained attention and comprehensive reforms to achieve a sustainable improvement.