From promise to practice in health reform
The government is planning to ensure free and quality primary healthcare services for all citizens by introducing a system modelled on the United Kingdom’s National Health Service (NHS), with a primary healthcare unit in every ward, recruitment of around 100,000 health workers and the introduction of nationwide e-health cards.
The initiative aims to bring healthcare to people’s doorsteps and create a coordinated digital health system that benefits patients, service providers and the government alike, while also facilitating future treatment planning and research.
Although challenging in Bangladesh’s current context, health sector stakeholders believe the plan is achievable with proper implementation and accountability.
According to Health Ministry sources, Prime Minister Tarique Rahman recently held a meeting with top health officials after assuming office to discuss ways to deliver healthcare services at the grassroots level.
The discussion focused mainly on manpower and budget allocation.
Health experts say significant progress can be made even with existing manpower and resources if doctors and staff ensure regular attendance at their workplaces and perform their duties responsibly.
Curbing corruption and strengthening accountability mechanisms were also highlighted as key priorities.
The NHS, established in 1948, is a tax-funded universal healthcare system in the UK that provides most medical services free at the point of use, based on need rather than a patient’s financial capacity.
Patients usually register with a general practitioner (GP), who acts as the first point of contact and refers them to specialists or hospitals when necessary. Emergency services remain accessible to all.
Health Minister’s review of attendance records across the country reportedly found that only around 50 per cent of doctors were present at their workplaces, with absenteeism particularly high at upazila and district levels.
A doctor working at the 300-bed Narayanganj General Hospital said adopting an NHS-style model in Bangladesh is possible if healthcare workers are provided with adequate facilities and required to maintain strict workplace discipline.
A former health and family welfare secretary said the GP-based system could help reduce overcrowding at major hospitals such as Dhaka Medical College Hospital, where patients often seek treatment for conditions that could be handled at upazila health complexes.
He said the proposed model would establish primary healthcare units at union level, strengthen upazila health complexes with specialist services and develop district hospitals as secondary healthcare centres, allowing tertiary hospitals to focus on complex cases.
“Any new system will face challenges at the beginning, but it is not impossible.
With proper equipment, manpower and coordination, primary healthcare services at the upazila level can be significantly improved,” he said, adding that some services could be outsourced under public-private partnership (PPP) arrangements.
State Minister for Health Dr. MA Muhit said the ultimate goal of the reforms is to ensure quality healthcare for all, particularly marginalised communities, while addressing clinical quality and infrastructure challenges.
He said the proposed ‘e-health card’ system would digitally store patients’ medical histories, enabling doctors to access previous treatment records instantly and ensure continuity of care.
The e-health system will be implemented in phases, starting with a pilot district where all residents will receive e-health cards linked to union, upazila and district-level healthcare facilities.
The government hopes that the integrated system combined with grassroots health workers and strengthened primary care, will reduce pressure on tertiary hospitals and ensure accessible, affordable and efficient healthcare services across the country.
