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Introduction
The government, the private sector and non-governmental organisations have been integral to the development of the health sector of Bangladesh. Since independence, both public and private sector healthcare have accelerated in their outreach and numbers, especially in recent years. In 1973, the public sector had 308 hospitals with 10,449 beds increased to 678 hospitals with 46,833 beds in 2013 (Ahmed et al., 2015). The public sector not only endeavours to provide a wide-range of preventive, curative and rehabilitative health services but also engages in establishing policy, regulation and providing stewardship. The private sector, on the other hand, provides mostly for-profit curative services and has developed as a part of a broader socio-political system that contributes to almost two-thirds of the total medical care. In 1997, the private sector had 158 hospitals with 6,213 beds, for both in-patient and out-patient services, and 455 nursing homes with 5,158 beds, giving in-patient services (Bangladesh Bureau of Statistics, 1998). In 2013, this sector had 2,983 hospitals with 45,485 beds, and 5,220 diagnostic centres (Directorate-General of Health Services, 2014), and employed 40,000 doctors and 5,000 nurses (Ahmed et al., 2013). Thus, it is evident that there has been a substantial growth of the private sector as compared to the public sector in healthcare. This paper examines the factors that have triggered the privatisation of Bangladesh’s healthcare sector. This paper first defines privatisation. Second, it offers a framework of analysis. Finally, it examines the role of various socio-political forces that have driven the country towards accelerating privatisation in the healthcare sector, including economic reforms, public–private mix, social factors, inherent problems in the public health sector and the role of donor agencies.
What is privatisation?
Privatisation in healthcare is a process of the retreat of state management practice in the health sector, while non-governmental actors become increasingly involved in the financing and managing of the provision of healthcare services (Uplekar, 2000). There are various processes of privatisation, such as directly or indirectly shifting the burden to individuals/families or third parties, allowing private providers to deliver services, contract-out management and load-shed (Maarse, 2006). Healthcare privatisation in Bangladesh stemmed out of the challenges of the different socio-economic realities within the country. The policy directions meted out by international organisations and the...