DR ZIAUDDIN HYDER

In a small village in southern Bangladesh, 52-year-old Abdul Karim began feeling weak, dizzy, and breathless. He walked for hours to the nearest health facility—a subdistrict hospital—only to find a long queue, no medicines for hypertension, and a lab closed for the day. He was turned away and told to come back tomorrow. That night he fainted at home, and it was only by chance that a neighbour’s private doctor visited and gave him treatment at a price his family struggled to afford.

Abdul’s suffering is not an isolated case. It reflects the deeper crisis in Bangladesh’s health system: for millions in rural areas or urban slums, primary health care is either absent, poorly equipped, or unreachable.

After decades of fragmented investments, our health system has become increasingly urban-centric, hospital-dependent, and inequitable. The COVID-19 pandemic laid bare the weaknesses of this system, where millions remain outside the safety net of essential health services. In this context, the Bangladesh Nationalist Party’s (BNP) 31 Points to Repair the State present a transformative blueprint to rebuild a fair, efficient, and people-centred health system, anchored on the foundation of Primary Health Care (PHC).

WEAK AND FRAGMENTED PRIMARY HEALTH CARE SYSTEM

Bangladesh’s primary health care (PHC) system remains weak, fragmented, and unevenly distributed across the country. Despite the constitutional commitment to “Health for All”, Bangladesh does not yet have a fully functional nationwide PHC network. In rural areas, community clinics, union health centres, and upazila health complexes exist in name but often suffer from inadequate staffing, poor logistics, weak referral mechanisms, and irregular service delivery. In urban settings, where nearly half the population now lives, PHC services are virtually non-existent, leaving low-income urban residents dependent on unregulated private providers or drug shops for basic care. As a result, preventable diseases continue to cause significant illness and death, while out-of-pocket health expenditure remains among the highest in South Asia. The absence of a coherent, well-financed PHC system has also weakened the country’s capacity to prevent and manage non-communicable diseases, ensure maternal and child health, and respond effectively to public health emergencies.

THE NEW PRIMARY HEALTH CARE MODEL

At the heart of BNP’s reform agenda lies a bold but pragmatic commitment: each union in rural Bangladesh and each ward in urban municipalities will have a fully functional Primary Health Care Unit (PHCU)—the true frontline of a new national health architecture.

These PHC units will operate 24/7, equipped with a mini laboratory, basic diagnostic tools, and a pharmacy to ensure uninterrupted access to essential medicines. Their role will be to deliver an essential package of preventive, promotive, curative, and rehabilitative services – the first point of contact for every citizen.

Linked to every PHC unit will be three satellite health hubs, each staffed with three community health care workers responsible for delivering household-level services. These hubs will focus primarily on non-communicable disease (NCD) prevention, nutrition in children, and health promotion activities. By detecting hypertension, diabetes, and malnutrition early and promoting healthy lifestyles, these teams will keep people healthier and reduce the burden on higher-level hospitals.

INTEGRATING MENTAL HEALTH AND ELDERLY CARE

The reimagined PHC network will not only fight infectious and chronic diseases but also give prominence to two long-neglected priorities: mental health and elderly-friendly services. Recent data suggest that nearly 18.7% of adults in Bangladesh live with one or more mental health disorders, while only about 10% of those affected ever access formal care, leaving a vast treatment gap. Moreover, among older adults, over 80% report symptoms of anxiety or depression, often alongside multiple comorbidities.

In the reform model, mental health screening, counselling, and public awareness will become standard at each PHC unit, with clear referral pathways for more severe conditions. Special attention will be given to elderly citizens who now make up about 9–10% of the population and whose number is rising rapidly by ensuring accessibility, continuity of care, and dignity in service delivery. The aim is for PHC units to proactively monitor, manage, and coordinate both mental and geriatric care within communities, rather than relegating them to overburdened hospitals.

DIGITAL TRANSFORMATION FOR EFFICIENCY, QUALITY AND ACCOUNTABILITY

Every citizen will receive an electronic health card (e-health card)—a gateway to a digitally connected referral and integrated patient management system. Through this innovation, every patient’s health information will be securely stored, updated, and shared across all levels of the health system—from primary to tertiary care. The integrated system will enable real-time monitoring of diagnosis, treatment, and follow-up, enhancing both the efficiency and quality of patient care.

If a PHC unit cannot provide a specific treatment, the patient will be electronically referred to the appropriate higher-level facility, ensuring seamless continuity of care. This referral-based gatekeeping mechanism will prevent unnecessary overcrowding in tertiary hospitals, reduce costs, and improve coordination across the entire health system. No citizen will be allowed to bypass the referral pathway except during emergencies. This reform will ensure that scarce tertiary resources are reserved for complex cases, while routine and preventive services remain easily accessible and well-managed at the community level.

EQUITY, EFFICIENCY AND EMPOWERMENT

This PHC-centred vision is not just a health policy. It is a social contract that aligns with BNP’s larger state-repair agenda. By guaranteeing universal access to essential care, empowering local governance structures, and decentralising decision-making, the plan seeks to bring health services closer to people’s lives.

Local PHC units will be granted limited administrative and financial autonomy to procure small equipment, manage supplies, and maintain their infrastructure. This empowerment will enable real-time problem-solving and ensure accountability.

TOWARDS A HEALTHIER, FAIRER BANGLADESH

BNP’s vision for health is rooted in the belief that no one should die without receiving quality treatment—a principle that goes beyond politics. It is a promise of dignity, justice, and equity.

By building a nationwide network of PHC units, powered by technology, local innovation, and community engagement, Bangladesh can finally transition from a reactive to a preventive, people-centred health system.

This transformation will not only improve health outcomes but also stimulate employment, local entrepreneurship in health supply chains, and domestic manufacturing of essential medical products—linking public health with economic resilience.

CONCLUSION

The path to a healthier Bangladesh begins not in expensive hospitals, but in every village, ward and community where people live and hope. BNP’s proposed Primary Health Care revolution, aligned with its 31 Points to Repair the State, offers a practical and visionary roadmap to achieve universal health coverage and restore people’s trust in the system.

________________________________________

The writer is Adviser to the Chairperson, Bangladesh Nationalist Party and former World Bank Senior Health and Nutrition specialist