Transforming and restructuring the health sector to implement the BNP election manifesto

Bangladesh's health sector has reached a critical point of transformation. Public expectations are no longer limited to increasing the number of hospitals or constructing new buildings. 

People want a health system in which they can receive quality care easily, affordably and with dignity when they need it; where no family is driven into poverty by medical expenses; and where physicians and all other health professionals can perform their duties in a safe, respectful and professionally supportive environment.

The time has come to implement the commitments made in the BNP election manifesto to establish a people-centred, accountable, decentralised and universally accessible health system.

Under the leadership of Honourable Prime Minister Tarique Rahman, a comprehensive National Health Transformation and Restructuring Programme could bring visible, sustainable and historic improvements to Bangladesh's health system within the next five years.

The current crisis in the health sector is not limited to shortages of physicians or hospital beds.

Weak primary healthcare, an ineffective referral system, limited capacity at district and upazila hospitals, an imbalance among physicians, nurses and medical technologists, high treatment costs, insecurity among health workers, administrative complexity, weak research capacity, damaged or unused medical equipment, inadequate patient-safety mechanisms, weak disease surveillance and limited healthcare access for the urban poor have together created a multidimensional national challenge.

An Independent National Health Commission

To implement the health commitments of the BNP election manifesto, a legally empowered and independent National Health Commission may be established under the direct leadership of the Honourable Prime Minister. The commission would serve as the country's highest institution for long-term health-sector direction, policy coordination, priority-setting, implementation monitoring and accountability.

The Honourable Prime Minister may serve as the chair or head of the commission. Consideration may be given to appointing a trustworthy and competent physician as deputy head or executive vice-chairperson. 

Under such leadership, the commission could manage its day-to-day work, coordinate among ministries and agencies, monitor progress on the manifesto's health commitments and ensure their time-bound implementation.

Bangladesh is fortunate that Dr Zubaida Rahman, the spouse of the Honourable Prime Minister, is herself a highly accomplished physician with considerable knowledge and experience in the health sector. Her professional expertise could be utilised through an appropriate role in the National Health Commission.

Her participation could help strengthen coordination, build confidence among health professionals and bring together a sector that has long remained institutionally fragmented and professionally divided. A credible and inclusive platform of this nature could become a powerful mechanism for uniting physicians, nurses, public-health professionals, medical educators, researchers, administrators and other stakeholders around a common national health agenda.

Through such coordinated leadership, the government would be better positioned to translate the BNP's election commitments into practical, measurable and time-bound actions. It could also provide an effective institutional solution for overcoming divisions within the health sector and facilitating the implementation of the government's health agenda.

The commission should include representatives of physicians, nurses, public-health specialists, health economists, medical educators, researchers, pharmacists, medical technologists, biomedical engineers, patients, the private health sector, local government and civil society. It should have its own secretariat, clearly defined legal authority, an implementation plan, timelines and an obligation to publish annual progress reports.

The commission would not replace the Ministry of Health. Rather, it would function as an independent and powerful mechanism for policy direction, coordination, oversight and evaluation of results.

A New Health System Centred on Primary Healthcare

One of the principal reasons for excessive patient pressure on tertiary hospitals in Bangladesh is the weakness of primary healthcare and the absence of an effective referral system.

Patients with common fever, cold, diabetes, hypertension or minor illnesses often go directly to medical college hospitals and specialised institutions. As a result, physicians are unable to give adequate time to each patient, while seriously ill patients may also be deprived of the attention they require.

A system should be introduced under which every citizen is registered with a designated primary healthcare centre and a family physician or general practitioner. A tiered digital referral system should connect community clinics, union health centres, upazila health complexes, district hospitals, medical colleges and specialised institutions.

Primary healthcare should integrate maternal health, child health, immunisation, nutrition, mental health, elderly care, diabetes, hypertension, cancer screening and essential rehabilitation services. Early detection and regular follow-up would significantly reduce dependence on expensive hospital-based treatment.

Strengthening Upazila and District Hospitals

Simply posting physicians to an upazila health complex does not make it functional. Physicians must have a suitable working environment, essential medicines, diagnostic facilities, nurses, medical technologists, security, accommodation and administrative support.

Each upazila health complex should gradually be equipped with 24-hour emergency services, X-ray, ultrasonography, basic laboratory testing, essential medicines, a functional operating theatre, emergency obstetric care, telemedicine and digital referral facilities.

