Advisor Titumir calls for primary healthcare in Bangladesh to be guaranteed by state

He says allocating and implementing 5 percent of GDP for health is essential to reduce inequality and ensure universal primary care

Primary healthcare must be guaranteed by the state to reduce inequality in health services, the Prime Minister's Finance Advisor Rashed Al Mahmud Titumir.

He spoke at a seminar organised by the Bangladesh Institute of Development Studies (BIDS) at its Agargaon office in Dhaka on Thursday.

A research paper on out-of-pocket health expenses and financial barriers to accessing care was presented there.

“We have seen, and your (BIDS) research has also shown, that inequality can be reduced if health sector spending is increased. But the question is where that spending should be increased,” Titumin, also the planning advisor, said.

“We believe primary healthcare must be ensured first. We also believe that secondary healthcare and tertiary healthcare exist, but among these three, the government must ensure primary healthcare.”

Highlighting the importance of treating health as a fundamental right, Titumir referred to ongoing policy discussions on upgrading 250-bed hospitals.

He said the government was considering ensuring three critical services at those facilities: cardiac coronary units, kidney dialysis, and complicated gynaecology and obstetric care.

“These three are very important because we see this is a major problem, and we are discussing how to overcome it,” he said.

He stressed that the state’s responsibility extends “from the womb to the final journey of life”, adding that healthcare is not charity but a rights-based, life-cycle entitlement.

A health sector reform commission formed by the interim government has recommended making primary healthcare a constitutional fundamental right and providing it free for the poor.

It also proposed establishing rural and urban primary health centres, integrating existing facilities, and introducing structured referral systems.

Titumir also reiterated the need to raise spending on health and education, aiming for 5 percent of GDP, while ensuring no waste.

“We want to go to 5 percent of GDP, and it should be fully utilised in the revised budget,” he said. “But that does not mean wasteful spending or spending just for the sake of spending.”

BIDS senior research fellow Abdur Razzaque Sarker presented the study, which found that 22 percent of people reported monthly healthcare needs, but 65 percent could not access required services.

Families spend an average of Tk 3,454 monthly on healthcare, about 11 percent of total household expenditure.

The study also found cancer and COVID-19 treatment to be the most expensive, with costs reaching up to Tk 847,900 for cancer patients.