Healthcare system must focus on patient outcomes, not just service delivery data

Over the past two decades, Bangladesh has achieved remarkable progress in public health. High immunisation coverage to increased institutional deliveries, and widespread access to primary health care have significantly strengthened the country's service delivery platform.

These achievements are routinely reflected in national health reports and donor dashboards. However, the reporting often focuses narrowly on service volumes, such as the number of patients seen, the quantity and types of services provided, and the distribution of health, family planning, and nutrition commodities, rather than on the quality or impact of those services.

These numbers certainly matter. But it is also important to ask whether or not they are giving us the whole story.

Globally, health systems are beginning to recognise the limitations of traditional input and output indicators. Robert S. Kaplan and Constance Spitzer, in an article published in the Harvard Business Review, noted that too often health systems focus on what is easy to measure, such as visits, procedures, costs, etc., while overlooking whether care actually improves lives. They call for the use of Patient Reported Outcome Measures (PROMs), tools that capture whether patients feel better, function better, or live better after receiving care.

This is not a conversation for high-income countries only. It is highly relevant for Bangladesh. In rural areas, a mother may have to walk miles to receive antenatal care, or a person with diabetes may regularly collect insulin from a facility, yet leave with a limited understanding of their condition or without noticeable health improvements. Current data systems, including the national DHIS2 platform, do not typically track whether care had a meaningful impact on a patient's life after a visit.

To be clear, Bangladesh is not starting from zero. There are already channels for patient voice: grievance redress systems, toll-free hotlines, and suggestion boxes at facilities. But these remain largely symbolic. Complaints are collected but rarely analysed systematically, follow-up is weak, and patients themselves often doubt whether their feedback leads to any change. As a result, the health system continues to produce service statistics while leaving the qualitative experience of patients underexplored.

Fortunately, the ground for change already exists. Bangladesh's health sector reform agenda includes plans to strengthen digital platforms, integrate data across providers and institutions, and move toward more responsive service models. This opens the door to begin capturing outcome-oriented and patient-centred information, not as an add-on, but as a core part of how we will measure progress. The Ministry of Health and Family Welfare, particularly the MIS units under DGHS and DGFP, could play a leading role in embedding outcome feedback into DHIS2 so that it contributes directly to facility monitoring, policymaking, and system-wide learning.

This does not require very high investments and sophisticated new systems. It can start with simple, practical steps. For instance, patients could be asked brief follow-up questions, either by phone or during routine visits of community health workers, such as, "Did the service help you?". In addition to these check-ins, basic outcomes could be tracked, such as whether individuals are recovering from their illness, managing their conditions with confidence, or regaining everyday function. As this feedback accumulates, it can be aggregated and reviewed to identify patterns, to see where services are working well and where improvements may be needed. Importantly, facilities would not only be reporting volumes, but also be accountable for whether patients' health is actually improving.

Such information from patients is not merely anecdotal stories, but if analysed systematically, they can provide meaningful evidence that can inform decision-making and serve as important indicators helping the health system identify gaps, adapt, and ultimately improve. They also strengthen the connection between service delivery and the lives of the people we serve.

Several countries are already experimenting in this space. In the UK, PROMs are integrated into routine surgical care to benchmark health care provider performance. In Rwanda, community health workers conduct structured follow-ups for chronic care patients. States in India, such as Kerala, are testing digital platforms to gather patient feedback on health services.

Bangladesh can learn from these approaches and adapt them to our context, building on our robust community health infrastructure and digital tools.

Of course, there are challenges. Measuring outcomes takes more time and coordination. It requires careful design, training, and a shift in mindset, from simply delivering services to understanding what happens next.

Bangladesh's health system has delivered results under immense pressure, often with constrained resources and high expectations. That in itself is an achievement, but as systems mature, so must the way we understand success. Measuring outcomes is not about finding fault; it is about building a system that listens, learns, and adapts based on what patients experience.

It starts by asking: Has your life improved?

And then having the courage to listen to the answer.

The author is a development professional with 10+ years of experience in project design, policy advocacy, strategic partnerships, and monitoring and evaluation.