In a small house in Angaria village under Dumki upazila of Patuakhali lives the family of Laizu and Rahman Shikder. Their four-year-old son, Ridwan, is now relatively healthy.
At first glance, he appears like any other child. But not long ago, he was hospitalized due to complications caused by malnutrition. His elder brother and sister have faced similar health problems. From early childhood, all three children have been caught in a cycle of malnutrition, weakness and irregular treatment.
The family said their illnesses were not detected or properly managed in the early stages due to prolonged low income, lack of regular health check-ups and the absence of consistent healthcare services at the local level.
As a result, conditions that could have been treated easily at the beginning gradually worsened, eventually requiring hospital admission.
Ridwan’s mother, Laizu, said they had visited the local community clinic several times but often did not receive medicines.
“Most of the time, we found the clinic closed. And when we went to a clinic a bit far away, they told us to go to the Upazila Health Complex. Because of a lack of money, we were delayed. Later, when the condition became worse, we had to take him to the hospital,” she said.
Her experience reflects a broader rural healthcare reality in Bangladesh, where community clinics serve as the first point of care but services are often inconsistent, with shortages of medicines and limited availability of staff.
In such situations, patients are forced to visit multiple facilities even for primary care, and many eventually turn to Upazila or district-level hospitals. This leads to delays, higher costs and increased hardship for low-income families.
Community clinics were designed to be the first point of trust in rural healthcare and are considered a lifeline for millions. Yet concerns persist over capacity gaps, staffing shortages and service limitations.
According to government and development data, there are more than 14,400 community clinics operating across Bangladesh. The World Bank and the World Health Organization say these clinics function as the first level of primary healthcare for rural populations, with each designed to serve around 6,000 to 12,000 people. In reality, many serve significantly larger populations.
At the same time, around 490,000 people receive services from community clinics daily, translating to roughly 160 million service visits a year, putting significant pressure on the primary healthcare system.
Government data shows that these clinics handle a large number of patients every day, including children, women, elderly people, laborers and farmers. However, service expansion has not kept pace with population growth and rising demand.
Most community clinics do not have regular MBBS doctors. Instead, services are primarily provided by Community Health Care Providers (CHCPs), whose training is focused on primary healthcare. For complicated cases, referral to higher-level facilities is required.
A field visit to Angaria village in Dumki upazila showed uneven service delivery. One community clinic was found locked, with no healthcare worker present nearby.
Local residents said clinics often do not open on time, and even when they do, essential services and medicines are not always available. As a result, patients with common illnesses such as fever, cold or childhood infections often return without treatment or seek care elsewhere.
At another clinic, several patients were seen waiting outside. Some had brought children, while others were seeking care for long-term conditions. Inside, Community Health Care Provider Bilkis was briefly attending to her three-year-old child.
After some time, she returned to work, while her child remained nearby.
During the visit, basic child health measurements such as weight and height were not consistently taken, with limited equipment available. In some cases, assessments were made based on estimation rather than standard measurements.
Local residents said staff shortages, high patient loads and limited resources place additional pressure on health workers, affecting service quality.
CHCP Bilkis said operational challenges are common in the field.
“We do not always have proper weighing machines or stadiometers. Sometimes the available equipment does not work properly. In those cases, we are forced to rely on observation or experience,” she said.
She added that due to workload and time constraints, it is not always possible to examine every patient in detail.
“As a result, some conditions are difficult to detect at an early stage,” she said, adding that she tries to ensure no patient is left untreated.
She also said that service quality could improve significantly with better equipment, regular supplies and adequate manpower.
Bangladesh’s health profile has been shifting rapidly. Earlier, infectious diseases such as diarrhoea, cholera and pneumonia dominated. Now, non-communicable diseases (NCDs) such as hypertension, diabetes, heart disease, stroke and cancer are increasing.
A 2026 study found that among rural populations screened, 54.2% were at risk of diabetes or hypertension. It also found that 34.5% had high blood pressure and 27.9% had elevated blood sugar levels.
However, essential services for managing these conditions, including regular follow-ups, testing and long-term treatment, remain largely absent in community clinics.
Another study found that overall preparedness of community clinics for managing non-communicable diseases stands at only 38.7%.
Field data shows that around 84% of health workers report patients returning repeatedly due to lack of medicines.
At the same time, manpower shortages remain a major challenge. A single CHCP is often responsible for patient care, record-keeping, vaccination, reporting and administrative duties, leaving limited time for individual consultations.
Some clinics also face shortages of electricity, water, internet connectivity and basic equipment, further affecting service delivery.
Five-month pregnant Afroza, who regularly visits the clinic for antenatal care, said she relies on community clinics for basic maternal health services.
“Bilkis madam gives me advice, tells me how to take care during pregnancy and provides medicine when needed,” she said.
However, she added that service availability is not always consistent.
“But sometimes she is not available at the clinic. Then I have to return or come another day,” she said.
Experts say Bangladesh’s community clinic model remains one of the country’s most successful primary healthcare initiatives, contributing significantly to reductions in maternal and child mortality and improved immunisation coverage.
However, they warn that new challenges have emerged, including rising non-communicable diseases, ageing populations, mental health needs and long-term disease management.
UNICEF Research and Data Support Officer Yasmin Ara said community clinics must evolve beyond basic primary care.
“Community clinics should no longer be seen only as primary care centers. They must be transformed into effective centers for long-term disease management. Otherwise, pressure on rural health systems will increase, and people will be forced to go to city hospitals,” she said.
She added that strengthening the system requires structural reforms, including deployment of doctors, training for NCD management, consistent medicine supply, digital health services and a stronger referral system.
Preventive healthcare, she said, must also be strengthened to ensure early detection and control of diseases.
Dr Nigar Ferdousi, Medical Officer at the Institute of Public Health, said the government has taken initiatives to modernize and strengthen the community clinic system.
She said these clinics play an important role in delivering healthcare in rural areas and efforts are underway to improve service delivery.
She added that steps are being taken to increase manpower, ensure medicine supply and expand digital health services, along with strengthening maternal and child health and preventive care.
Ridwan’s story is not just the story of one child. It raises a broader question of whether the country’s first point of healthcare is strong enough to meet the needs of rural populations.
Community clinics remain the backbone of Bangladesh’s primary healthcare system. But without sustained improvements in staffing, supplies and service capacity, families like Ridwan’s and Afroza’s may continue to face delayed and incomplete care.