District hospitals should be strengthened as regional secondary-care centres. The presence of specialists in medicine, surgery, gynaecology, paediatrics, anaesthesia, emergency medicine and other essential disciplines should be ensured. If adequate capacity is developed at district and upazila levels, the present excessive pressure on medical college hospitals and specialised institutions will be reduced.

Effective Measures to Retain Physicians in Rural and Remote Areas

The simplistic claim that physicians do not want to stay in rural areas conceals the real problems. Personal insecurity, unsuitable accommodation, children's education, employment opportunities for spouses, inadequate equipment, shortages of supporting staff, uncertainty regarding transfers and limited opportunities for promotion are major barriers to long-term rural service.

A comprehensive incentive package should be introduced for physicians working in remote and underserved areas.

It may include special rural allowances, secure accommodation, fixed-tenure postings, a transparent transfer policy, priority in postgraduate education, promotion based on rural service, support for children's education, assistance with spousal employment and the provision of necessary equipment and staff.

At the same time, timely, merit-based and corruption-free promotion must be ensured. 

Competitive salaries, research opportunities, higher education, overseas training and a safe working environment are essential to retain skilled physicians in the country.

Safety of Physicians and Health Workers

Violence in hospitals is not merely a matter of personal safety for physicians. It directly threatens patient care, normal hospital operations and national health security. Patient care cannot remain safe when physicians and health workers are unsafe.

An effective Healthcare Institution and Health Worker Protection Act should be enacted and implemented without delay. There should be rapid legal action against hospital violence, trained security teams, CCTV surveillance, emergency response mechanisms and direct coordination with the local administration.

In intensive care units, coronary care units and emergency departments, regular documented communication with the families of critically ill patients, structured informed consent, clear explanations regarding treatment limitations and trained bereavement-support and counselling teams could reduce misunderstandings and the risk of violence.

When allegations of medical negligence arise, a physician should not be publicly presented as a criminal before an expert investigation. Unintentional medical error, professional negligence and deliberate criminal conduct must be considered separately.

Independent investigation boards or medical tribunals may be formed with expert physicians, legal professionals, patient representatives and healthcare quality specialists.

A Balanced Health Workforce

Bangladesh faces shortages not only of physicians but also of nurses, medical technologists, pharmacists, biomedical engineers, medical physicists, paramedics, rehabilitation professionals, public-health specialists and health-information experts.

For a physician to work effectively, trained nurses, technologists, pharmacists and other supporting professionals are essential. A national health-workforce plan should therefore ensure needs-based recruitment, quality training and realistic ratios among physicians, nurses and technologists.

Nursing and allied health education should be upgraded to higher academic levels. Their salaries, professional status and working conditions should be improved, and specialised training should be introduced in intensive care, emergency medicine, cancer care, operating-theatre practice and rehabilitation.

Universal Health Protection and Reduction of Treatment Costs

A large share of healthcare expenditure in Bangladesh is still paid directly by patients. A serious illness can push an entire family into poverty. To change this situation, social health insurance, publicly financed essential health-service packages and a National Health Protection Fund for poor and vulnerable groups should be introduced gradually.

Essential medicines and diagnostic tests should be provided free of charge or at subsidised rates in public hospitals.

Where government capacity is limited, services may be purchased from approved private institutions at predetermined standards and prices.

A national health technology assessment mechanism should be established to regulate the rational cost of medicines, investigations and hospital services and to select cost-effective technologies.

A National Digital Health System

Introducing a unique health identification number and a national electronic health record for every citizen would enable authorised health institutions to access a patient's medical history, investigations, medications and referral information.

The national digital health system may include online appointments, patient queue management, digital referrals, telemedicine, central dashboards for hospital beds and intensive care units, ambulance coordination, medicine-supply monitoring and digital tracking of the condition and maintenance of medical equipment.

Patient privacy, informed consent, cybersecurity and ethical standards for the use of health data must be ensured.

Damaged and Unused Medical Equipment

The purchase of expensive medical equipment that later remains damaged or unused represents a serious waste of national resources. Before procurement, hospitals should ensure that there is a genuine need, trained users, adequate electricity, suitable rooms, maintenance arrangements and staff training.

Every major item of equipment should include a comprehensive maintenance contract of five to ten years. Relevant physicians, medical physicists, technologists and biomedical engineers must be involved in preparing technical specifications.

Every tertiary hospital should have a biomedical engineering department, while a national digital inventory and repair-tracking system should cover all major medical equipment.

Good Governance in Private Healthcare

Private hospitals, clinics, diagnostic centres and pharmacies make an important contribution to healthcare in Bangladesh. Instead of sudden and punitive enforcement drives, there should be a regular, transparent, predictable and standards-based regulatory system.

