Assignment Name: Political Economy Analysis of the Health Sector in Bangladesh Under the Better Health Bangladesh Program

Country: Bangladesh

Client Name: Foreign, Commonwealth and Development Office (FCDO)

The “Political Economy Analysis (PEA) of the Health Sector in Bangladesh” was a pivotal research initiative under the Better Health Bangladesh Programme, funded by the UK Foreign, Commonwealth and Development Office (FCDO). It aimed to provide a deeper understanding of the political, institutional, and governance dynamics influencing health sector reforms, with the goal of supporting evidence-based decision-making and driving sustainable improvements in health service delivery.

This analysis focused on identifying key political, economic, and institutional factors shaping health policies and reform implementation. It explored how bureaucracy, political priorities, and power dynamics within the Ministry of Health and Family Welfare (MoHFW) influenced decision-making processes across technical, administrative, financial, and legal domains. Attention was also given to formal and informal governance challenges, such as mismanagement, corruption, and inequities, which have historically hindered reforms and led to disparities in healthcare access.

The study delved into the relationships between key stakeholders, policy processes, and governance mechanisms, highlighting the role of informal institutions and vested interests in shaping outcomes. Special emphasis was placed on gender and social inclusion, assessing opportunities to design health policies that are pro-poor, equitable, and inclusive. Additionally, it examined the implications of dividing the MoHFW into two directorates, analyzing the resulting opportunities and challenges for efficiency and service delivery.

The findings informed FCDO’s strategic focus, ensuring that its technical assistance aligned with the health sector’s critical needs while maximizing impact. By identifying actionable entry points, the analysis provided recommendations to strengthen governance, enhance equity, and improve accountability within the health system. This study not only guided FCDO’s interventions but also supported broader donor engagement, fostering collaboration toward achieving Sustainable Development Goals (SDGs) related to health and well-being.

Ultimately, the PEA empowered FCDO and its partners to address systemic challenges and prioritize reforms that deliver sustainable, inclusive, and equitable health services. It contributed to improving the overall health outcomes of Bangladesh, especially for the poor and marginalized, solidifying FCDO’s role as a strategic partner in the country’s health sector reforms.

The project team, comprising political economy and health sector specialists, delivered the following services:

Stakeholder Mapping and Engagement:

• Identified key stakeholders across government, civil society, the private sector, and development partners.
• Conducted targeted Key Informant Interviews (KIIs) with government officials, health professionals, civil society representatives, academics, and development agencies to gather insights on health sector governance and reform dynamics.

Comprehensive Literature Review:

• Analyzed policy documents, research papers, and reports to establish a baseline understanding of Bangladesh’s health sector challenges and governance structures.
• Synthesized evidence on political, institutional, and economic factors influencing health sector outcomes.

Political Economy Analysis (PEA):

• Assessed the influence of political priorities, elite commitments, and state capacities on health service delivery.
• Examined the role of formal and informal institutions, patronage systems, and vested interests in shaping health sector policies and practices.
• Explored gender and social inequalities within health policy frameworks and implementation.

Methodology Development:

• Designed an analytical framework to assess governance, accountability, and reform opportunities within the health sector.
• Developed tools for qualitative data collection, including KII protocols and interview guides.

Data Analysis and Reporting:

• Analyzed qualitative data to identify barriers and opportunities for health sector reforms.
• Produced actionable insights on feasible entry points for FCDO’s technical assistance, emphasizing sustainability and inclusivity.

Final Reporting and Dissemination:

• Delivered an inception report, key findings presentation, draft report, and final report in line with FCDO requirements.
• Developed practical recommendations for strengthening governance, promoting equity, and enhancing health system efficiency.
• Presented findings to FCDO and other stakeholders to support evidence-based decision-making.
• Ensured alignment with ethical standards, safeguarding protocols, and data protection regulations.

This comprehensive approach ensured that the study addressed FCDO’s objectives while generating valuable insights to inform strategic health sector interventions in Bangladesh.