Bangladesh is undergoing a major demographic shift. The population over 60 is expected to more than double from 13 million in 2019 to an estimated 36 million by 2050. This change will be felt most acutely in cities, where chronic illnesses like cancer, heart disease, and frailty are on the rise.
Yet, the country's palliative care system, which focuses on relieving suffering and improving the quality of life for those with life-limiting illnesses, is severely underdeveloped.
Currently, palliative care services are limited to a handful of institutions, primarily the Department of Palliative Medicine at Bangabandhu Sheikh Mujib Medical University (BSMMU). While there have been successful small-scale, community-based initiatives, such as Compassionate Narayanganj and Compassionate Korail, these remain isolated efforts.
A national guideline for palliative care exists, but its implementation is inconsistent. A major barrier is the severe restriction on the availability of opioids like morphine, which are crucial for pain relief. Many doctors, even in Dhaka, lack the training or authorization to prescribe them, leading to unnecessary suffering for patients.
The problem is particularly acute in urban areas. Patients are often discharged from hospitals too quickly, with limited follow-up or symptom management. While some private clinics and NGOs offer home nursing, few provide comprehensive palliative care that includes pain control, psychological support, and end-of-life planning.
As cases of cancer, cardiovascular disease, and dementia increase in cities, the need for a structured and accessible palliative care system is no longer optional; it's a critical necessity.
A new economic opportunity
Beyond the public health imperative, palliative and aged care represent an untapped economic sector with significant job creation potential. This field requires a diverse workforce, including not only doctors and nurses but also trained care assistants, social workers, psychologists, pharmacists, and patient navigators.
According to international standards, a modest staffing ratio of just 0.5 palliative or aged-care workers per 100 older adults in Bangladesh's four largest cities could generate 5,000 to 8,000 direct jobs within the next decade.
This figure doesn't even account for the indirect jobs created in training, logistics, pharmaceuticals, and equipment supply.
A phased approach could produce rapid results. Establishing six urban palliative "hubs" in the first three years, each with 75 staff members, could directly employ 450 people. Doubling the number of hubs and adding hospice units in the following years could create over 2,000 new urban healthcare jobs.
Developing a skilled workforce
Bangladesh already has a foundation for training, with BSMMU offering postgraduate residency programs and short courses in palliative medicine. However, the current scale is nowhere near what's needed.
To meet future demand, Bangladesh needs to create an "urban palliative care academy" to train new cadres of workers, such as care assistants, community nurses, and bereavement counsellors.
These programs should use both local guidelines and internationally recognized curricula. Partnerships between city corporations, universities, and private providers could help fund these training programs, ensuring a steady pipeline of skilled workers.
From health gap to growth engine
Palliative care is more than just a humanitarian necessity; it's also an economic opportunity. As the urban population ages, the demand for compassionate, home-based, and specialized care will only increase.
By treating this as a strategic sector, Bangladesh can both address a pressing health gap and create thousands of decent jobs in its cities.
The choice is clear: We can either wait until the suffering becomes too severe to ignore, or we can act now to build a system that relieves pain, restores dignity, and creates a new engine for urban employment.
Faysal Kabir Shuvo is an Australian-based urban planner and environmentalist.