As the world approaches the 2030 deadline for achieving the Sustainable Development Goals (SDGs), the health sector in Bangladesh stands at a critical turning point.
Among the 17 goals, SDG 3 -- ensuring healthy lives and promoting well-being for all -- demands urgent attention. At the core of this goal is the promise of universal health coverage (UHC): That no one should be denied health care due to an inability to pay.
Despite notable progress with selected health indicators, Bangladesh's UHC Service Coverage Index stood at just 52 in 2024, one of the lowest in the WHO South-East Asia Region, with a high catastrophic health expenditure of 24%.
Rising health-care costs, a shortage of health workforce, increasing cases of noncommunicable diseases, and limited access to medicines and diagnostics highlight systemic gaps in the health sector. This is further exacerbated in the face of rapid urbanization, climate change and the increasing frequency of public health emergencies.
The country stands at the crossroads and must act decisively. Should it be business as usual? Or should Bangladesh reorient health systems and accelerate progress towards UHC for a healthier and stronger nation?
The recently published Health Sector Reform Commission Report 2025 provides much-needed vision and guidance. It lays out bold, systemic reforms that could reposition health care, not as a privilege for a few, but a constitutional right for all citizens.
Embedding health as a constitutional right
The cornerstone of the commission’s proposal is an amendment to the Constitution to make primary health care a fundamental right for all.
While Article 15 currently mentions access to basic medical care, a formal constitutional guarantee would provide legal accountability and ensure long-term political commitment towards ensuring free primary health care for all.
“The enjoyment of the highest attainable standards of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition”.
Almost 77 years after these words were adopted by the Constitution of the World Health Organization, they are now more powerful and relevant than ever for Bangladesh.
The “right to health” is not just symbolic. Global experience suggests that it is the foundation upon which financial, legal, and governance reforms must be built.
Governance, legislative modernization, and structural overhaul
To modernize health governance, the commission proposes reviewing outdated health laws and enacting new legislation to protect patient rights, decentralize power of authority for better accountability and management of the health workforce, enforce service quality standards, and improve financial protection.
Central to this reform is the proposed Bangladesh Health Commission (BHC) -- an independent, permanent authority to coordinate a “health in all policies” approach that will mainstream health in other sectoral policies such as education, environment, food industry, and urban planning, to name a few. The BHC would oversee 17 specialized wings tasked with strategy, policy, and monitoring.
Equally transformative is the call for a unified Bangladesh Health Service (BHS) that consolidates all health personnel under one administrative structure, merging the directorates such as DGHS, Family Planning, and Medical Education. This would streamline coordination, increase efficiencies, and professionalize the health workforce.
The commission’s proposal to establish a dedicated Public Health Department presents an opportunity to reorient Bangladesh’s health system. Until now, public health functions have been merged with the Department of Health Services, which has primarily focused on clinical care.
Creating a standalone structure would enhance the prominence of public health, strengthen the national public health workforce, and increase emphasis on preventive and promotive services, both at national and subnational levels.
To promote merit-based recruitment, the commission recommends establishing a dedicated Public Service Commission (Health) to ensure timely and transparent hiring and promotions. The proposal to establish an Allied Health Professional Council is also a long-awaited and much-needed step toward ensuring quality and regulated health care for all.
The ‘right to health’ is not just symbolic. Global experience suggests that it is the foundation upon which financial, legal, and governance reforms must be built
Transforming service delivery across levels
The commission outlines a restructured service delivery model anchored in free, and accessible, primary care:
- Rural Union health and family welfare centres would be upgraded to full-fledged primary health care (PHC) centres
- Ward-level urban clinics would ensure services reach underserved city populations
- To reduce overcrowding in tertiary hospitals, district-level tertiary care and strengthened upazila (secondary) care are proposed, backed by robust referral and gatekeeping systems
This decentralization process, supported by adequate technical, financial and institutional capacity, along with well-defined roles and authority at the subnational level, will bring services closer to communities, and potentially improve equity in access and continuum of care across all levels of health facilities.
Ensuring access to medicines, emergency services and digital innovation
Affordable, accessible medicines are essential for effective primary health care and progress towards UHC. The commission recommends:
- Free essential medicines at the primary level, and subsidized access at higher levels
- VAT exemptions on life-saving drugs for diseases like cancer and diabetes
- Expanding the essential medicines list, updated every two years
- Modernizing EDCL and partnering with private suppliers for quality assurance
This is a low-hanging fruit, and if implemented with quality, it can promptly deliver significant benefits to the community, industry and economy. Bangladesh is a hub for pharmaceutical manufacturing and can further strengthen its regional and global position.
