How government can utilise the private sector to improve Bangladesh’s health

With the support and conducive conditions from the government, NGOs can ensure more efficient and effective quality health services for people.Photo: Rajib Dhar

Since 1950, just two years after the establishment of the World Health Organization (WHO),  World Health Day has been celebrated on 7 April as a global health awareness day.

Every country's context is unique and different, and the focus depends accordingly. Considering Bangladesh's contemporary health requirements, this article focuses on the proven potential of the private sector's increasing role in the health sector and the government's essential responsibilities.

Private entities, compromising both for-profit and non-profit entities, are integral to the Bangladesh healthcare sector. They cover not only doctors, technicians and hospitals but also all prevention and primary healthcare services through different tiers of healthcare services. For instance, more than 110 non-government organisations (NGOs) and 40 international non-government organisations (INGOs) provide health services in Bangladesh to some extent. 

In the complex landscape of health systems, the role and coverage of the private sector have been expanding in many forms. Private sectors cover a range of health services, such as primary and preventive healthcare, nutrition, social awareness, counselling, etc. 

Regarding coverage, private sector entrepreneurship holds around 60% of the health sector in Bangladesh, which has approximately 70,000 doctors and 1,00,000 hospital beds. These numbers indicate the intensity and importance of the private sector.

In this regard, the government must play a broad instrumental role in two ways. First, they should enhance the scope of the private sector to flourish in their service and optimise their resources. With the support and conducive conditions from the government, NGOs can ensure more efficient and effective quality health services for people. 

The next major role should be to navigate the private entities to maintain the quality of services in alignment with the country's health service principle, which prioritises accessibility and affordability for all.

For the first broader role, the government needs to create an enabling environment and flexible space for NGOs and complement the emerging health demands. The NGO's contribution to primary health care services, particularly in urban health services, through contracting, popularly known as outsourcing, in donor-funded projects, is well recognised. Unfortunately, no NGOs can participate in government-led contracting due to the lack of legal and regulatory issues.

For example, Bangladesh's procurement system currently has limited scope for procuring health services (clinical and non-clinical) from NGOs. In Bangladesh, public procurement is regulated by the Public Procurement Act (PPA) and Public Procurement Rules (PPR). These regulations need to be adjusted to allow NGOs and private sectors to participate in government procurement. So, the government needs to create a policy environment to welcome NGOs in the required way.

Under the second broader spectrum, the government's role as a steward ensures effective resource utilisation, prevention of negative private sector behaviour and alignment with national health goals. Collaborative leadership of the government is the key to having a functional public-private partnership to elevate the healthcare sector. 

Another important role of the government is to enhance the capacity of the private sector to comply with government rules and regulations. For instance, NGOs have no experience contracting with government-funded money for health-related services. Although some NGOs have experience providing health services under donor-funded contracts, the general capacity of the NGO sector to potentially undertake government contracting is not evident. 

On the contrary, the capacity of government agencies to manage the contract is also crucial, which includes strengthening the capacity of regulatory agencies, health financing institutions and monitoring and evaluation mechanisms. Therefore, identifying the government agencies that will deal with the private sector engagement issue is important, and the government needs to train them accordingly.   

Evidence suggests that the public and private sectors should work hand in hand to improve the health and well-being of the population. The above-stated government roles can navigate the optimisation of the private sector's potential to meet Bangladesh's escalating health service demand. Most importantly, government cooperation, capacity and a welcoming atmosphere are the driving factors for engaging the private sector effectively.

Monaemul Islam Sizear is a Health System Researcher and Technical Advisor at Health System for TB, Open Development. [email protected]

Disclaimer: The views and opinions expressed in this article are those of the author and do not necessarily reflect the opinions and views of The Business Standard.