An independent National Healthcare Regulatory Authority may be formed with physicians, public-health specialists, legal experts, economists and patient representatives. It should provide an integrated system for licensing, quality control, patient safety, price transparency and complaint resolution.

The sale of antibiotics without prescriptions from registered physicians must be stopped. Internal and external quality assurance should be mandatory in diagnostic centres, and reports should not be issued without approval from appropriately qualified specialists.

Patient Safety and Quality of Care

Every hospital should have a mandatory patient-safety programme. National clinical guidelines, surgical safety measures, medication safety, infection prevention, antimicrobial stewardship and confidential incident-reporting systems should be introduced.

A culture of learning from mistakes should replace the culture of concealing them. Regular mortality and morbidity reviews, clinical audits, patient-satisfaction surveys and hospital accreditation should be implemented.

Non-Communicable Diseases and Cancer Control

Diabetes, hypertension, cardiovascular disease, cancer and chronic respiratory diseases are placing an increasing burden on Bangladesh's health system.

Every primary healthcare centre should provide non-communicable disease screening, patient registration, regular follow-up and essential medicines.

Health taxes should be imposed on tobacco, sugar-sweetened beverages and ultra-processed foods, alongside strengthened public-awareness programmes.

National cancer-control priorities should include population-based cancer registration, tobacco control, HPV and hepatitis B vaccination, organised screening for cervical, breast and colorectal cancers, regionally distributed comprehensive cancer centres, increased radiotherapy and pathology capacity, affordable cancer medicines and accessible palliative care.

Communicable Diseases and Public-Health Emergency Preparedness

Outbreaks of dengue, measles and other infectious diseases have demonstrated that public-health emergencies cannot be managed merely by increasing hospital-bed capacity.

Bangladesh needs a permanent and adequately funded national centre for disease control, real-time disease-surveillance systems, a public-health emergency operations centre and trained epidemic-response teams at district level.

The responsibilities of the Ministry of Health, local government institutions, city corporations and other relevant agencies should be clearly defined. National capacity should be developed for vaccines, emergency diagnostic kits, essential medicines and personal protective equipment.

Antimicrobial Resistance

The sale of antibiotics without prescriptions, unnecessary use and hospital-acquired infections pose a severe threat to the future of healthcare.

Every major hospital should have an antimicrobial stewardship committee, microbiology and culture facilities, antibiotic-use monitoring and links to a national antimicrobial-resistance surveillance system.

The use of antibiotics in livestock and agriculture must also be effectively regulated.

Mental Health

Mental health should be treated as an integral part of mainstream healthcare. Mental-health services should be incorporated into primary care; the numbers of psychiatrists, psychologists and mental-health nurses should be increased; and programmes for suicide prevention, substance-use treatment and mental health in schools and workplaces should be expanded.

Separate support programmes are also needed to address burnout, psychological stress and the effects of workplace violence among physicians and health workers.

Emergency and Trauma Care

Bangladesh needs an integrated pre-hospital emergency-care system. A national emergency number, a licensed ambulance network, trained paramedics and emergency medical technicians, standardised triage and regionally distributed trauma centres should be established.

A legal obligation should ensure that life-saving initial treatment is provided to emergency patients before payment is demanded.

Healthcare for the Urban Poor and Slum Residents

Because residents of urban slums and low-income communities lack adequate primary healthcare, they often go directly to major hospitals.

Urban primary healthcare centres should gradually be established in every ward of city corporations and large municipalities.

Responsibilities, financing and accountability should be clearly divided between the Ministry of Health and the Local Government Division.

Family-based registration, maternal and child health, immunisation, non-communicable disease services, mental healthcare and digital referrals should be integrated.

Where appropriate, non-governmental and private institutions may be engaged through properly regulated contracts.

Medical Waste Management

Mixing medical waste with general waste, disposing of it in public bins and burning it in an uncontrolled manner pose serious risks to public health and the environment.

Waste should be separated at the point of generation through colour-coded containers, transported by licensed operators and processed in regional central treatment facilities using autoclaves and environmentally safe non-incineration technologies. Indiscriminate incineration should not be used for unsuitable waste.

Digital tracking from collection to final disposal and regular environmental audits should be mandatory.

Medical Education, Research and Innovation

Although the number of medical colleges has increased, the quality of education will decline unless competent teachers, adequate patient exposure, opportunities for skill development, research, ethics and modern teaching methods are ensured.

