Robust public financial management (PFM)systems are crucial to ensure the efficacy and integrity ofpublic health spending, thereby contributing to improvedservice coverage and financial protection, as required forachieving universal health coverage. A weak PFM system hasimpeded implementation of the Bangladesh health carefinancing strategy 2012-2032. This paper aims to identifyand document major PFM challenges in relation to theinterventions outlined in this strategy document, on thegrounds that relaxing these constraints will strengthenimplementation. Further, the study examines PFM barriers inservice delivery, such as delays in fund availability andprocurement and the lack of operational funds at thefacility level. The paper points to a number of obstacles,including the absence of a legal framework for implementinga social health protection scheme, no laws to retain userfees at health facilities or to change financial rules tointroduce flexible cash at facilities, district healthmanagers without delegated financial power, noncompliancewith audit observations, and need for PFM capacitystrengthening. Short-, medium- and long-term actions arepresented to address these PFM issues. Removing thesebarriers will not require significant additional resources,but will offer the potential to significantly enhance valuefor money for Bangladesh’s government health budget.
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