Enhancing health system efficiency with resilient infrastructure and digital innovation
To improve the overall efficiency and responsiveness of the health system, the commission recommends strengthening critical support infrastructure and harnessing the potential of digital health. Recommendations include:
- A national emergency care network, along with centralized pharmacy, diagnostics, ambulance, and blood transfusion services
- A fully paperless, integrated health information system, supported by smart health cards and unique health IDs for all citizens
- A digital grievance redressal system to improve accountability
Digital health solutions have huge potential particularly in low-resource settings, to address workforce and specialist shortages, reaching remote rural populations, and simply improving the efficiency gains through tele-health. However, these changes require digital readiness not just in health facilities, but also in communities. Digital literacy and staff training must go hand in hand with infrastructure upgrades.
The cost of inaction is clear: Continued fragmentation, inefficiency, and inequality in care
Financing health as a public investment
Perhaps the most game-changing proposal is for the government to allocate at least 15% of the national budget to health, with over 50% earmarked for primary care. To sustain this commitment, the commission recommends:
- Enacting a health financing law
- Increasing taxes on harmful products like tobacco and alcohol to fund health care
- Establishing a health security fund supported by CSR contributions from the private sector
Additionally, to reduce outbound medical travel, the commission calls for upgrading local tertiary care, promoting domestic medical tourism, and reforming medical education to meet World Federation for Medical Education (WFME) standards. Health research, public-private coordination, and workforce development round up this investment-driven vision.
More clarity is needed on the health security fund supported by private-sector CSR, as fragmented schemes risk inefficiency and poor coverage. Clear implementation steps are vital, and the revised health financing strategy -- once approved -- could provide a more coherent approach.
Turning vision into action: What will it take?
Global evidence shows there is no single blueprint for the country’s UHC journey. The starting point for any reform is the existing arrangement of functions and policies, as well as the context (fiscal, administrative, political, social). While experiences from other countries can guide the reform agenda, each country must ultimately have its own UHC roadmap.
The commission’s 2025 report is more than a set of recommendations -- it is a blueprint for a healthier, fairer Bangladesh. But implementation will require:
- High-level political commitment and policy coherence across ministries
- Cross-sector coordination, especially in finance, education, recruitment and ICT
- A time-bound national action plan to prioritize and phase the reforms based on feasibility, leveraging on existing initiatives
- Continuous monitoring, learning, recalibrating and public accountability
At the same time, concerted actions would be needed for strategic stakeholder engagement and ensuring public trust in the health system. Indeed, there would be many pitfalls along the way (Fig 1) and the astute stewardship would foresee the risks and take proactive actions to overcome barriers.
The cost of inaction is clear: Continued fragmentation, inefficiency, and inequality in care. But the opportunity for transformation is equally clear, and within reach.
WHO’s role and alignment
WHO welcomes the report of the Health Sector Reform Commission. The report aligns closely with WHO’s longstanding emphasis on primary health care as the cornerstone of universal health coverage and reflects a pro-primary health care approach.
WHO has consistently supported many of its key priorities and assures our firm commitment and support in its endeavour to reform and strengthen the health sector in Bangladesh. WHO has worked closely with the Ministry of Health to generate evidence and revise national strategies on health financing, human resources, digital health, and medical education.
It has also contributed to the design of essential health service packages, development of national health service standards, and the drafting of an architectural blueprint to guide the digitization of the health system.
We continue to support the government’s efforts on updating the National Essential Medicines List and strengthening EDCL’s production and DGDA’s regulatory capacity toward Maturity Level 3 (ML-3) vaccine regulation, reflecting strong alignment with many of the commission’s recommendations.
Additionally, WHO’s work on climate-related health challenges, mental health, non-communicable and infectious diseases, strengthening health systems readiness to emergency health response and digital health infrastructure further supports the broader environment needed for reform.
A rare window for reform
Bangladesh now faces a choice: Continue with fragmented, inefficient, inequitable and underfunded systems, or seize this moment to build a resilient, rights-based progressive health infrastructure for robust and healthy future generations.
Dr Ahmed Jamsheed Mohamed, WHO Representative to Bangladesh.
