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Published : 06 May 2025, 03:22 AM
Years of chasing shadows in pursuit of effective changes to Bangladesh’s troubled health sector have culminated a government reform commission unveiling bold recommendations—including declaring primary healthcare a “fundamental right” and overhauling existing laws.
But despite the optimism surrounding the proposals, a pressing question remains: can meaningful reform of this complex sector truly be achieved?
Health experts have welcomed the commission’s recommendations, calling them essential remedies for the country’s fragile healthcare system. Yet many warn that turning these ambitious plans into reality will be an uphill battle.
Some specialists also noted that while the report contains positive proposals, it overlooks certain critical public interest issues.
Commission head Professor AK Azad Khan defended the recommendations as “achievable,” telling bdnews24.com: “These proposals are meant to be implemented. It will take time—these reforms cannot happen overnight. But a decision must be made, and the work must begin. If they seek our help in implementation, we are ready.”
The Health Reform Commission submitted its full report to Chief Advisor Muhammad Yunus on Monday, as part of a broader package of state reform initiatives launched after the July Uprising.
The panel estimates that the proposed healthcare transformation will take around two years to complete.
Key recommendations include setting up a high-level inter-ministerial committee to oversee implementation, amending the Constitution to guarantee primary healthcare as a basic right, and ensuring free care for people living in extreme poverty.
Among other proposals: establishing a Bangladesh Health Service, creating a dedicated “medical police” force, and allocating 15 percent of the national budget to the health sector.
Under the plan, “the extremely poor will receive all services free of charge, while 10 percent of poor patients will receive free care in private hospitals. Essential medicines should be provided free initially and at subsidized rates later, with the drug list updated every two years.”
The commission also recommended eliminating VAT on cancer and diabetes medicines and expanding the list of emergency drugs.
In a bid to curb aggressive pharmaceutical marketing, the panel proposed banning direct meetings between company sales representatives and doctors, allowing only email or postal communication.
Speaking at the report handover ceremony, Yunus hailed the commission’s work as a “groundbreaking step.”
“The health sector has been mired in chronic problems, but if we can solve them through these reforms, it will be transformative,” Yunus said, emphasising the urgency of implementing actionable measures and decentralising the healthcare system to ensure doctors remain at their assigned posts.
SPOTLIGHT ON LAWS
A major focus of the report is legislative reform. The commission recommended enacting several new laws, including:
>> Bangladesh Health Commission Act
>> Bangladesh Health Service Act
>> Primary Health Care Act
>> Health Protection Act
>> Drug Origination and Access Act
>> Allied Health Professional Council Act
>> Bangladesh Medical Research Council Act
It also proposed additional legislation such as the Healthcare Provider and Patient Safety Act, the Hospital and Diagnostic Accreditation Act, and the Bangladesh Safe Food, Drug, IVD, and Medical Devices Act.
Amendments were advised for existing laws, including the Bangladesh Medical and Dental Council Act, Medical Education Accreditation Act, Nursing and Midwifery Council Act, Bangladesh Pharmacy Council Act, Tobacco Control Act, and Municipal and City Corporation Act.
Public health expert Dr Abu Jamil Faisel expressed doubts about the feasibility of enacting so many laws simultaneously.
“They’re recommending major changes to the legal framework,” he told bdnews24.com. “But lawmaking is not easy. That’s why it feels unrealistic to me.”
PRIMARY HEALTHCARE FIRST
The report recommends setting up primary healthcare centres in both rural and urban areas and appointing primary care physicians accordingly.
In rural areas, union health and family welfare centres should be merged, while in urban areas, ward-level centres should be established as first-tier facilities.
A structured and, where applicable, mandatory referral system must be introduced to ensure patients receive the right level of care at the right time.
It has also been recommended that universal access to essential medicines be declared a basic health right.
All citizens must be provided with essential medicines based on need—free of charge at the primary healthcare level and, in the case of the extreamly poor, either free or at subsidised rates.
The commission suggests modernising and structurally reforming state-owned pharmaceutical production facilities and strengthening strategic procurement systems to source affordable and quality medicines from the private sector.
To ensure the availability of essential medicines, the panel said every government hospital and primary care facility must operate a 24-hour pharmacy.
These pharmacies would be managed under a national pharmacy network.
Public health expert Jamil said, “They are calling for a separate directorate to ensure primary healthcare.
“That’s a good initiative, but it will require significant manpower and funding,” he added. “The idea of offering free medicines is excellent.”
REGULATING PHARMACEUTICAL REPRESENTATIVE
To prevent pharmaceutical companies from unduly influencing physicians, the Health Sector Reform Commission has called for curbing the presence of drug company representatives in hospitals.
It recommended that offering product samples or gifts to sway physicians must be explicitly prohibited.
