Time to engage Japan, South Korea in developing health system in Bangladesh    

As the health system in Bangladesh has some limitation in terms of delivering expected and desirable services, India has become a popular destination of the health tourism to Bangladeshi patients over the years. However, the scenario has changed after Sheikh Hasina quit the power through a mass revolution on August 5, 2024, engineered by students. India has restricted the issuing of travel and medical visas to Bangladeshis on political and strategical grounds.

Meanwhile, the Foreign Office Consultation (FOC) between Bangladesh Foreign Secretary Jashim Uddin and Indian Foreign Secretary Vikram Misri took place December 9, 2024 at the state guest house Padma with an expectation that both counties would work with a positive mindset that visa process will get momentum like previous years. But the situation has not improved, rather has get complicated on security, political, strategical and lack of trust grounds.

Bangladesh’s tourist arrivals in India during the concluded year 2024 dropped by 20 per cent compared to the previous year 2023 amid political rift between two neighbouring countries.

USA topped the top tourist arrivals with 18.14 per cent, followed by Bangladesh with 17.57 per cent, UK 10.28 per cent, Australia with 5.20 and Canada with 4.78 per cent.

However, the during the month of December 2024, a total of 53,495 Bangladeshis visited India, perhaps the lowest in the last 20 years, sources said.

According to the Tourism Board of India, a total of 16,96,735 Bangladeshi tourists visited India in 2024 as against approximately 2.12 million Bangladeshi tourists visited India in 2023.

The relations between Dhaka and New Delhi reached a new low after Sheikh Hasina stepped down on August 5, 2024 against the backdrop of massive uprising, engineered by the common students.

India tightened the visa of Bangladeshi tourists on security and strategic ground that radical elements in Bangladesh have increased their position after Shiekh Hasina stepped down that Dhaka has rejected.

The number of Bangladeshi tourists visiting India has seen a drop in recent months, particularly noticeable in October-December of 2024.

According to the Tourism Board of India, Bangladesh’s tourist arrivals in December plummeted to a record 5.91 per cent of total tourist arrivals in India.

However, the data of the January-June of the 2024 showed that Bangladeshi tourist arrivals during the first six months of the last year showed a higher upward trend.

But the political turmoil during July-August in Bangladesh and ungracious departure of Shiekh Hasina through mass uprising pursued India on streamlining visas of Bangladesh during the period of July—December, 2024.

Foreign tourist arrivals (FTAs) in December, 2024 were 10,28,765 as compared to 11,01,914 in December, 2023 and 12,26,398 in December, 2019 registering a growth of -6.6% and -16.1% with respect to 2023 and 2019 respectively. 1.2 FTAs during the period January-December, 2024 were 96,57,003 as compared to 95,20,928 in January-December 2023 and 1,09,30,355 in January-December, 2019 registering a growth of 1.4% and -11.6% with respect to 2023 and 2019 respectively, according to the data of Indian Tourism Board.

According to available data, approximately 2.12 million Bangladeshi tourists visited India in 2023, representing the largest share of foreign tourist arrivals in India with a 22.3% share.

Bangladesh topped the list of countries sending tourists to India in 2023, accounting for over 22% of total foreign tourist arrivals.        

Meanwhile, Foreign Affairs Adviser Md Touhid Hossain very recently expressed his hope over the normalisation of the visa issue with India but stressed that the decision to issue a visa is considered a "sovereign right" of a country.

"We did not create visa complications. India has stopped it for whatever reason. It is their sovereign right.... ," he said, adding that if a country does not issue a visa to anyone or to any group, no question can be raised about it as it is their decision.

Talking to reporters at the Ministry of Foreign Affairs, Hossain said they hope that India will announce their decision or step up their activities so that people who want to go to India can get visas.

The Foreign Adviser said what Chief Adviser Prof Muhammad Yunus said is completely the position of Bangladesh.

"We have always said we want a good working relationship (with India) on the basis of reciprocity and mutual respect," he said, adding that is the reflection of their clear position.

Highlighting historical close ties, Chief Adviser Prof Muhammad Yunus told BBC Bangla that there is no alternative to maintaining a good relationship between Bangladesh and India, as there had been some clouds in the relations that mainly came through propaganda.

Bangladesh should mull over engaging Japan and South Korea deeply in the mid- and long-term in developing tertiary health services as both countries have major success in improving health services to the worldclass levels in the regions, according to Bangladesh diplomats, health economists and health specialists.

