Make NCDs Visible and Treatable: A National Registry with a Medicines Guarantee
Shaikh Afnan Birahim :
World leaders gathered in New York for the fourth UN High-Level Meeting on noncommunicable diseases on 25 September 2025.
They adopted a declaration urging countries to make prevention and treatment measurable, financed, and accountable. Bangladesh hardly needs convincing: noncommunicable diseases already account for about two-thirds of deaths in the country, according to WHO country report.
Yet in too many upazila health complexes and community clinics, lifesaving medicines, antihypertensives, diabetes drugs, inhalers, and statinsremain unavailable when patients arrive.
In mid-2024, it was warned that the medicine supply to community clinics had nearly collapsed. In early September 2025, the government dispatched Tk 120 crore worth of drugs to 14,467 clinics to fill the gap. Firefighting was necessary, but emergency consignments are not a system. To save lives on a scale, NCD care must become both visible and reliable.
A practical way forward, simple, transparent, and achievable, is to pair a national NCD registry with an Essential-Medicines Guarantee. Start with hypertension and type-2 diabetes, the two heaviest burdens.
Build a digital registry on existing DHIS2 rails to record enrolments, follow-ups, and control status, with privacy preserved and district-level summaries published monthly.
At the same time, legislate a guarantee that a small, protocol-based basket, including amlodipine, losartan, hydrochlorothiazide, metformin, insulin, an inhaled corticosteroid, a statin, and low-dose aspirin, will always be available at NCD corners and community clinics.
Every month, the Ministry of Health should publish the control rate and the number of stock-out days for each district’s drugs on a public dashboard.
This reform combines clinical impact with governance transparency, providing the system with a clear north star: to treat, control, and maintain a steady supply of resources. The proposed basket already aligns with international standards.
The evidence is decisive. Bangladesh’s HEARTS hypertension program has demonstrated that when treatment protocols are followed and medicines are in stock, control rates can increase from around 20 percent to over 50 percent within months (Resolve to Save Lives).
A BMJ Heart study confirms substantial blood pressure reduction and improved outcomes when the model is applied (BMJ Heart). The lesson is clear: standardized care, regular measurement, and a steady supply save lives.
If a patient knows their clinic will have metformin and amlodipine available at each visit, and the nurse can track their blood pressure trend on a tablet screen, control improves, and complications decrease. This quiet revolution might not make headlines today, but it will mean fewer stroke and dialysis cases tomorrow.
The weak link has always been supply. The 2024–25 shortages exposed that fragility, and the September consignment showed the cost of reacting instead of planning.
The fix is procedural: define a service standard of no more than three stock-out days per month per medicine, link reorders to real-time consumption, maintain a 30-day buffer stock at district depots, and authorize a secondary procurement panel to act when the main pipeline stalls. Bangladesh already has the machinery in place.
Essential Drug Company Limited manufactures many of these generics (EDCL), and the Central Medical Stores Depot handles national procurement and distribution (DGHS plan). What we need now is a binding guarantee, a live dashboard, and consistent oversight.
The costs are minimal compared with the human toll of inaction. These drugs are generic and have already been purchased in bulk; the guarantee ensures continuity.
Funding could come from slight budget re-programming, a modest top-up from health taxes on tobacco or sugary drinks, and targeted loans aligned with measurable health results. The moment is ideal.
The WHO Essential Medicines List was updated in September 2025, adding key therapies for diabetes and cancer, and the WHO renewed its call to make hypertension control a global priority.
Sceptics will say Bangladesh already has NCD corners. True, but without a registry and an Essential-Medicines Guarantee, those corners cannot ensure continuity of care.
Others will cite privacy or logistics. Privacy can be protected through encryption and aggregated reporting; logistics improve when standards are defined, reorders are automated, and results are published. In management, what gets measured gets managed; in public health, what gets made visible gets fixed.
Within eighteen months, progress could be tangible: a million hypertensive adults enrolled, 55–60 percent control in pilot divisions, and nine out of ten clinics maintaining every guaranteed drug within the three-day stock-out limit.
That would not only restore efficiency but rebuild trust. Patients will return because they know the clinic has the necessary medicines and that the system is in place to monitor them.
Bangladesh has already demonstrated its ability to eradicate diseases, establish registries, and scale innovations when it sets a clear goal. The UN meeting provides international backing; the motivation is fewer strokes, fewer amputations, and fewer families pushed into poverty.
A national NCD registry, paired with an Essential Medicines Guarantee, would make care visible, reliable, and fair. Start with hypertension and diabetes. Measure, publish, replenish, repeat until steady control replaces crisis management.
(The writer is an analyst, Postgraduate student of Computing Science at the University of Glasgow, UK.)