BANGLADESH’S healthcare system has long grappled with systemic challenges: underfunding, urban-centric services, and a fragmented referral structure. Historically, health sector allocations have hovered around 5 per cent of the national budget, translating to less than 1 per cent of GDP. This chronic underinvestment, compounded by unprecedented corruption, mismanagement, and inefficiency, has led to overburdened tertiary hospitals and inadequate primary and preventive care, particularly in rural areas. Poor quality of care, misdiagnosis, absence of accountability, and a growing trust deficit between patients and healthcare providers have further eroded confidence in the domestic health system. As a consequence, a significant number of Bangladeshi patients, including many from the middle and lower-middle classes, travel to neighbouring countries, particularly India, Thailand, and Singapore, for medical treatment. This outflow of patients drains billions of dollars in hard-earned foreign exchange every year, further weakening the country’s economic resilience.
Key health indicators reflect these systemic weaknesses: life expectancy at birth stood at approximately 72 years in 2021, with healthy life expectancy at around 63 years. While maternal and child health indicators have improved over time, stark disparities persist, especially in underserved rural and peri-urban areas. Meanwhile, non-communicable diseases such as diabetes, hypertension, cancer, and cardiovascular ailments continue to rise sharply, further straining the fragile health infrastructure. The shortage of adequately trained healthcare professionals and weak institutional capacity only deepen the crisis. These interlinked factors underscore the urgency for bold, comprehensive health sector reforms to establish a transparent, equitable, and efficient healthcare delivery system across the nation.
On June 2, 2025, Bangladesh stands at a pivotal juncture as the interim government, led by chief adviser Muhammad Yunus, unveils the national budget. This moment follows the historic July Revolution of 2024, a student-led uprising that catalysed the fall of the previous fascist government and ushered in a wave of reformist aspirations. Central to these aspirations is the Bangladesh Nationalist Party’s 31-point agenda, which envisions ‘Health for All’ through a revitalised primary healthcare system and an efficient referral mechanism. At the core of BNP’s health commitment lies a simple but powerful moral imperative: no person in Bangladesh should die before receiving the right treatment with quality health care. This principle underscores BNP’s pledge to build a humane, just, and inclusive health system that prioritises timely and affordable access to care for all citizens, regardless of income, geography, or social status.
BNP’s 31-point vision
THE BNP’s comprehensive health reform proposal, rooted in its 31-point agenda, outlines a phased but holistic approach to transform Bangladesh’s health system into an equitable, efficient, and patient-centred model. In the short term (1–3 years), BNP commits to strengthening union sub-centres, appointing more rural health assistants, and upgrading upazila health complexes into effective primary referral centres that can manage most common health issues locally. State-funded primary healthcare services will be delivered under the leadership of government-registered general physicians, while district and Sadar hospitals will be upgraded and better equipped to handle more advanced cases, reducing the current overwhelming burden on tertiary care facilities. In the medium term (1–5 years), BNP plans to introduce universal health cards to facilitate state-funded medical benefits, thereby reducing the heavy out-of-pocket health expenditures that currently cripple many households, while simultaneously building a fully functional, accountable referral system that guides patients seamlessly through different levels of care based on medical need and clinical protocols. In the long term, BNP envisions enhancing Bangladesh’s regional and international competitiveness in healthcare by strengthening medical education, investing in cutting-edge research, and developing world-class medical infrastructure to eventually support health tourism. Crucially, throughout all these phases, BNP places particular emphasis on health promotion and disease prevention as essential pillars of its health strategy. This includes large-scale national programmes to prevent and manage non-communicable diseases such as diabetes, hypertension, cancer, and cardiovascular conditions, which are rapidly rising in Bangladesh. Special attention will be given to improving nutrition for women, adolescent girls, and children to break the intergenerational cycle of malnutrition, stunting, and anaemia that continues to undermine human capital development. By investing in preventive care, community health education, and early intervention, BNP aims to reduce the burden of preventable diseases, promote healthy lifestyles, and shift the health system’s focus from reactive, hospital-based care to proactive, community-based wellness.
