Bangladesh exports pharmaceuticals to around 140 countries, yet patients at home are struggling to find a basic intravenous (IV) saline. For families of dengue patients and sick children, a routine prescription has become a search across pharmacies.
Behind the shortage is a mismatch between a regulated price and rising costs.
Manufacturers said the maximum retail price of liquid saline has not changed since 2015, while imported raw materials, packaging, and other inputs have become much costlier. They said production now costs around Tk120 a bag, against the regulated price of Tk87.
A price-revision proposal has been pending with the health ministry for nearly three months, discouraging investment as dengue and measles outbreaks drive up demand.
Several established manufacturers have stopped or cut production amid mounting losses.
Libra Infusions, once the country's largest saline producer, has shut down, while Square Pharmaceuticals has suspended saline production and Beximco has halted some output.
Opsonin, OSL Pharma, Essential Drugs, and Popular Pharma have also reduced production. Incepta, Healthcare, ACME, and ACI have stayed out of the market, citing poor profitability.
Critical for patients
IV saline helps manage dehydration and maintain fluid and electrolyte balance in seriously ill patients who cannot drink enough. While critical for some dengue patients, they are not always necessary and must be administered under careful clinical monitoring to avoid harm.
On 6 October, Sonia Akter of Mirpur was diagnosed with dengue and prescribed IV fluids. Her husband, Sabbir Hossain, searched at 10 pharmacies before finding a bag in Shyamoli.
"None of the shops could supply it. They all said there was no stock," he told TBS.
Monowar Hossain, attending a patient at Holy Family Hospital, also searched pharmacies around Moghbazar and Eskaton without success. "I visited almost every pharmacy but could not find even one bag. Now I will have to go to Shahbagh to look for it," he said.
Faisal Ahmed of Medicare Pharmacy in New Eskaton said customers were leaving empty-handed as supplies were irregular, with the shortage worsening in the past 20 days.
Demand doubles as supply falls short
Manufacturers estimate monthly demand for saline has doubled from 40-45 lakh bags to 80-90 lakh during the dengue surge, while available supply meets only about one-third.
The government-owned Essential Drugs Company Limited (EDCL) also struggles to secure supplies from manufacturers. Khairul Basher, assistant vice-president of Orion Infusion, said the company sometimes supplied just 10,000 bags against an order for 50,000.
"We are also receiving huge demand from large hospitals, including Evercare, and from other institutions, but we can't supply them," he told The Business Standard. "The raw materials are not available. How can we supply the product?"
Manufacturers said demand for fluids used to treat children had also risen amid the measles outbreak. Bangladesh imported liquid saline from India at around Tk148 a bag during the 2023 dengue season, but such imports are no longer available, they said.
EDCL produces an estimated three to four lakh bags a month, far below normal demand and insufficient to offset the private-sector shortfall, industry sources said.
Tk120 cost against Tk87 price
Md Moniruzzaman Aurko, deputy manager and head of the Victory Business unit at Popular Pharma, said the taka's depreciation had sharply increased imported input costs.
"In 2015, the dollar was worth around Tk75-78. Now, we have to calculate the cost of purchasing the same imported products at Tk123-125 to the dollar," he told TBS.
Popular continues to produce saline at a loss of at least 25%, subsidising the business with profits from other medicines despite cutting output, he said.
Orion Infusion's Basher said almost all production inputs, except water, has to be imported from China and Europe, as saline bags are not available locally.
"Previously, producing saline worth Tk1 crore would cost around Tk85 lakh. Now, producing the same value of products costs approximately Tk1.20 crore," he said.
"How long can companies keep subsidising production? Since 2020, companies have been unable to continue bearing subsidies of Tk1 crore, Tk1.5 crore or Tk2 crore a month," he said. "No one will enter a loss-making business."
Leading manufacturers retreat
Libra, which began producing saline in 1985 with a capacity of one lakh bags a month, has shut its factory after years of losses and a working-capital crunch. The Dhaka Stock Exchange found the factory locked during a visit in July, according to information provided to TBS.
Libra has not published financial reports since reporting a Tk6.44-per-share loss in 2022.
Company Secretary Shafiqul Islam Bhuiyan said, "For several years, we couldn't produce at our capacity because of a shortage of capital. We also could not obtain bank loans," he said.
Beximco Pharma, meanwhile, said it has resumed supplying 500ml packs of its Celoride saline after suspending production due to losses. A company official told TBS the packs would reach pharmacies soon, with one-litre packs expected by the end of October.
Price revision stuck at health ministry
Basher said they had submitted revised cost calculations proposing a 10-15% margin. "We don't need profit, but companies must be able to survive. We have submitted calculations covering import costs, and other expenses. Nearly three months have passed."
The Directorate General of Drug Administration (DGDA) confirmed it had forwarded the proposal to the health ministry after review. Its director and spokesperson, Dr Md Akter Hossain, told TBS the ministry's relevant committee is examining the matter.
"The next decision will be taken after the committee meeting," he said.
Basher said the government had asked manufacturers to temporarily increase production during a similar shortage in 2023, promising to adjust prices later. "The process stalled after the change of government, and the fresh proposal remains pending."
Govt capacity constrained
The government's Institute of Public Health produced around 8,000 bags of liquid saline a day at its Mohakhali facility in Dhaka before halting production in 2020 for failing to meet World Health Organization requirements. Its six regional centres also stopped production.
IPH Director Dr Syed Abu Ahammad Shafi said production could resume after the existing infrastructure is renovated.
"A renovation proposal has been prepared. If the government approves, we may be able to resume production within a year after making the necessary corrections," he said.
The plan offers no immediate relief. Until production resumes, supply will depend on private manufacturers whose output is constrained by costs and regulated prices.
Skills and investment draining away
Manufacturers said years of losses have discouraged investment and depleted the skilled workforce. Libra once employed 350-400 people, but its factory now has no staff.
Basher said the sector is losing its appeal as a career. "When there is little career potential in the infusion sector, new skilled workers are not entering the field," he said.
Even if prices are revised, companies may need time and investment to rebuild capacity and recruit experienced staff. With no new investment since 2015, industry sources question how quickly production could rise to meet demand surges.