Bangladesh's government spends about $8 a person on health — so households pay 79% of the bill

Introduction

Bangladesh has made large gains in health: maternal deaths, child deaths and vaccination gaps have all narrowed over three decades. Yet the money behind the system tells a different story. In 2023 the government spent an estimated US$7.74 per person on health, equal to just 0.31% of GDP.¹

$7.74

Government health spending per person in Bangladesh, 2023 (current US$).

That is below its 2021 peak of $9.60, and far below what neighbours spend. Because the state pays so little, families cover most of the cost themselves, at the point of care.

Spending that has not kept pace

In dollar terms, government health spending per person rose from $2.33 in 2000 to a high of $9.60 in 2021, then eased to $8.74 in 2022 and $7.74 in 2023.¹ As a share of the economy it has barely moved in a quarter-century and has recently dropped: from 0.51% of GDP in 2000 to 0.47% in 2010, 0.39% in 2021 and 0.31% in 2023.²

The health sector’s claim on the government budget has also shrunk. Health took 5.21% of general government expenditure in 2000; by 2023 that was 2.47%.³ These are estimates compiled by WHO from national accounts and expenditure reports, so small year-to-year moves should be read with caution, but the direction since 2018 is consistent across all three measures.

Households fill the gap

Who pays for health care has shifted markedly. In 2000, households paid 61.8% of current health expenditure out of pocket, the government 28.2% and external donors 7.8%. By 2023, households paid 79.3%, the government 14.5% and donors 3.5%.⁴ The remaining shares are covered by other sources such as voluntary schemes and non-profit providers.

Out-of-pocket payment is the least equitable way to fund care: those who fall sick bear the cost directly, and poorer households are more likely to delay treatment or sell assets to pay for it. The WHO and World Bank track the share of the population pushed into financial hardship by such spending as a core measure of progress towards universal health coverage; the data series used here does not measure hardship itself, so this article does not estimate it.

The turn since 2018 is the sharpest part of the story. Between 2018 and 2023, government health spending per person fell from $9.39 to $7.74, the government’s share of total health spending fell from 21.0% to 14.5%, and the household share rose from 70.7% to 79.3%.⁴ These figures coincide with the pandemic years and a period of economic strain, but the data alone do not show why the public share fell, and the series should be checked against Ministry of Finance budget documents before drawing conclusions about specific decisions.

Donor support has also declined in relative terms, from 9.0% of health spending in 2010 to 3.5% in 2023,⁵ which leaves less external money to cushion low domestic spending.

A low position in the region

Among South Asian countries, only Afghanistan has lower government health spending per person than Bangladesh. India spends $33.05, Nepal $26.28, Sri Lanka $45.07 and Bhutan $108.11; Pakistan, at $10.89, is closest.¹ Differences in income explain part of this, but not all: Bangladesh’s government share of health spending (14.5%) is also lower than in India (39.0%), Pakistan (35.7%), Sri Lanka (33.6%), Nepal (31.3%) and Bhutan (66.7%); only Afghanistan’s (1.7%) is lower.⁴

One caution: these comparisons use current US dollars at market exchange rates and do not adjust for local prices, so they overstate gaps in what each dollar buys.

The service side shows the same pattern. Bangladesh had 0.72 physicians per 1,000 people in 2023 and 0.92 hospital beds per 1,000.⁶ Both have improved since 2010 (0.35 and 0.54), though they remain low.

What it will take

Evidence-based options from the data above:

• Raise public health spending as a share of GDP. Rebuilding it from 0.31% towards the levels of neighbouring countries would reduce the reliance on household payments.
• Protect health’s share of the budget. Health’s fall from 5.2% to 2.5% of government spending since 2000 reflects budget choices that can be reversed.
• Shift from out-of-pocket to pooled financing. Tax-funded services, insurance schemes or social health protection spread the cost across the population.
• Track financial hardship. Regularly publishing the share of households with catastrophic health spending would show whether reforms reach the poor.