All medical colleges should follow a standard national curriculum, maintain adequate teaching staff, provide hospital-based training, conduct competency-based assessment and implement quality-assurance systems.

Medical research requires separate and adequate national funding, research-support units, data-management facilities and biostatistical assistance.

Academic physicians should receive protected research time. Promotion should be based not merely on the number of publications but also on research quality, ethical standards and contributions to solving national health problems.

Joint research, clinical trials, technology transfer and researcher-exchange programmes with international universities should be expanded.

Technical Leadership and Decentralisation in Health Administration

The health sector is highly specialised and technical. Therefore, major policy and management positions require integrated leadership involving people with experience in medicine, public health, economics, management, nursing and technology.

Responsibilities for medical education, hospital management and public-health activities should be clearly defined. Administrative and financial authority should be decentralised to divisional and district levels, while independent auditing, performance evaluation and accountability must be ensured.

An independent health-service commission or another appropriate institutional mechanism may be considered to ensure merit, competence, experience and transparency in recruitment, posting and promotion.

A Climate-Resilient and Disaster-Ready Health System

Bangladesh must build a climate-resilient health system because of the growing risks of floods, cyclones, heatwaves, waterlogging and waterborne diseases.

Hospitals should have uninterrupted electricity, water, oxygen, emergency communication and alternative supply arrangements.

Climate-sensitive disease surveillance, mobile health teams, secure supplies of emergency medicines and vaccines and disaster-response training for health workers should be ensured.

Priorities for Implementation within the First 12 Months

Under the leadership of the Honourable Prime Minister, a set of priority measures may be implemented within the first year to create rapid and visible improvements in the health sector. These measures should include establishing an independent National Health Commission and enacting its legal framework, as well as introducing a Healthcare Institution and Health Worker Protection Act. 

A national primary healthcare and referral policy should be approved to strengthen coordination across different levels of care. Family physician-based pilot programmes may be introduced in selected districts and urban areas, alongside pilot initiatives for a unique health ID and a national electronic health record system. 

A national digital inventory of medical equipment in public hospitals should be developed, while digital monitoring of essential medicines and diagnostic supplies can help improve availability and reduce shortages. 

To ensure a safer healthcare environment, hospital-violence prevention protocols and counselling teams should be introduced, together with national standards for patient safety, infection control, and appropriate antimicrobial use. 

An integrated incentive package for rural physicians should also be piloted to encourage healthcare professionals to serve in underserved areas. For vulnerable urban populations, integrated primary healthcare centres may be established in selected wards. 

In addition, competitive national grants should be launched to promote medical and health research, while a transparent quality-control system should be introduced for private hospitals and diagnostic centres. 

A national emergency ambulance and trauma-network plan should be prepared to strengthen emergency care and referral services. Finally, a public progress dashboard should be launched to transparently monitor the implementation of health commitments made in the election manifesto and ensure accountability for progress during the first year. 

National Goals for the Next Five Years

Over the next five years, Bangladesh may commit to strengthening its health sector by ensuring the registration of every citizen under a primary healthcare system and establishing an effective upazila-district-tertiary referral network. 

The country may also aim to develop a national electronic health record system and a unique health ID for every citizen, while gradually moving towards universal health protection. Emphasis should be placed on developing a needs-based and balanced health workforce and ensuring that both public and private hospitals provide safe, accessible, and quality-assured services. 

Bangladesh should also work towards the regional distribution of cancer, trauma, and other specialised healthcare services to reduce disparities in access. At the same time, strong disease surveillance systems and effective public-health emergency preparedness should be strengthened to respond to outbreaks and other health emergencies. 

Environmentally responsible medical-waste management should be promoted across the health sector, alongside greater investment in health research, innovation, and locally developed technologies. Finally, the health sector should be guided by the principles of merit, transparency, decentralisation, and accountability to ensure efficient, equitable, and sustainable healthcare delivery throughout the country. 

Our objective should not merely be to build more hospitals or purchase more equipment.

The objective should be to create a health system in which every citizen receives quality care at the right level and at the right time; no family is impoverished by medical expenses; physicians and health workers can perform their duties in a safe environment; and every institution operates with transparency, efficiency and accountability.

If the health commitments of the BNP election manifesto are implemented within clearly defined timelines through an independent National Health Commission under the leadership of the Honourable Prime Minister, a new era may begin in the country's healthcare system.

A healthy, safe and productive population is the foundation of an advanced, prosperous and humane Bangladesh. Investment in health is therefore not an ordinary expenditure; it is the most important investment in the country's human resources, economy, social stability and future national capacity.