Introduction

Healthcare and tourism are two of the world’s fastest-growing industries; their combination is called Medical Value Tourism (MVT). Earlier termed as ‘medical tourism’, “the rapidly-growing practice of travelling across international borders to seek healthcare services,”^[1] the name evolved into MVT to capture the “patients’ healthcare-seeking behaviour as well as the wider economic impact of such travel on nations hosting them.”^[2] While estimates of the global MVT market size vary due to the absence of standard definitions and robust means of data collection, most accounts point to a substantial size. While an Indian tourism ministry document puts the figure at US$60-80 billion annually,^[3] the Federation of Indian Chambers of Commerce and Industry (FICCI) says the global MVT market size was US$115.6 billion in 2022 and could grow to US$286.1 billion by 2030, with a compound annual growth rate (CAGR) of 10.8 percent.^[4] It is estimated that around 14 million people across the world travel overseas annually for medical reasons, spending on average US$3,800-7,000 per visit on medical and related costs,^[5] making MVT one of the fastest-growing tourism segments in recent years.^[6]

Among the world’s top destinations for medical tourism is India. According to the Medical Tourism Index 2020-2021 of the US-based International Health Care Research Centre, India ranks 10^th among 46 leading MVT destinations, 12^th in the world’s top 20 wellness tourism markets, and 5^th among 10 wellness tourism destinations in the Asia-Pacific.^[7] India’s reputation for delivering high-quality, affordable treatment, with excellent healthcare infrastructure and services, attracts an average of 399,250^[a] medical tourists annually.^[8]

Tourism ministry figures show that medical travel to India has surged, with revenue rising from US$3 billion in 2015 to US$9 billion in 2020. Despite the drastic curbs on international travel enforced during the COVID-19 pandemic, 2020 still saw over 180,000 medical tourists arrive in India.^[9] FICCI estimated the Indian MVT market at around US$6 billion in 2022, and expects it to grow to US$13 billion by 2026.^[10] Cardiovascular treatment and neurological surgeries have the highest demand among medical tourists in India,^[11] while knee transplants, cosmetic surgery, and dental treatment also draw many patients.  India also scores over other MVT destinations in Asia, such as Thailand, Singapore, Kuala Lumpur, or Seoul, by being the least costly (see Table 1).^[12]

Table 1: Relative Cost of Select Medical Procedures, India and Other Asian Destinations (in US$)

Medical Procedure	India	Malaysia	Thailand	Singapore	South Korea
Heart Bypass	7,900	12,100	15,000	17,200	26,000
Angioplasty	5,700	8,000	4,200	13,400	17,700
Valve Replacement	9,500	13,500	17,200	16,900	39,900
Hip Replacement	7,200	8,000	17,000	13,900	21,000
Knee Replacement	6,600	7,700	14,000	16,000	17,500

Source: NITI Aayog^[13]

There is also considerable ease of payment, as several health insurance policies are available to overseas patients to cover their hospital stays, surgeries, and other medical procedures. Many hospitals also permit paying in instalments.^[14]

Yet another advantage India has is that it is home to alternative therapies, such as homeopathy and Ayurveda, along with wellness practices like yoga and meditation. To promote the country as an MVT hub, the Ministry of Health and Family Welfare (MoHFW) and the Ministry of AYUSH^[b] launched the ‘Heal in India’ programme in March 2022, which classifies health interventions into three categories: medical treatment; wellness and rejuvenation promotion; and cures through traditional medicine systems. The Ministry of Tourism also released a ‘National Strategy and Roadmap for Medical and Wellness Tourism’^[15] document in January 2022, alongside setting up a dedicated, interactive web platform that helps overseas residents connect with medical facilitators in India who can schedule their appointments, finalise medical visas, and purchase flight tickets.^[16] The Indian Healthcare Federation, affiliated to the Confederation of Indian Industry (CII), has also prepared a guide on Indian hospitals for potential overseas patients.

