Non-communicable disease services to be taken to rural communities

Highlights:

• Government expands NCD services to all community clinics nationwide
• JICA finances Tk341.70 crore of the Tk398.48 crore project
• Project improves MNCH and NCD care at primary facilities
• 14,500 clinics to offer screening, referral, and follow-up services
• Free diabetes and hypertension medicines provided at community clinics
• Digital tools, equipment, and training will strengthen rural healthcare

The government is moving to expand non-communicable disease (NCD) services to the grassroots level through a new project that will cover all functioning community clinics across the country.

The initiative aims to enhance early detection, continuous care and referral support for the rapidly rising burden of NCDs, including diabetes, hypertension and cardiovascular diseases.

The "Health System Strengthening through MNCH Services Improvement and NCDs Control Project," involving an outlay of Tk398.48 crore, will be implemented between July 2025 and June 2027 with support from JICA. Of the total cost, the government will provide Tk56.78 crore, while JICA will finance Tk341.70 crore as a loan.

The project is expected to improve maternal, neonatal and child health (MNCH) services and strengthen NCD care at the primary and secondary healthcare facilities.

It will expand NCD prevention, screening and management; engage community groups, local government bodies and other stakeholders in health-promotion activities; and supply medical instruments and essential logistics to community clinics. 

Infograph: TBS

Under the project, 14,500 community clinics will provide antenatal (ANC) and postnatal (PNC) check-ups and introduce screening, referral, management, and follow-up services for diabetes and hypertension patients.

The plan includes ensuring drug refills, promoting health awareness at the community level, and establishing an effective referral mechanism, with a target to refer at least 3% of patients.

Besides, fully equipped NCD corners will also be operationalised in 434 upazila health complexes and 30 district hospitals.

The move follows concerns that the government's gradual withdrawal from sector-wide health programmes could disrupt essential services such as staffing, medicine supply, equipment provision and facility maintenance.

In response, ministries were instructed to prepare project-based proposals integrating development partners' financing.

Subsequently, the Ministry of Health and Family Welfare has submitted the Development Project Proposal (DPP) to the Planning Commission for the new JICA-supported project.

The Directorate General of Health Services (DGHS) and the Community Clinic Health Support Trust (CCHST) will jointly implement the project.

Two previous loan agreements with JICA under the 4th Health Sector Programme are being extended by two years. The new project was reviewed in the Project Evaluation Committee meeting held on 23 October 2025.

Why the focus on NCDs? 

Bangladesh has achieved significant progress in maternal and child health over the past three decades.

Infant mortality dropped from 92 per 1,000 live births in 1990 to 24 in 2023, while under-five mortality fell from 146 to 29.

However, NCDs have now emerged as the country's most significant health challenge.

They now account for 71% of all deaths in Bangladesh - about 573,000 deaths annually -  of which 19% are premature (before age 70), 34% are linked to cardiovascular diseases, while diabetes and hypertension affect 9.7% and 23.5% of adults respectively.

Rapid urbanisation, poor diets, sedentary lifestyles, and tobacco use are among the major drivers. Poorer, rural and disadvantaged populations remain the most vulnerable, facing both higher exposure and limited access to preventive care.

NCD services to reach rural doorsteps 

Dr Asif Mahmud, director (Field Administration) at the Community Clinic Health Service Trust, told The Business Standard that the long-held perception that rural residents are less prone to NCDs is no longer valid. 

Many people in villages are now affected by hypertension or diabetes. This project will bring regular NCD follow-up services much closer to rural communities, he said.

"Every Upazila Health Complex already has an NCD corner for screening hypertension and diabetes. Under this project, follow-up care and medicines will be provided at community clinics so patients don't need to travel long distances every month," he said.

Community clinics have already been providing two essential medicines for diabetes and hypertension for the past two to three years. The project will formalise and expand this service.

Upazila Health Complexes typically provide five medicines—two for diabetes and three for hypertension. Under the project, the two most commonly prescribed, nifedipine (for hypertension) and metformin 500 mg (for diabetes), will be supplied free of cost at community clinics.

"These medicines were selected because they are widely used and carry a lower risk of harmful side effects if taken incorrectly," Dr Mahmud explained.

Patients will receive a health booklet for monthly follow-ups and drug refills. Only registered patients with completed records will receive medication.

Bangladesh has already digitised NCD service delivery in 45 upazilas across eight districts, including Sylhet and parts of Chattogram. Under the new project, community clinics nationwide will receive tablets with NCD and MNCH software, enabling digital profiling of every patient.

The community clinics are suffering from a shortage of equipment such as measuring tapes, weighing scales that are essential to provide ANC and PNC care. Most of the BP machines and glucometers at community clinics are currently non-functional. The project will supply these items and organise training for service providers.

 "This initiative will significantly strengthen NCD services at the community level. With proper equipment, training, medicines and monitoring, community clinics will be able to provide meaningful support to millions of rural people," Dr Mahmud hoped.