As Bangladesh steps into a new political chapter under the recently elected government, expectations are mounting for bold and transformative reforms. One sector of note is urban primary healthcare.
In cities such as Dhaka, rapid urbanization has outpaced public health infrastructure. Overcrowded hospitals, rising out-of-pocket expenditures, and fragmented service delivery systems continue to weigh heavily on urban families. For millions of city dwellers, timely, affordable, and quality health care remains more a privilege than a right.
Global evidence shows that strong primary health care forms the foundation of universal health coverage. In many low and middle-income countries, integrated primary care systems reduce hospital overcrowding by up to 30% in urban settings.
When primary care functions effectively as the first contact point, hospitals can focus on emergencies and specialized care. With political commitment and strategic planning, Bangladesh can build an equitable, efficient, and accountable health system, positioning itself as a regional example.
One pressing expectation is the establishment of urban general practitioners (GPs) in high-need areas, identified through scientific geographic mapping. These centres would serve as structured entry points into the health system, where trained GPs manage common illnesses such as respiratory infections, hypertension, diabetes, maternal health issues, childhood ailments, and minor injuries.
Handling routine cases at the community level would reduce unnecessary hospital visits and bring care close to urban residents.
However, primary care cannot work in isolation. A robust digital referral system connecting primary, secondary, and tertiary care is essential.
Clear referral protocols, referral desks in hospitals, and feedback mechanisms will ensure smooth transitions for patients needing advanced care. Training hospital staff in referral management will streamline patient flow, reduce delays, and improve continuity of care, resulting in better health outcomes and system efficiency.
Equally important is guaranteeing free access to essential medicines at all government primary health care (PHC) facilities.
Nearly three-quarters of Bangladesh’s health expenditure is out-of-pocket, a heavy burden for low and middle-income families. Ensuring reliable access to drugs, particularly for chronic conditions like hypertension and diabetes, will ease financial strain and improve adherence.
Digital inventory tracking can prevent stockouts, while expanding government-run community pharmacies through public-private partnerships (PPP) can increase availability. India's Jan Aushadhi initiative demonstrates that affordable essential medicines can reduce costs by 50-90% while improving compliance, offering a useful model for Bangladesh, particularly to underserved urban communities.
Transparency and accountability must underpin urban health reform. Civil society engagement is key to monitoring public services. Establishing an independent monitoring body, coupled with citizen scorecards and grievance systems, would empower residents to evaluate service quality.
Public dashboards showing real-time data on service availability, referrals, and medicine stocks can build citizen trust. Countries like Indonesia show that community oversight can improve service delivery by up to 25%. A government that welcomes scrutiny signals commitment to genuine reform.
Urban healthcare can’t be one-size-fits-all. Bangladesh’s cities range from densely populated slums to high-rise apartments. Area-specific assessments should guide service delivery.
Successful initiatives such as Aalo Clinic, Smiling Sun, Rangdhanu, or government-operated urban dispensaries (GODs) can be expanded through PPP and digitally integrated into the national health management information system (HMIS2).
Evidence suggests that locally tailored primary health care models can enhance coverage by 40% in heterogeneous urban environments. Customization is essential for achieving universal health coverage.
The private sector should also be integrated constructively. Standardized accreditation for private primary healthcare clinics can ensure quality while leveraging efficiency. Concurrently, investment in water, sanitation, and hygiene (WASH) infrastructure in hospitals is critical. Poor sanitation contributes significantly to hospital-acquired infections.
Strengthening infection prevention protocols with independent monitoring will protect vulnerable urban populations and enhance public confidence in healthcare services.
Coordination between the Asian Development Bank-funded Urban Primary Health Care Services Delivery Project (UPHCSDP) under the local government division (LGD) and the Ministry of Health and Family Welfare (MoHFW) is imperative for efficiency and sustainability.
Integrating project-supported facilities into the national system and developing a shared urban health strategy will ensure sustainability beyond donor funding. Experiences from countries like Vietnam show that inter-ministerial collaboration can maintain urban health gains even after external support ends.
The new cabinet stands at a crucial juncture. By prioritizing structured GP centres, digital referrals, free essential medicines, civil society oversight, localized service models, private sector engagement, WASH enhancements, and inter-ministerial coordination, it can lay the foundation for a resilient urban health ecosystem.
Urban residents envision a Bangladesh where every city dweller, regardless of income or location, has access to timely, affordable, and quality care. Bold implementation will not only fulfill electoral promises but also secure a lasting legacy of health equity and social progress.
Dr Maliha Khan Majlish is Technical and Development Manager, Eminence Associates for Social Development and Associate, Bangladesh Urban Health Network (BUHN).