Bangladesh is committed to achieving universal health coverage (UHC) by 2032; to this end, the government of Bangladesh is exploring policy options to increase fiscal space for health and expand coverage while improving service quality and availability. Despite Bangladesh’s impressive strides in improving its economic and social development outcomes, the government still confronts health financing and service delivery challenges. In its review of the health system, this study highlights the limited fiscal space for implementing UHC in Bangladesh, particularly given low public spending for health and high out-of-pocket expenditure. The crisis in the country’s human resources for health (HRH) compounds public health service delivery inefficiencies. As the government explores options to finance its UHC plan, it must recognize that reform of its service delivery system with particular focus on HRH has to be the centerpiece of any policy initiative.

I take advantage of the staged-rolled out of the Family Medicine System at the provincial level to estimate its effect on patient satisfaction using provincially-representative patient exit survey data from 2010, 2011 and 2012. This study provides some of the first national level evidence that primary health care reform underpinned by the FM system can effectively improve patient satisfaction - a health system goal. The final chapter summarizes the main results of Chapters 2, 3, and 4, discusses their limitations, and presents policy implications that can be derived from this research.