The High Commission of India has squeezed visa process in Bangladesh on political and security grounds after the ouster of former Prime Minister Shiekh Hasina, the most trusted partner of India, through a mass uprising engineered by general students.

“South Korea and Japan have no political and strategical interests like the USA, Russia, China and India have  in engaging developing projects in Bangladesh,” according to Bangladesh diplomat. 

“Bangladesh seems come out of Indian political and strategical interests as Sheikh Hasina has quit the power. Indian politicians will continue to use ‘Hindutva card’ and “the minority issue in Bangladesh’ to gain political leverage in local and  national elections,’ said the Bangladesh diplomat who worked in India in close cooperation with the Indian politicians.

“India will never engage itself in developing health services in Bangladesh as improved health services will stop Bangladeshi patients’ spree to visit the neighbouring country to get health services,’ said the seasoned Bangladesh diplomat.

Though Bangladesh Bank has no reliable statistics on medical expenses in India, unofficial statistics suggest that Bangladesh spends 4/5 billion US dollars in medical tourism in India, said a health economist.
Japan has a major stake in developing tertiary health services in some southeast Asian counties like Singapore, Malaysia, Vietnam and Thailand over the years.

Mount Elizabeth Hospital and Mount Elizabeth Novena Hospital in Singapore are members of IHH Healthcare, the world's second-largest hospital group. The major Japanese company Mitsui & Co., Ltd is the largest shareholder of IHH Healthcare, said a young Bangladesh diplomat who worked both in Japan and India.

Japan's Mitsui & Company became the largest shareholder in Malaysian hospital operator IHH Healthcare to gain exposure to Southeast Asia's health care market.

A number of Bangladeshi physicians who got higher training in Japan also their views that Japan’s deep engagement in developing health system will rein in patients’ spending spree  in neighboring India.

South Korea government has extended economic cooperation to set up Super Specialized Hospital under Bangabandhu Sheikh Mujib Medical University at Shahbag in Dhaka city.

Ambassador of Japan to Bangladesh Iwama Kiminori will leave Bangladesh this month completing his tenure here. The government of Bangladesh should keep in touch with him and this successor in engaging  Japan in overall health services in Bangladesh, said the Bangladesh diplomat.

Meanwhile, Dr Ahmed Mushtaque Raza Chowdhury, a convener of Bangladesh Health Watch and professor of the School of Public Health at Columbia University, in an interview said that the visa restrictions pose challenges, they come at a time when the interim government is already working to reform various sectors.

"The new environment also gives a new avenue to improve our healthcare system and restore the confidence of citizens who previously relied on treatment abroad," said Dr Mushtaque, also the former Vice Chair of BRAC.

Public health activist Sumit Banik also highlighted the significant challenges in Bangladesh's healthcare system, including a shortage of trained professionals, inadequate facilities and limited access to quality care, particularly in rural and marginalised areas. According to him, the concentration of tertiary care in urban centres and the lack of specialised services and modern diagnostics often compel patients to seek treatment abroad.

"Amid these challenges, the [Indian] visa restrictions offer a chance to redirect focus and resources towards strengthening the local healthcare sector," he shared his opinion.

Dr Shafiun Nahin Shimul, a professor at Dhaka University's Institute of Health Economics, highlighted communication gaps within the healthcare system.

Meanwhile, the political intervention in the medical education and health system, particularly in tertiary treatment, in Bangladesh stands in the way of improving health services in Bangladesh that in turn is encouraging a section of well-off and even some critically patients to seek treatment in neighbouring countries, Thailand , Singapore and Malaysia , according to top leading physicians and  professionals.

Though reliable and correct statistics are not available, unofficial statistic reveal that Bangladeshi patients spend 3/4 billion US dollars in the Indian medical hospitals and some corporate hospitals.     

The number of Pakistani patients seeking treatment in India is very nominal compared to the number of Bangladeshi patients seeking treatment in India, according to available statistics.

A former director and professor of the National Institute of Cardiology and Vascular Diseases (NICVD) said that India and Pakistan have progressed well ahead of Bangladesh in improving medical education as politicians of both countries have not used medical students and teachers in their narrow political interest
He said a section of physicians and doctors in Bangladesh maintain connection with political parties overlooking their main responsibilities of medical education and health service.   

He said that heart treatment in Bangladesh has progressed well, bit politicization of the health system is still bad to the desired level of the development in the country.

He said USA has the best health system with the best physician, nurses and technicians   in the world. He said some 20-25 per cent Indian-American, 9-10 per cent Pakistani –American and 0.2 per cent Bangladeshi-American are contributing to the health system of USA.   