Most medical tourists in India are from Bangladesh. Kolkata, the capital of West Bengal, which borders Bangladesh and has several connectivity links with it, is often their preferred treatment destination. However, due to the regime change in Dhaka last year and subsequent changes in the bilateral dynamics between the two countries, MVT has suffered a hit. In the long term, this downturn may not only weaken India’s position in the regional MVT market but also diminish Kolkata’s potential role in revitalising India-Bangladesh ties. Moreover, it raises concerns about access to affordable and quality healthcare for many Bangladeshis, who may find alternative destinations too expensive or logistically unfeasible.

This paper aims to provide an understanding of how MVT between India and Bangladesh, focused on Kolkata, can be improved. It takes stock of the impact of the current diplomatic situation on Bangladesh’s MVT to Kolkata; identifies the reasons behind the flow of patients from Bangladesh; assesses why Kolkata is their preferred MVT destination and the challenges; and recommends ways in which the sector may be revived.

Seeking Medical Treatment Beyond Borders

More than half of the medical tourists in India arrive from the neighbouring country of Bangladesh. In 2019,^[c] the year before the outbreak of COVID-19, India’s tourism ministry registered 697,357 foreign tourist arrivals for MVT,^[d] of whom more than 15 percent^[17] were from Bangladesh. While the number of medical tourists from Bangladesh declined in subsequent years due to pandemic-induced travel restrictions, their percentage share among the total number of medical tourists arriving annually in India surpassed pre-pandemic levels in 2021 (see Table 2).

Table 2: Medical Tourists to India from Bangladesh (in %, 2018-2022)

A	B	C	D	E	F	G	H
Year	Total No. of FTAs	FTA% for MVT	Total No. of FTAs for MVT (C/100*B)	Total No. of FTAs from BD	BD FTA% for MVT	Total No. of BD FTAs for MVT (F/100xE)	BD FTA% for MVT (G/D*100)
2018	10557976	6.10	6,44,037	2256675	14.30	3,22,705	50
2019	10930355	6.38	6,97,357	2577727	15.40	3,96,970	57
2020	2744766	6.80	1,86,644	549273	18.10	99,418	53
2021	1527114	21.20	3,23,748	240554	77.60	1,86,670	58
2022	6437467	7.40	4,76,373	1277557	25.60	3,27,055	69

Source: Compiled by the author based on data from India Tourism Statistics Reports (2019-2023)^[18]

Note: FTA - Foreign Tourist Arrivals; MVT - Medical Value Tourism; BD – Bangladesh. Columns B, C, E, and F were obtained from the above source.  The author calculated the values for Columns D, G & H.

While official data for 2023 and 2024 is unavailable, India, according to a report in The Hindu newspaper, “witnessed a 48 percent rise in medical tourists from Bangladesh in 2023 compared with 2022,” the number rising to 4.49 lakhs.^[19] Bangladesh’s outbound medical travel is driven by various factors, primary of which are the push of the gaps in its domestic healthcare system and the pull of attraction to neighbouring countries, particularly India. Yet, both India and Bangladesh have the lowest total health expenditure (THE) among the South Asian countries (see Figure 1).

Figure 1: Total Health Expenditure (THE) as % of Per Capita GDP, 2019, PPP (Constant, 2017) in US$

 

Source: Review of Bangladesh’s Health Care Financing Strategy 2012-32^[20][e]

A primary reason for low health expenditure is the small share of the national budget allotted to the health sector in both countries. In FY 2019-2020, Bangladesh allocated 4.9 percent to the health sector,^[21] while India reserved even less, 2.32 percent for the MoHFW and 0.07 percent for the Ministry of AYUSH.^[22] In 2023-2024, Bangladesh’s health expenditure rose to 5 percent of its budget,^[23] while India’s fell further to 2 percent for the MoHFW and 0.08 percent for the Ministry of AYUSH’s budgets (see Figure 2).^[24]

Figure 2. National Budget Allocations for the Health Sector, Bangladesh and India (in %)

Source: Compiled by the author using data from Bangladesh’s^[25] and India’s^[26] official documents

Note: The budget shares for India are the sum of the percentages allocated to the Ministry of Health and Family Welfare and the Ministry of AYUSH. 

