Bangladesh's next health breakthrough

A mother in a rural village should not have to travel hundreds of kilometres to Dhaka for a service that ought to be available at her local health facility. Yet this remains the reality for many Bangladeshis. While the country has earned global recognition for reducing maternal and child mortality and expanding immunisation coverage, millions still struggle to access basic healthcare close to home. The problem is not a lack of success stories. It is a lack of investment where it matters most: primary health care.

Bangladesh's public health achievements over the past three decades are remarkable. Life expectancy has increased, maternal and child mortality have fallen substantially, and immunisation coverage has become a global success story. These accomplishments demonstrate the country's ability to deliver effective health interventions despite limited resources. However, they also mask a growing vulnerability: a health system that remains heavily focused on treating illness rather than preventing it.

With the FY2026-27 national budget now announced, the debate should no longer centre on whether health deserves greater attention. The more pressing question is whether Bangladesh can continue to rely on overcrowded hospitals while underinvesting in the frontline services that prevent illness, detect disease early, and keep communities healthy. More importantly, the challenge is not simply how much the country spends on health, but whether those resources are directed towards the areas where they can deliver the greatest impact.

The first challenge is that Bangladesh has long spent too little on health and asked households to shoulder too much of the burden. Encouragingly, the proposed FY2026-27 budget signals a shift in priorities, with the Ministry of Health and Family Welfare allocation almost doubling to around Tk 694.00 billion, raising public health spending to just above 1 per cent of GDP and about 7.4 percent of the national budget. This represents an important step forward. However, higher allocations alone will not be enough. Households still finance nearly 79 per cent of total health expenditure directly from their own pockets, one of the highest rates in the region. Despite the welcome increase in public spending, for many families, illness means borrowing money, selling productive assets, or delaying treatment altogether.

This financing model is not only inequitable; it is economically unsustainable. No country can achieve universal health coverage, sustain a productive workforce, or realise its development ambitions when millions remain vulnerable to financial catastrophe because of illness. Every untreated diabetic, unmanaged hypertensive patient, or preventable stroke represents not only a health loss but also a productivity loss. As Bangladesh prepares to graduate from the Least Developed Country (LDC) category and pursue upper-middle-income status, investing in health should be viewed not as social expenditure but as an investment in economic growth, human capital, and national productivity.

The second challenge is that Bangladesh's disease burden has changed, but the health system has not adapted quickly enough. Today non-communicable diseases (NCDs), including cardiovascular diseases, diabetes, cancers, and chronic respiratory diseases account for nearly 70 per cent of all deaths in the country. These illnesses are driven by risk factors such as tobacco use, unhealthy diets, physical inactivity, air pollution, and rapid urbanisation.

Yet too many people enter the health system only after complications become severe. A patient with undiagnosed hypertension may first seek care after suffering a stroke. A person living with uncontrolled diabetes may only present when kidney failure or vision loss has already occurred. At this stage, treatment becomes far more expensive and outcomes far less favourable.

This is precisely where primary health care matters. Regular blood-pressure monitoring, blood-sugar screening, nutrition counselling, smoking-cessation support, and early referral services can identify health risks long before they become medical emergencies. Community-based prevention is not simply good public health; it is one of the most cost-effective investments a government can make.

Bangladesh has already demonstrated the power of prevention. The country's success in reducing child mortality was built not through sophisticated tertiary hospitals, but through community-based health services and immunisation programmes delivered close to where people live. Millions of children were protected from diseases such as measles, polio, diphtheria, and tetanus through sustained investments in grassroots health programmes. Recent concerns surrounding measles outbreaks are a reminder that maintaining public-health gains requires continuous investment and vigilance.

The same preventive approach must now be applied to the country's growing NCD crisis.

The third challenge is that healthcare resources remain disproportionately concentrated in urban tertiary facilities, while frontline services continue to face shortages of personnel, medicines, and diagnostic capacity. Evidence suggests that nearly 35 per cent of doctors and 30 per cent of nurses serve only 15 per cent of the population living in major cities, while rural districts continue to experience persistent workforce shortages.

The consequences are visible every day. Dhaka's major public hospitals operate far beyond their intended capacity. Dhaka Medical College Hospital alone receives approximately 5,000 outpatient visits and 1,300 emergency visits daily. Many patients travel long distances seeking treatment for conditions that could have been prevented, detected earlier, or managed effectively at the primary-care level. Hospitals are increasingly being forced to compensate for weaknesses elsewhere in the health system.

Global experience offers a different path. Thailand's universal health coverage reforms demonstrated how a strong primary-care foundation can dramatically reduce out-of-pocket spending while expanding access to essential services. Similarly, the United Kingdom's National Health Service (NHS) places primary care at the centre of healthcare delivery, with General Practitioners serving as the first point of contact for prevention, diagnosis, treatment, and referral. While no model should be directly duplicated, the lesson is clear: countries that invest in strong primary-care systems achieve better health outcomes at lower overall cost.

Bangladesh already possesses one of the key foundations required for such a transformation: an extensive network of primary-care facilities. What is lacking is sufficient investment, stronger governance, and a strategic shift in priorities.

The FY2026-27 budget provides an opportunity to begin that shift. The challenge now is not only to sustain higher public investment in health, but also to ensure that resources are used strategically. A larger share of public spending should be directed towards preventive and primary-care services, where the greatest health gains can be achieved. Essential medicines and diagnostic services must be consistently available at primary-care facilities. Rural doctors, nurses, and health workers should receive financial incentives, housing support, and professional-development opportunities to encourage long-term service in underserved areas. Expanding digital health systems, strengthening accountability mechanisms, and exploring sustainable financing options, including earmarking a portion of health taxes on products such as tobacco and sugary drinks for health promotion and primary-care strengthening, could further improve efficiency and reduce financial barriers to treatment.

Bangladesh stands at an important crossroads. The country can continue spending scarce resources treating advanced disease in overcrowded hospitals, or it can invest in preventing illness before it becomes costly, disabling, and sometimes fatal.

The evidence is overwhelming: stronger primary health care saves lives, reduces inequality, protects families from financial hardship, and delivers better value for public money. Bangladesh's next health breakthrough is unlikely to come from building more hospital beds alone. It will come from preventing disease, detecting illness early, and ensuring that quality care is available close to people's homes.

The real question facing policymakers is not whether Bangladesh can afford to invest more in primary health care. It is whether Bangladesh can afford not to.

Salina Siddiqua is Postgraduate Researcher, University of York, UK and Associate Professor (on Study Leave), Department of Development Studies, University of Dhaka, ssiddiqua@du.ac.bd; , Dr S M Abdullah is Associate Professor, Department of Economics, University of Dhaka, Bangladesh; abdullahsonnet@gmail.com; Dr Rumana Huque is Professor, Department of Economics, University of Dhaka, Bangladesh; rumanah14@yahoo.com