The major political parties in Bangladesh—Bangladesh Awami League and Bangladesh Nationalist Party (BNP) -- that ruled the country most of the time since independence used the Swadhinata Chikitshak Parishad (SWACHIP) and Doctors Association of Bangladesh (DAB) to gain their political purpose costing the interest of the country, according to a physician of the Dhaka Medical College and Hospital.

Doctors Association of Bangladesh (DAB) is an organization of pro- Bangladesh Nationalist Party doctors of Bangladesh and Swadhinata Chikitshak Parishad (SWACHIP) is an organisation of pro-Awami League doctors of Bangladesh.

The political culture of intervening into the health system should be reduced in phases in the greater interest of improving medical education and health services in Bangladesh, said a professor of National Institute of Ophthalmology and Hospital (NIOH).

Doctors Association of Bangladesh (DAB) is an organization of pro- Bangladesh Nationalist Party doctors of Bangladesh and Swadhinata Chikitshak Parishad (SWACHIP) is an organisation of pro-Awami League doctors of Bangladesh.

Meanwhile, since the ouster of dictator Prime Minister Sheikh Hasina on August 5, 2024, Indians have been in deep shock with the Dhaka–New Delhi relations show no sign of improvement and HCI restricting issuing visa to Bangladeshis on national security ground, sources said.

Spokesperson of India's foreign ministry Randhir Jaiswal  responding to a question of an Indian  reporter said the High commission of India in Bangladesh will start issuing visas at normal speed after law and order situation improves in Bangladesh and conducive situations prevail.

Former Regional Adviser to World Health Organization (WHO) Muzaherul Huq said that Bangladesh can develop medical tourism targeting citizens of North-east India and Nepal.

Bangladesh can replicate the model of medical tourism like countries of India, Thailand, Malaysia and Singapore in the mid-and long-term by ensuring some steps like improvement in nursing, extensive, rigorous and higher hands-on training of doctors, good behavior of the persons engaged in health services and better hospital services, opined experts.

But, Muzaherul Huq, also former senior adviser to the World Federation for Medical Education, said Bangladesh will have to set up international standard hospitals in Cox’s Bazar and Chittagong to help boost medical tourism.

The people of Seven Sisters of India, which include Arunachal Pradesh, Assam, Meghalaya, Manipur, Mizoram, Nagaland, and Tripura, will visit Bangladesh and avail of the treatment in Bangladesh.

Muzaherul Huq, however, said that Bangladesh will have to ensure an international standard quality health system and service to patients.

Huq said Bangladeshi patients usually go to Chennai, Valore, Kolkata, Bangalore and New Delhi to avail themselves of better treatment.

Huq who worked in Kathmandu during his medical career said that Nepal has improved medical tourism in recent years targeting Indian tourism.

He said “Bangladesh has the largest sea beach in Cox’s Bazar. Patients will come to get treatment and see the beauty of the beach. Against this backdrop, Bangladesh will have to improve local and tourism and health system.”

Meanwhile, though Bangladeshis spend several billion US dollars every year on treatment abroad, the central bank statistics show peanuts of that medical tourism, according to economists, policy-makers, bankers and physicians.

The banking and income tax systems of the country need an overhaul to help estimate the cost of medical tourism abroad, said a former member of National Board of Revenue (NBR).

Md Serajul Islam, former Executive Director of Bangladesh Bank, said Bangladeshis abroad spent 2.2 million US dollar in 2018-19 fiscal year, 1.6 million US dollars in 2019-20, 1.6 million US dollars in 2020-21 fiscal and 05.0 million US dollars during the July-September period of the current fiscal year while taking treatment abroad.

The treatment cost in Singapore, Thailand and Malaysia are 4/5 times higher than it is in Bangladesh. Even treatment costs in major Indian cities like Mumbai, New Delhi, Hyderabad and Chennai are also expensive.

The local health system of the country has witnessed an enviable improvement as the entrepreneurs invested some taka 200,000 crore by setting up 200 hospitals of different sizes across the country, sources said.

“Though reliable and proper statistics are unavailable, entrepreneurs of the country have invested nearly taka 200,000 crore in the health sector during the last 20 years,” said Managing Director Managing Director of LABAID Cardiac Hospital Dr Abu M Shamim.

Besides major cities of the country, the government has set up several hundred hospitals at district and upazilla levels to reach health services to grassroots levels.