Low budget allocations translate to low government health expenditures (GHE). In 2019-2020, Bangladesh’s and India’s GHEs were, as a percentage of their national budgets (Government General Expenditure), the lowest and second lowest in South Asia (see Figure 3). In this context, the question is how India, despite limited overall health spending, has emerged as a key destination for medical tourists from Bangladesh.

Figure 3: Government Health Expenditure as a Percentage of GGE in South Asia, 2019

 

 

Source: Review of Bangladesh’s Health Care Financing Strategy 2012-32^[27]

The answer may lie in the difference in out-of-pocket expenditures for health in the two countries. Although there is a high reliance on OOP in India and Bangladesh to access private healthcare services and pharmacies, there is a wide margin between the two. In 2019, Bangladesh recorded the second highest OOP in South Asia, second only to Afghanistan, while India registered the fourth highest (see Figure 4). While OOP expenses remain high in both countries,^[28] the gap widened in 2021 as Bangladesh’s OOP rose to 72.99 percent of total health expenditure, but India’s fell to 49.82 percent of CHE.^[29] Among the many reasons fuelling MVT in Bangladesh, this would be the foremost.

Figure 4: Out-of-Pocket Health Expenditure as a Percentage of THE in South Asia, 2019

 

Source: Review of Bangladesh’s Health Care Financing Strategy 2012-32^[30]

Bangladesh’s high OOP can be attributed to the government’s relatively low regulatory control over private healthcare services.^[31] According to the “Review of Bangladesh’s Health Care Financing Strategy 2012-32,”, an analysis of the sector by experts from the Swedish government, the UK government and the United Nations, published in July 2023 by the Government of Bangladesh, the country’s private health sector remains largely unregulated, while service quality varies widely across different types of providers.^[32] The report stated, “The government’s regulatory bodies are not capacitated in terms of manpower and internal capacity, and have limited authority to take action against irregularities.”^[33] Compounding the challenge is Bangladesh’s overall financial condition—it is categorised among the world’s least developed countries (LDCs)^[f],[34] by the World Bank, where 18.7 percent of the population lived below the national poverty line as late as 2022.^[35]

In India, healthcare facilities are not only more affordable but are also better regulated. They must comply with “healthcare-specific legislation for facility registration, pharmaceutical usage, and biomedical waste disposal, as well as more generic legislation relating to employment, building safety, and company registration.”^[g],[36] The quality and affordability of medical care is much better than in Bangladesh. Accordingly, as per the US-based World Population Review, India scored 45.84 out of 100 in healthcare on a global scale, ranking 44^th out of 127 countries, while Bangladesh scored 31.9 and ranked 107^th.^[37] Thus, Bangladeshis who can afford it often opt for MVT to India for better healthcare at affordable rates.

The following paragraphs discuss the challenges in Bangladesh’s medical sector in more detail.

• Insufficient Medical Personnel

A 2018 survey by the Bangladesh Medical and Dental Council recorded a total of 54,167 registered doctors (25,739 males and 28,425 females),^[38] catering to a population of almost 162.7 million.^[39] Thus, the doctor-patient ratio was 0.53:1000,^[40] while the World Health Organization’s prescribed standard for adequate healthcare is 1:1000. The ratio improved to 0.67:1000 by 2021,^[41] but patients continue to face hurdles in accessing adequate medical attention. According to a May 2023 paper in Public Health, Bangladeshis have to wait on average for 90 minutes to see a doctor in the outpatient department of any public hospital, while the consultation itself barely lasts a minute; with specialist doctors in Dhaka, it could last at best five minutes.^[42] The situation worsens during health crises, such as the COVID-19 pandemic, or the dengue epidemics which are frequent in the country.^[43] Pathologists, radiologists and other technical personnel, nurses and midwives are also scarce in number.^[44]

This critical shortage has led to a widespread increase in unregulated and informal health providers in the private sector, often of dubious quality.^[45] But even trained medical personnel find their efficiency compromised by their heavy workload and insufficient technical support.^[46],[47] In contrast, India crossed the WHO-prescribed doctor–population ratio of 1:1,000 in 2018^[48] and has since raised it to 1:834 in 2022.^[49] 