Pharmaceutical companies will only be allowed to communicate product information to doctors via email or postal services, rather than through daily in-person visits by sales representatives.
In addition, before hosting any medical conference in Bangladesh, organisers must apply for Continuing Professional Development (CPD) credit points approved by the Bangladesh Medical Accreditation Council.
The financial statements of such events must be submitted to the tax office, with copies sent to the Bangladesh Medical and Dental Council (BMDC).
Mostafizur Rahman, chief executive officer (CEO) of the Bangladesh Association of Pharmaceutical Industries, told bdnews24.com that it is essential for doctors to be informed about new drugs — including dosage, precautions, and side effects — which is why company representatives meet them.
“These are research-based products, updated annually through scientific analysis,” he added. “This happens globally. Now, who will deliver these innovations to doctors?
“Yes, direct interaction by representatives may cause some issues, but the matter needs open discussion.”
The CEO also noted that the commission has recommended doctors prescribe 25 percent of total medicines in generic names.
He said: “But it is still unclear which 25 percent this refers to. Is it 25 percent of cancer drugs, antibiotics, or common medicines? That must be clarified.
“If prescriptions are made by generic names, how can one ensure that a quality product is provided instead of one from a substandard company? Not every pharmacy even has a pharmacist,” he added.
ENSURING SAFETY FOR DOCTORS, PATIENTS
Vandalism in hospitals and attacks on doctors and healthcare workers following allegations of medical negligence have become frequent in Bangladesh.
The commission proposes setting up a modern digital platform to handle patient complaints efficiently.
To address this, the reform commission has recommended forming a dedicated “medical police” to ensure the security of healthcare professionals and prevent violence in hospitals and clinics.
It also recommends making the legal authority and organisational structure of the BMDC, Bangladesh Nursing and Midwifery Council (BNMC), Pharmacy Council, and Allied Health Professional Council fully functional.
The panel proposes that no arrest should be made in cases of alleged professional negligence without prior approval from the relevant council.
It also suggests that investigations and decisions in such cases be completed within 90 days.
RECOMMENDATION TO INCREASE FUNDING
The commission has recommended that the government allocate at least 5 percent of the national income and 15 percent of the annual budget to the health sector, using primary healthcare as the budgetary foundation.
To ensure sustainable and equitable financing in healthcare, the commission has proposed enacting a Health Financing Protection Act.
It also advocates for recognising health as a public welfare and merit-based sector, and identifying it as a strategic component of national security, economic growth, and sustainable development.
The report recommends mainstreaming the concept of health in all policies and introducing targeted programmes to reduce catastrophic healthcare expenditure.
To reduce dependence on foreign treatment and establish Bangladesh as a regional healthcare hub, the commission calls for the development of internationally standardised Centres of Excellence.
As part of this initiative, the commission advises promoting public-private partnerships, encouraging investment in high-tech specialised hospitals, and expanding medical tourism.
Additional recommendations include reforms in medical and allied education, closure of substandard institutions, regulation and development of the private health sector, increased health research funding, and restructuring of public health and medical education institutions.
IS IMPLEMENTATION FEASIBLE?
When asked about the feasibility of implementing the Health Sector Reform Commission’s recommendations, public health expert Mushtuq Husain told bdnews24.com that while the proposals are well thought out and aim for fundamental reform, some will not be possible without active cooperation from all stakeholders.
“To ensure success, the door for dialogue with stakeholders must remain open,” he added. “Opposition from certain groups should not derail the initiative. These are not fundamental issues; they can be discussed.
“But core reforms—like establishing a health service commission, regulating the quality of private healthcare, and setting service fees—are essential.”
Mushtuq noted that not all the recommendations require parliamentary approval and that many can be implemented through administrative orders.
“If there is goodwill, these reforms are quite possible. It will take time to see results, but work must begin without delay,” he said.
Public health expert Jamil also said the commission's recommendations are very good, but their practicality must be considered.
He felt the commission should have focused on proposals that are realistic and can be implemented quickly.
“To bring so many changes, the whole healthcare system would need to be overhauled, which isn’t possible right now,” he said. “All the suggestions are positive, but if implementation takes 10 years, it will serve little purpose.
“They should have said what can be done realistically and immediately.”
The expert also pointed out that some major issues were missing from the recommendations, such as doctor absenteeism and the need for reform in the nursing sector.
“There is nothing about how to stop doctors from being absent at their workplaces,” Jamil said. “And in the Directorate of Nursing and Midwifery, the [director general] or [additional director general] positions are held by government officers.
“Why can’t a nurse be appointed DG? If nurses hold that post, it will make the sector’s work much easier,” he concluded.
[Writing in English by Syed Mahmud Onindo and Sheikh Fariha Bristy]