“The entrepreneurs have set up some 200 hospitals of different sizes investing some taka 200,000 core in the last 15-20 years. The yearly turnover of these hospitals is hovering around 150,000 crore taka. Each hospital has over 100 beds. Some 50,000 physicians and 11 lakh health workers employed in these hospitals are rendering the best possible health services to thousands of patients,” claimed Dr Abu M Shamim, Managing Director of the Lab Aid that set up a high standard in the heart treatment in the country besides the National Heart Foundation at Mirpur and National Institute of Cardiovascular and Diseases Hospital at Sher-e-Bangla Nagar. Now Labaid Specialized Hospital and Labaid Cancer Hospitals are offering treatment to different diseases.

Though entrepreneurs started investing in the health sector since 1990, the country witnessed a momentum in investment since 2000, said Dr Abu M Shamim.

“The development of the health sector by Bangladeshi entrepreneurs in the country during the last 20 years have offered quality treatment to thousands of patients in the country. During the pandemic period, leading politicians, business leaders, high civil and military bureaucrats and well-off section of the society took treatment in the country as international travel ban was imposed on Bangladesh by major countries. The local healthcare offered the best possible treatment to Bangladeshi patients during the pandemic period, “Dr Abu M Shamim.

The country in the last 15-20 years has witnessed setting up of some posh and high-end hospitals like Square Hospitals, United Hospitals, Apollo Hospitals (now Evercare Hospital), Lab Aid Hospital, Green Life Hospitals, Popular Life Hospital, Ali Asghar Hospitals, Ayesha Memorial Hospitals and some 200 low and  mid-level hospitals.

The cost of open-heart surgery in Bangladesh hovers taka 2,00,000 -400,000 in Bangladesh, the same treatment costs taka 10,00,000 -15,00,000 and taka 20,00,000-25,00,000 in Singapore.

Most patients with complications in heart, neuro and eye go to India, Thailand, Malaysia and Singapore to avail themselves of the better treatment.

Under the existing rules of Bangladesh Bank, a person can carry up to 12,000 US dollars on medical purpose without BB permission while going abroad.

Dr Syed Abdul Hamid, a professor at the Institute of Health Economics of the University of Dhaka, said that data of Bangladesh Bank on treatment cost abroad is very low compared to the patients and their relatives spend in reality.

Dr Syed Abdul Hamid said that Bangladesh Bank and National Board of Revenue (NBR) can estimate the cost of medical tourism abroad, provided some steps are taken by authorities concerned of the government.

“Foreign missions in Dhaka can provide data on medical visas to authorities concerned of Bangladesh that, in turn, can help prepare a sound paper on medical tourism abroad, said Dr Syed Abdul Hamid.

Mahbub Ahmed, a former secretary of the Bangladesh government, while this correspondent said that Bangladesh Bank, National Board of Revenue (NBR), commercial banks, BIDS, Bangladesh Bureau of Statistics (BBS)  and research institutes can do work on medical tourism abroad.

Meanwhile, with economy growing substantially over the last 20 years, Bangladesh-- a new economic power in South Asia and a member of middle-income group--- has become a major contributor to Thai health system, according to sources. 

Bangladesh is now the 41st largest economy in the world, according to new data of the International Monetary Fund (IMF). Bangladesh and India are the only two South Asian countries considered to be part of the 50 largest economies of the world.

The data can be seen in a visualized statistic published by the Visual Capitalist with data from the IMF, the 50 largest economies were responsible for the $100 trillion world economy.

Bangladeshi citizens, availing themselves of better medical treatment, spent some 6.7 billion Thai baht to the economy of Thailand in 2019.  According to sources of Ministries of Tourism and Sports, about 4,300 Bangladeshis got medical visas in 2019 and spent the money, said a Thai diplomat while talking to this correspondent recently.     

According to sources, 85 percent of total outbound Bangladeshi patients get treatment in India, some 10 per cent in Thailand and the rest in Singapore, Malaysia, the UK, USA and China, sources said.      

According to the Thai immigration, a total of 1,39,622 Bangladeshi tourists visited Thailand, a total of  21,817 Bangladeshis in 2020, 1,955 Bangladeshis in 2021 and during January-June period of 2022, a total of 6,319 Bangladeshis visited Thailand. The outbreak of the COVID-19 restricted movement of travelers across the globe during 2020, 2021 and in the early 2022.  From April 2022, South Asian countries opened their countries to global tourists.  Against this backdrop, the number of Bangladeshi tourists dropped in 2020 and 2021 and started picking up this year slightly.              

The writer is senior journalist