• Poor Quality of Healthcare Infrastructure

Bangladesh also lacks medical infrastructure,^[50] with gaps in basic equipment for medical examinations seen in 70 percent of its health centres.^[51] Emergency services and organisational and managerial processes in most hospitals and health centres are outdated; community health services are not properly developed; health research is  limited.^[52] Many Kolkata doctors maintain that they cannot rely on the results of medical tests conducted in Bangladesh’s laboratories, especially the more complex ones such as blood tests for coeliac disease, thyroid issues, CT scans, MRIs, and PET scans.^[h],[53]

Even the quality of drugs sold in Bangladesh is often unreliable. Patients complain that the absence of proper monitoring enables local drug companies to get away with low-quality drugs, which doctors prescribe to their patients in exchange for illicit payment.^[54]

• Corruption

Bangladeshi media reports regularly cite instances of corruption in medical institutions, even petty ones such as unscrupulous hospital staff charging patients for a stretcher trolley.^[55] An investigation by the country’s Anti-Corruption Commission in 2019 showed that almost 40 percent of doctors in 11 public hospitals and health centres were frequently absent. Nor do doctors or hospitals have much fear of legal consequences.^[56] Touts lure naïve patients into visiting specific clinics, assuring them of better treatment, but in fact only to make them pay more.^[57] Naturally, many turn to private hospitals, which are exorbitantly expensive. Specialised doctors in private hospitals reportedly earn between BDT (Bangladeshi Taka) 1-1.5 crore (US$80,000-120,000) a month.^[58]

Most government doctors in the country are reportedly affiliated to one of the two leading political parties, and use their connections to secure good postings and other undue facilities. Transparency is lacking, as is accountability for wrong treatment.^[59] Coordination between the ministries responsible for primary healthcare services in rural and urban areas is poor.^[60]

• Dearth of healthcare in rural areas

Medical facilities are mainly concentrated in cities, even though 59.53 percent of Bangladesh’s population live in rural areas.^[61],[62] The unsanitary living conditions in budget hotels in the cities, and poor food quality in budget restaurants make rural residents reluctant to visit them for medical treatment;^[63] if they can afford it, they would rather go to India.

All these factors are to varying extents responsible for the outbound patient exodus from Bangladesh and flowing to India, particularly Kolkata.

Focus: Kolkata

The US-based Joint Commission International (JCI) accredits medical services around the world that satisfy its stringent conditions. While Bangladesh has only one—Evercare Hospital in Dhaka—India has 61 JCI-accredited hospitals, although most are located in western and southern states. Kolkata has three of them: the Apollo Multi-Speciality Hospital, the Narayana Super Specialty Hospital, and the Rabindranath Tagore International Institute of Cardiac Sciences.[64] Moreover, though not JCI-accredited, a number of its other hospitals, such as Fortis and AMRI, have also acquired a high reputation, especially in Bangladesh.  Almost 60 percent of the 4.49 lakh Bangladeshis who sought medical treatment in India in 2023 went to Kolkata, the rest visiting Delhi, Mumbai, Bangalore, Chennai, and Hyderabad.[65] The reasons for choosing Kolkata are many, and they are discussed in turn in the following paragraphs:

• Affordability of Treatment

The cost of medical treatment in Kolkata is lower than in other Indian metropolises. A 2019 estimate showed Kolkata has some of the lowest surgery rates among Tier 1 cities (Table 3).[i]^,[66] The overall cost of living is also substantially lower in Kolkata than in other Tier-1 Indian cities, making it more feasible for Bangladeshis, whose currency, the taka, is weaker than the Indian rupee.

