Bangladesh Should Reconsider the Push Toward Public Private Partnerships (PPP) in Healthcare
Healthcare is a fundamental right, and it is the responsibility of a welfare-oriented state to ensure equitable access for all citizens. However, in recent years, the increasing emphasis on Public–Private Partnerships (PPP) in Bangladesh’s healthcare sector has raised serious concerns. While PPP is often portrayed as an innovative solution to rising health demands, the reality is more complex. The push toward privatization risks undermining universal health coverage, increasing financial burdens on ordinary citizens, and weakening the government’s ability to provide fair, transparent, and affordable public services. Before adopting PPP as a national strategy, Bangladesh must critically analyze its implications, both domestically and in the global context.
According to National Health Accounts, approximately 69% of Bangladesh’s total health expenditure comes directly from people’s pockets. This already indicates that the country suffers from a severe lack of financial protection for patients. In such an environment, expanding the role of private institutions through PPP may actually deepen this crisis. A system where 62% of patients already depend on private providers is not necessarily a sign of strength; instead, it signals a public sector weakened by underinvestment, forcing citizens into costly private alternatives. The growing number of private health facilities—over 15,233 as of 2024—reflects not public choice but public necessity. Increasing PPP involvement risks shifting even more essential services away from government oversight and into the hands of profit-driven actors.
Proponents of PPP argue that engaging private operators can utilize unused government infrastructure or expensive equipment. But this argument ignores a fundamental truth: once private providers take control of public assets, the government loses authority over pricing, quality, and accessibility. Instead of strengthening public institutions, PPP often creates long-term dependencies where private partners operate critical services with minimal transparency. If the objective is to ensure maximum use of public resources, the government should strengthen its own capacity rather than transferring control to private entities whose primary accountability is toward profit margins, not public welfare.
Supporters frequently reference global examples to justify PPP expansion. Yet these global cases actually present caution, not encouragement. The World Health Organization and the World Bank acknowledge PPP as an instrument, not a universal solution. Many countries have experienced mixed or negative outcomes. The UK’s Private Finance Initiative (PFI), often cited as successful, is now widely criticized because it left public hospitals with massive long-term debts and contractual obligations. Several major facilities are still struggling to recover from the financial strain caused by PFI projects.
India and Thailand are also pointed to as success stories, but their contexts differ greatly from Bangladesh. India’s PPP experience varies by state, and numerous reports highlight corruption, inflated costs, and quality inconsistencies. PPP-based diagnostic services and specialized surgeries often remain accessible only to urban populations, leaving rural areas underserved. Thailand’s celebrated universal coverage model is successful precisely because it is heavily funded by the government, tightly regulated, and cautiously incorporates private providers. The Thai model shows that strong state control—not privatization—is the actual foundation of universal healthcare. Bangladesh’s regulatory environment is not comparable to Thailand’s; therefore, borrowing their model without replicating their governance strength could lead to more harm than good.
The idea of using PPP to incorporate private providers into public insurance schemes, such as Bangladesh’s Shasthyo Surakkha Karmasuchi (SSK), also presents risks. Without strict price control and rigorous monitoring—both of which Bangladesh currently lacks—such partnerships may escalate costs. PPP contracts often include clauses that protect private operators financially, even when they fail to meet service standards. Instead of ensuring accountability, poorly structured PPP contracts may penalize the government, reduce public bargaining power, and undermine public trust in national healthcare programs.
Effective PPP implementation requires robust regulatory institutions. Bangladesh does not yet have such a framework. Bodies like the Directorate General of Health Services (DGHS) and the Bangladesh Medical and Dental Council (BMDC) struggle with limited staffing and outdated monitoring systems. In this context, introducing large-scale PPP risks overwhelming the system and creating significant blind spots in oversight. Even proposals for an independent Healthcare Regulatory Commission raise concerns. Without strong institutional integrity, such a commission may be vulnerable to bias, political influence, or corporate pressure. Regulation must be strengthened before—not after—private partnerships expand.
The argument that PPP will reduce reliance on imported medical equipment also deserves scrutiny. Establishing medical device factories requires large investments, strict quality control, and long-term national policy planning. Handing these critical industries to private investors under PPP may create monopolies where essential medical supplies become overpriced or inaccessible. Foreign joint-venture medical colleges also risk turning education into a commercial enterprise, compromising academic integrity and limiting opportunities for students from lower-income backgrounds.
Another frequently mentioned justification for PPP is improving private sector “capacity” through loans, training, and international accreditation. While capacity building is important, it should not be done at the expense of public investment. International standards like ISO certification may improve branding, but they do not guarantee affordability or ethical practice. As long as the private sector remains profit-driven, expanding its authority through PPP will not automatically translate into equitable healthcare.
The long-term consequences of aggressively pursuing PPP extend beyond immediate financial risks. A healthcare system increasingly shaped by private interests becomes fragmented, inconsistent, and exclusionary. Communities that rely on public services may face reduced access as resources shift toward PPP projects concentrated in urban areas. Meanwhile, the dream of universal healthcare becomes harder to achieve when pricing and service quality depend on corporate decisions rather than national policy.
Bangladesh aspires to a stronger, more inclusive health system by 2030. But achieving universal health coverage requires robust public investment, efficient management, and long-term commitment to strengthening public hospitals, not transferring responsibilities to private hands. The belief that PPP will elevate Bangladesh’s health market to 23 billion USD by 2033 reflects an economic projection—not a public health vision. A healthcare system should not be built around market size but around people’s needs.
In the present context, expanding PPP in Bangladesh’s health sector may create a system where affordability declines, inequality widens, and government responsibility becomes diluted. Before embracing PPP as a central strategy, the nation must ask a critical question: should healthcare be treated as a public right or a commercial opportunity? The answer will shape the future of millions of citizens who depend on a strong, accountable, and publicly guided healthcare system.
Sakif Shamim
Managing Director, Labaid Cancer Hospital & Super Speciality Centre,Deputy Managing Director, Labaid Group.