Health sector reform: The commission's proposals, political manifestos, and reality of voter behaviour

Bangladesh's health sector has long been burdened by multiple, interconnected challenges – shortages of infrastructure and human resources, rising out-of-pocket expenditure, uneven service quality, and declining public confidence.

Health, therefore, is no longer merely a sectoral concern; it has become a critical indicator of state capacity and political credibility. In this context, the proposals of the Health Sector Reform Commission deserve close attention, as they offer not only a diagnosis of systemic failures but also a structured roadmap for reform.

The commission's recommendations rest on three core pillars: recognition of health as a fundamental right, establishment of strong and transparent administrative and regulatory frameworks, and enforcement of governance, accountability, and ethical standards.

When political parties' public-health–related election manifestos are examined through this lens, both convergence and limitation become apparent.

The health manifesto of the Bangladesh Nationalist Party (BNP) shows substantial alignment with the Commission's structural agenda.

Its commitments include recognising health as a basic right, introducing universal health coverage and a national health insurance scheme, strengthening healthcare delivery from primary to tertiary levels, ensuring access to essential medicines, and expanding digital health services such as health cards and referral systems.

These proposals closely mirror the commission's emphasis on system strengthening and service delivery reform, suggesting that BNP acknowledges the need for an organised, state-led health framework.

However, the commission goes further by explicitly advocating for independent regulatory authorities, autonomous hospital governance, and insulation of health administration from political interference.

On these crucial issues, the BNP manifesto remains relatively cautious and less explicit. This should not necessarily be interpreted as rejection, but it does leave open questions about political willingness to limit discretionary power and enforce accountability – issues that lie at the heart of meaningful reform.

In contrast, the health perspective articulated by Jamaat-e-Islami places greater emphasis on ethical values and social responsibility. Its focus on equitable access for the poor, moral integrity in medical practice, human dignity.

The reform commission also recognises equity and ethical governance as essential components of a functional health system, and in this normative sense there is partial alignment.

Yet modern health systems require more than ethical intent. Clear positions on financing mechanisms, insurance models, regulatory authorities, hospital management structures, and procurement transparency are indispensable.

On these operational dimensions, Jamaat's health vision remains insufficiently articulated, limiting its capacity to translate moral commitments into actionable state policy.

This comparison inevitably raises a broader political question: do election manifestos – particularly on public health – actually influence voting behaviour? Can they increase or decrease electoral support?

Bangladesh's electoral history suggests that manifestos alone rarely determine election outcomes. Voter choices are shaped by political identity, leadership perception, past performance, and the broader electoral environment.

However, issues such as health, education, and employment increasingly matter to a segment of "silent" or undecided voters – especially among urban and semi-urban middle classes and younger voters – because these issues directly affect household experience.

In comparative terms, the BNP's public health manifesto arguably carries greater potential to attract voter interest, as it speaks more directly to everyday concerns such as treatment costs, hospital access, medicine availability, and financial protection through insurance.

These are tangible issues that resonate with lived experience. Yet this potential is constrained by important realities.

First, do voters actually read election manifestos? In practice, most voters in Bangladesh do not have direct access to manifesto documents. These texts are not widely disseminated, nor are they consistently presented in simplified or citizen-friendly formats.

As a result, manifesto content reaches voters largely through speeches, slogans, media summaries, and informal discussion – not through systematic reading.

Second, is the electorate uniformly equipped to analyse structural differences between manifestos? This is difficult to predict. Bangladesh's electorate is highly diverse in education, exposure, and political literacy.

While certain voter groups may engage with policy distinctions, many others rely on broader narratives and trust signals rather than technical policy detail.

Under these conditions, election manifestos are unlikely to trigger dramatic shifts in voting patterns. Their real value lies elsewhere: in preventing vote erosion, reinforcing credibility among undecided voters, and establishing a baseline of policy seriousness.

A coherent and implementable health manifesto may not win an election on its own, but it can help sustain political trust.

In this sense, the Health Sector Reform Commission's proposals present an opportunity for all political parties. Those who meaningfully align their manifestos with these recommendations and, more importantly, communicate a credible commitment to implementation can gain not only policy legitimacy but also public confidence.

Ultimately, health sector reform is not about manifesto language or electoral arithmetic alone. It concerns the lives, dignity, and security of citizens.

If health becomes a genuine political priority, its impact will extend well beyond votes – shaping the long-term relationship between the state and its people.

Dr Syed Md Akram Hussain, member of Health Sector Reform Commission and a professor (Clinical Oncology) at Bangladesh Medical University.

Disclaimer: The views and opinions expressed in this article are those of the author and do not necessarily reflect the opinions and views of The Business Standard.