Public-private partnership in health
Achieving universal health coverage in Bangladesh will not be possible without fully recognising and integrating the critical role of the private healthcare sector, which currently delivers a significant share of the country’s outpatient, diagnostic, and inpatient services. BNP acknowledges that while public health facilities are the backbone of essential health service delivery, private healthcare institutions, if properly regulated and integrated, can dramatically expand access, efficiency, and innovation. A carefully designed public-private partnership framework will serve as the cornerstone of this transformation, ensuring that both sectors complement rather than compete with each other. Through PPP arrangements, private sector expertise, investment, and technology can be harnessed to strengthen diagnostic services, specialised tertiary care, telemedicine, health IT infrastructure, pharmaceutical manufacturing, and even primary care in underserved areas. Simultaneously, transparent regulatory oversight and strict quality standards will ensure patient safety, affordability, and ethical practices. This collaborative approach will allow Bangladesh to mobilise much-needed resources, reduce pressure on overburdened public hospitals, and rapidly scale up service availability — bringing the vision of universal, equitable, and timely healthcare within reach for every citizen.
Nationwide emergency medical care system
IN ORDER to significantly reduce preventable deaths from cardiovascular diseases, strokes, road traffic accidents, and other time-sensitive emergencies, BNP emphasises the urgent need to establish a just-in-time nationwide emergency medical care system. Timely access to emergency care often makes the difference between life and death, yet Bangladesh currently suffers from a fragmented and largely uncoordinated emergency response infrastructure. The tragic experience of the July Uprising of 2024 painfully exposed these systemic weaknesses: many of the deaths and serious injuries sustained during the popular movement could have been prevented or minimised if a functional and efficient emergency medical care system had been in place. BNP’s reform agenda envisions the creation of a modern, digitally coordinated emergency response network — combining ambulance services, trauma centres, telemedicine support, and real-time data sharing — to ensure that critically ill patients receive appropriate care within the ‘golden hour’. This system will be anchored by a streamlined, efficient referral mechanism where patients are rapidly triaged at lower-level facilities and promptly referred to higher-level specialised centres when necessary. Without a fully functional referral chain, patients often waste precious time moving between multiple providers, leading to preventable complications and deaths. BNP believes that by building this integrated emergency and referral network, supported by well-trained personnel, standardised protocols, and modern infrastructure, Bangladesh can dramatically reduce its high mortality from non-communicable diseases and accidents and bring its health system closer to global best practices.
Aligning budget with vision
IMPLEMENTING these reforms requires substantial financial commitment, especially given the current fragile state of health financing in Bangladesh. For decades, the country has allocated a disproportionately low share of its national budget to health — hovering around 5 per cent of total budget allocations and less than 1 per cent of GDP — placing Bangladesh among the lowest in the Asia-Pacific region in terms of public health spending. Consequently, nearly 73 per cent of health expenditures come directly from out-of-pocket payments by patients, often driving households into financial distress and poverty. Recognising the unsustainability and inequity of this system, BNP is firmly committed to substantially increasing public investment in health. Specifically, BNP endorses the Health Sector Reform Commission’s recommendation to allocate at least 15 per cent of the national budget to the health sector — a threefold increase from the current level — to build modern infrastructure, expand primary care coverage, ensure the availability of essential medicines, and recruit and train an adequate number of healthcare professionals across the country. However, BNP also recognises that increasing the budget alone is not enough; therefore, equal emphasis will be placed on enhancing both allocative efficiency (investing in interventions that yield the highest health outcomes) and expenditure efficiency (ensuring that every taka spent delivers maximum value to patients). In parallel, BNP will undertake serious institutional reforms to establish full transparency, accountability, and oversight mechanisms aimed at eliminating widespread corruption, leakages, and mismanagement that have long plagued the health system at all levels. These financial governance reforms will be essential to restore public trust, ensure responsible use of public resources, and ultimately deliver better health outcomes for all citizens.
A call to action
THE unveiling of the 2025 national budget presents a historic opportunity to finally realign Bangladesh’s healthcare priorities with the long-suppressed aspirations of its people. BNP is determined to expand the financial resources allocated to health. It is also committed to improving the quality of care, patient safety, and service delivery across all levels of the system — from preventive community-based care to specialised tertiary treatment. This transformative journey will require bold political will, strategic investments, public-private collaboration, and institutional accountability, but most importantly, it will place the health and dignity of every Bangladeshi citizen at the very centre of national development.
Dr SM Ziauddin Hyder is an adviser to Bangladesh Nationalist Party chairperson and former senior World Bank official.