Table 3: Average Cost of Common Surgeries in Indian Metropolises, 2019 (INR)

Cities	Bypass Surgery	Angioplasty	Dialysis	Cataract	Gall bladder
New Delhi	310,000	260,000	3,250	65,250	115,900
Kolkata	282,500	193,000	4,300	64,000	118,275
Mumbai	420,000	302,500	3,300	66,500	189,250
Bengaluru	335,000	275,000	3,000	96,500	128,200
Hyderabad	475,000	226,500	3,100	79,000	197,515
Chennai	375,000	217,450	5,675	30,400	143,630

Source: Compiled by the author using data from ICICI Lombard.[67]

Note: The average price of surgeries has been calculated based on maximum and minimum price data from different cities. Data for Pune and Ahmedabad was unavailable.

• Proximity and Connectivity

Kolkata’s proximity also makes transportation costs lower for Bangladeshis. While affluent Bangladeshi patients may go to Dubai, Singapore, or Kuala Lumpur for their medical needs, the bulk of middle- and lower-middle-income groups prefer Kolkata. Until the partition of the subcontinent in 1947, West Bengal and Bangladesh formed one state in undivided India. Today, India and Bangladesh share the fifth longest boundary in the world,[68] a substantial part of which runs along West Bengal’s eastern boundary.

Public transport links between Kolkata and Bangladesh are numerous. Before the 5 August 2024 upheaval, the ‘Shyamoli Yatri Paribahan’[69] travel agency ran a daily bus service between Kolkata and Dhaka; there were around 36 flights every week between Kolkata and Bangladesh;[70] and three rail links operated between the two countries: the Maitree Express, four times a week between Dhaka and Kolkata; the Bandhan Express, four times a week between Khulna and Kolkata; and the Mitali Express, twice a week between Dhaka and Siliguri in north West Bengal. (There was also a daily goods train from Akhaura on the Bangladesh border to Agartala, with a passenger service scheduled to start soon. Agartala, the capital of Tripura, is well connected by air to Kolkata.[71]) The variety and frequency of inexpensive travel options has made it feasible for Bangladeshi patients to visit Kolkata for recurring medical follow-up appointments and prolonged treatments.[72]

• Ethnic, Family, and Cultural Linkages

Kolkata shares ethnic, cultural, and linguistic linkages with Bangladesh, with a common Bengali heritage, language, cuisine, cultural practices, and social norms. Their common language makes it much easier for Bangladeshi patients to understand diagnosis and care instructions than at other MVT destinations.[73] Many Bangladeshis also have family connections with Kolkata that provide them easy options for accommodation, thereby lowering the logistical costs.

Though most Bangladeshis select hospitals in Kolkata for treatment based on word-of-mouth recommendations, there is also an entire ecosystem to assist them. Travel agencies such as Aastha[74] and Musafirana[75] disseminate information about healthcare services and provide full assistance thereafter. Some hospitals, such as Tata Medical Centre which has linked up with Coal India Ltd, have corporate tie-ups to provide logistical support,[76] while others, such as Peerless Hospital, have seen numerous lodges and Bangladeshi food stalls and kiosks spring up in their vicinity. Part of Kolkata’s iconic New Market area is colloquially called ‘New Bangladesh’, as it has over 400 restaurants, hotels, and lodges of every range to cater to the flood of Bangladeshi visitors.[77]

• Avenues for Leisure

Kolkata, often regarded as India’s cultural capital, also serves as a popular shopping destination. Its rich artistic heritage, historical landmarks, and vibrant cultural festivals contribute to a therapeutic and engaging environment, particularly beneficial during the recovery period for medical travellers. For many Bangladeshi patients, the opportunity to combine medical treatment with leisure—such as shopping, especially in the lead-up to festivals like Eid,[78] enhances the appeal of Kolkata as an MVT destination. Therefore, the prospect of combining health and leisure activities makes Kolkata a preferred MVT destination for Bangladeshis.[j]

Consequences of Regime Change in Bangladesh

The number of medical tourists from Bangladesh to India has declined since August 2024, when the Awami League government of Sheikh Hasina was overthrown, India imposed visa restrictions, and New Delhi-Dhaka bilateral ties have become uncertain. Among Indian cities, the decline in patients from Bangladesh has been felt most in Kolkata.[79]

