The Impact of Health Sector Reforms on Health System in Bangladesh: A Scoping Review

Abstract

Abstract Background Climate-induced environmental changes, and their potential impact on population health, are among the most pressing challenges affecting health systems. These health impacts put additional strain on health systems, putting their resilience and capacity to deal with increased shocks and stresses to the test. Implementing reforms to address the vulnerabilities in the health system can help build its capacity to cope with these shocks. We conducted a scoping review to explore the literature on health sector reforms in Bangladesh and understand their impact on health systems. Methods A scoping review was conducted by searching through academic (MEDLINE, SCOPUS, Web of Science and Google Scholar) and grey literature published in English and French between 1991 and 2021 that addressed national health sector reforms impacting the health system and access to care. Results Our search yielded 2688 articles for screening and 22 were included in our scoping review. One of the major health sector reforms was the shift from a project-based approach to a sector-wide approach (SWAp) in health. Studies found that implementing initiatives such as community clinics, a voucher scheme for pregnant women, increase in hospital beds at public facilities improved health care access and delivery of care, especially for rural districts. Despite government efforts, the health system continues to be vulnerable to shocks due to a significant shortage of formally qualified health professionals especially nurses and technologists and relatively low public financing. Conclusions Evidence suggests that health sector reforms implemented as part of SWAp have had a limited improvement on the health system. More emphasis should be placed in the future on implementing reforms to address critical issues such as human resources for health and health financing, which may contribute to building their capacity to cope with emerging threats due to climate change and improving access to care. Key messages Building a resilient health system may involve assessing the system's vulnerabilities, strengths and limitations through the perspective of health sector reforms. Current health sector reforms have had limited impact in addressing the vulnerabilities of the health system.