In December 2024, popular hospitals in Kolkata, such as Peerless Hospital and Desun Hospital, reported that their Bangladeshi patients had dropped by as much as 75 percent since August.[80] Apollo Hospitals Enterprise, which is considered a market leader in this sector and has a branch in Kolkata, reported in November 2024 that it had witnessed “a 15 percent drop in overall international patient revenue in the first half of the (financial) year compared to last year, largely due to a 27 percent drop in revenue from Bangladeshi patients.”[k]^,[81] Manipal Hospitals, another frontrunner in the field, attributes around 10 percent of its revenue to international patients who frequent its centres in Kolkata and Bengaluru; it claimed Bangladeshi patients earlier accounted for almost 40-45 percent of its total count of international patients, but their number dipped by 50-60 percent in September 2024. Despite improvement in November, the figure stalled at 60 percent of the earlier patient flow.[82] The administrator of another leading private hospital in south Kolkata told this author, on condition of anonymity, that while there were at least 300-400 Bangladeshis to be seen daily in his outpatients’ department before the political upheaval, their number has since dropped by 40 percent.[83]

The sales of pharmaceutical products from the hospitals have also declined with the drop in Bangladeshi patients, as they would usually purchase wholesale from accessible hospital pharmacies.[l]^,[84] Even the pathological labs, those around the Dharmatala locality frequented by Bangladeshi patients, have taken a hit. Enterprises such as budget hotels, room rent facilities, restaurants, and even small businesses such as shops selling local SIMs and groceries that serve the city’s MVT industry have also been affected.[85]

Although MVT is considered an emerging prospective market, currently it contributes only 3 to 5 percent of the country’s earnings from the entire hospital sector.[86]  Thus, the financial implications of this fall in traffic are not severe. Even so, beyond its commercial gains, MVT has value as it also serves core diplomatic purposes of strengthening bilateral ties and generating public goodwill. As a humanitarian area of cooperation, it has generated trust and confidence in India among Bangladeshis. The sector has been a pillar of cooperation between the two countries, enhancing people-to-people connectivity and building on their shared bonds of cultural, lingual, and ethnic heritage. Kolkata, as a preferred MVT destination, has played a key role in strengthening India’s diplomatic bonhomie with Bangladesh.

However, this status is currently in jeopardy with all three rail services connecting India and Bangladesh—the Maitree Express, the Bandhan Express, and the Mitali Express[87]—having been suspended since last August due to the political situation in Bangladesh. This not only compromises Kolkata’s role as an MVT hub but also affects this industry in other Indian cities. The halted connectivity and the restrictions on issuance of Indian visas are gradually weaning away Bangladeshi patients to alternative treatment destinations such as Thailand, Malaysia, and Singapore.[88] Rating agency CareEdge Ratings noted in a report that the turmoil in Bangladesh could reduce total MVT to India by 10-15 percent,[89] which, in the long term, will impact India’s prospects of nurturing the MVT market.

Kolkata-bound MVT may have been a cornerstone of the India-Bangladesh relationship until recently, but it has historically faced challenges. Perhaps the biggest yet, as discussed earlier, is the collapse of the Awami League government in August 2024.[90] Since then, anti-India sentiment has been raging in Bangladesh, fuelled by Hasina’s continuing stay in India and New Delhi’s studied indifference to Dhaka’s demands for her extradition, as well as a near-breakdown of law and order in Bangladesh, with regular reports of attacks on its minority Hindu community. Border control has become much more stringent since then, hindering the smooth transit of people and goods between the two countries.[91] MVT has suffered mainly for two reasons:

• India’s Visa Restrictions

India suspended all visa operations in Bangladesh for about a week after Hasina’s ouster. It resumed vastly scaled-down operations on 13 August 2024, with visas being cleared so slowly that street protests erupted outside its visa application centre in Dhaka on 26 August 2024, prompting India to seek greater security for all its five consular offices in the country.[92] In September 2024, the Dhaka office alone rejected over 20,000 Bangladeshi visa applications.[93] Daily appointment slots at the five visa centres had declined from 7,000 in July 2024 to 500 in January 2025. Only visas for emergency and humanitarian needs are being cleared.[94] The earlier liberalised visa process that allowed Bangladeshi patients to bring attendants, family and friends along to Kolkata, is no longer available; there are even instances of patients missing doctors’ appointments or surgeries which they had scheduled before the regime change, as they were denied visas. (However, there are reports that the Indian consular offices have lately begun accepting more emergency applications, though online submission options remain limited.[95])

• Snapped Transport Links

With all three train services halted indefinitely after 5 August, and the number of flights significantly reduced, public transport options for Bangladeshis, even when they do get visas, have reduced considerably.[96] Private transport remains prohibitive. There are poignant stories of the tribulations that Bangladeshis are experiencing—on 26 September 2024, for instance, India’s Border Security Force (BSF) intercepted a vehicle crossing the Teenbigha border with Bangladesh by road, which was found to have four Styrofoam boxes containing over 100 blood samples. It is believed that these were being illegally transported for testing to India, as they belonged to people living in remote areas of Bangladesh for whom the nearest reliable pathology laboratory was in India.[97]

As noted earlier, Kolkata’s hospitals have seen a steep fall in Bangladeshi patients.[98] While August 2024 saw no patients at all, their number has been rising, albeit very slowly, from September. Oncological patients, who were midway through their treatments, have been particularly hard hit. Tele-consultations have been increasing, but they are yet to become popular.[99] Pharmacists, pathology labs and even small retailers around Kolkata hospitals have all been impacted. Even attitudes have been affected—following the successive media reports about Hindus being targeted in the wake of the regime change, at least one Kolkata hospital, J. N. Ray Hospital, officially declared it would not provide medical assistance to Bangladeshis henceforth. (The West Bengal Medical Council immediately responded, insisting that the state’s hospitals were open to all, regardless of nationality. The India Medical Association has also maintained that any discrimination violates medical ethics.[100])

Other Challenges

In 2024, West Bengal became India’s leading state on one metric of healthcare: 25 percent of its healthcare facilities, the highest among Indian states, have obtained the National Quality Assurance Standards (NQAS) certification, awarded by the MoHFW. The distinction certifies that these facilities meet global benchmarks in service provision, patient rights, clinical care, infection control, and quality management.[101] Curiously, however, even residents of West Bengal are increasingly seeking medical care in other states, especially in cities such as Chennai and Vellore, and medical tourists are bound to follow suit. The reasons are discussed in the following paragraphs:

• Declining Trust in Kolkata’s Medical Care Quality

Ironically, the NQAS certification notwithstanding, West Bengal residents seek treatment outside their state for the same reason that Bangladeshi patients travel to Kolkata—i.e., they do not trust local doctors. There is anecdotal evidence of what people refer to as the “callousness, greed, and incompetence” of West Bengal doctors.[102] Doctors who got their jobs on the basis of fraudulent degree certificates have been arrested from top hospitals in Kolkata; one seller of such certificates was also apprehended.[103] Since Kolkata’s hospitals often charge domestic and foreign patients differently, Bangladeshi patients find themselves vulnerable to touts, just as they were back at home.[104] The rape and murder of a doctor at Kolkata’s R.G. Kar Medical College and Hospital on 9 August 2024, which made global headlines, and the associated corruption charges against key medical personnel that emerged thereafter, tarnished Kolkata’s healthcare system’s image even further.[105]

• Inadequate Branding

Hospitals in other Indian metropolises have taken to active brand building which Kolkata hospitals have not. Patients, including those from Bangladesh, naturally prefer treatment in hospitals whose names they are familiar with. Such brand-building comes not only through media campaigns but also by nurturing personal trust.[106] Bengaluru, for instance, has drawn numerous Bangladeshi cardiology cases thanks to cardiac surgeon Devi Shetty, chairman and founder of the Narayana group of hospitals.[m] Bangladeshis are familiar with Dr Shetty’s name, as he was requested by Sheikh Hasina herself in March 2019 to examine former Cabinet minister Obaidul Quader;[107] he also inaugurated the Apollo Imperial Hospital in Chattogram, Bangladesh, in April 2019, which includes a cardiac centre operated in collaboration with Narayana Health.[108]

Recommendations and Conclusion

Bangladeshi citizens to India should be more systematised. It is still a largely unorganised sector that relies heavily on people-to-people contacts and informal networks. Although some attempts have been made to regulate it in recent years, through an interactive MVT government website, and other private endeavours (The ‘Bangla Health Connect’ authorised a representative of Apollo Hospitals India in Bangladesh to help with visa assistance and doctor appointments),[110] it could also help to install a Bangladesh government-designated medical coordinator in India.[n]^,[111] Starting an e-medical visa facility, as was proposed in the India-Bangladesh joint statement of June 2024, would also enhance the ease of MVT.[112]

Second, it should be recognised that although MVT is an important vertical of the India-Bangladesh relationship, it is an unsustainable sector of cooperation. Developing its domestic health sector is a priority for Bangladesh, as every year its citizens spend nearly US$50-60 million of foreign exchange on medical tourism to India alone.[113] And the sector is improving: Bangladesh has eliminated the polio virus and also, in 2023, became the first country in the world to completely eradicate kalazar (visceral leishmaniasis).[114] It is doing well on basic health parameters too: life expectancy at birth rose from 50 years in 1971 (when the country was born) to 72 in 2021; child mortality (below five years) declined from 251 deaths per 1,000 live births to 31 in the same period; childhood immunisation coverage increased from 2 percent in 1978 to nearly 100 percent in 2021.[115] With high-quality private hospitals also opening in the country, such as Apollo Hospital and Square Hospital, specialised treatments are now more widely available than before. All these trends are bound to gradually reduce the number of patients travelling to India.[116]

India needs to broaden its understanding of medical tourism to include exchange training programmes for health practitioners from Bangladesh. Medical skill development is necessary in Bangladesh, and India can share its knowledge and technical expertise. No doubt, several Bangladeshi doctors (private, government, and from the Bangladesh military) are already undergoing training programmes as international fellows in Kolkata’s hospitals,[117] following a memorandum of understanding signed between the two countries in 2013.[118] The scope of this understanding was broadened by the 2024 MoU on “Cooperation in the Field of Health and Medicine.”[119] However, it is unutilised due to the diplomatic strain.

Third, as anti-India sentiments continue to simmer in Bangladesh, medical cooperation can be an instrument of diplomacy to re-foster goodwill among Bangladeshis. Positive stories about India’s contribution to Bangladesh, such as that of Indian doctors staying back in Dhaka, at great personal risk, to save lives amidst the political unrest,[120] should be publicised. That Indian hospitals have entered Bangladesh[121]^,[122] should also help to change perceptions. There is need for more India-Bangladesh medical conclaves, such as the one organised in April 2024 by Byatikram MASDO, an Assam-based socio-cultural organisation, and supported by the Bangladesh Assistant High Commission, and not-for-profit organisations—e.g., Friends of Bangladesh and Sampriti Bangladesh—to discuss how to reduce healthcare disparities and enhance health cooperation.[123]

As for Kolkata, it should market itself not only as a medical destination but also as a wellness hub offering rejuvenation treatments such as yoga and Ayurveda. It should also exert more effort to ensure that more city hospitals acquire the global JIC accreditation. It should build the reputations of skilled local doctors further on social media till they become brands. The state health and tourism ministries should coordinate better with their central counterparts.

Sohini Bose is Associate Fellow, ORF Kolkata.

The author is grateful to the medical personnel at the Tata Medical Centre – Cancer Hospital & Research Centre, Kolkata, and the marketing team at Peerless Hospital in Kolkata for their insights.

Endnotes

• Neighbourhood
• India
• Neighbourhood
• Bangladesh
• heal in india program
• india bangaldesh
• india bangladesh medical tourism
• india bangladesh realations
• medical tourism between Bangladesh and India
• medical tourism in india
• medical value tourism
• mvt between india and bangladesh
• national strategy and roadmap for medical and wellness tourism

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