‘Of all the forms of inequality, injustice in health is the most shocking and inhuman.’ Martin Luther King Jr spoke these words in 1966, yet they remain painfully relevant today. When life-saving medicines are out of reach, the price is paid not merely in currency but in human misery and lost lives.
Bangladesh has made significant strides in healthcare: it has built a thriving generic pharmaceutical industry, achieved remarkable immunisation coverage and expanded its network of community clinics. Yet millions still struggle to access basic medicines. Out-of-pocket spending accounts for nearly three-quarters of the nation’s total health expenditure, one of the highest proportions in the world. For poorer families, this often means delaying treatment, selling assets, or abandoning therapy altogether.
The National Drug Policy of 1982 was a landmark reform. By prioritising a list of essential medicines, rationing irrational drug combinations and imposing price controls, it successfully increased both affordability and availability in its early years. But four decades on, the challenges have shifted: chronic diseases are more widespread, medicine prices are rising and regulatory enforcement has weakened. Renewed political will and modernisation of policy are urgently needed.
Several factors continue to drive the inaccessibility of medicines. First, the lack of financial protection: with minimal health insurance coverage, patients are forced to pay directly from their own pockets. Second, partial enforcement of price regulation leaves many essential drugs beyond reach. Third, in rural areas, people often depend on informal sellers who dispense antibiotics over the counter, wasting money and fuelling antimicrobial resistance, a looming public health crisis.
Global changes are adding pressure. In 2026, Bangladesh will graduate from its least-developed-country status, losing many of the waivers that currently protect it under the WTO’s TRIPS regime. Until 2033, LDCs remain exempt from pharmaceutical patents, allowing them to produce cheap generic medicines. Once these waivers expire, stricter intellectual property rules could drive up the cost of vital drugs, including cancer treatments and antivirals. Time to prepare is running short.
The consequences of inaction are measured in lives. Treating drug-resistant tuberculosis can cost thousands, far beyond the means of most families. Cancer treatment or dialysis forces many to sell land, livestock or property. The Covid-19 pandemic further exposed the fragility of supply chains, with shortages and price gouging hitting the poorest hardest.
Yet there are reasons for hope. Bangladesh’s Gavi-supported immunisation programme has shown how finance and logistics can be combined to reach near-universal coverage. Global Fund support for HIV, TB and malaria has made medicines widely available. BRAC’s community health workers have delivered affordable care to millions in rural and urban slums. These examples prove that partnerships, sound financing and political commitment can overcome systemic barriers.
Ensuring affordable medicines for all requires a multi-pronged approach. First, financial protection must be strengthened. Social health insurance schemes need to move beyond pilot projects and guarantee basic medicines at little or no cost. Expanding pooled procurement and using electronic supply platforms can contain costs and prevent shortages. Publishing real-time dashboards of medicine prices and stock levels would increase transparency and accountability.
Second, the list of essential medicines must be updated. Beyond antibiotics and maternal-child health drugs, top priority should go to non-communicable disease medicines such as insulin, inhalers and antihypertensives. Strict enforcement of generic prescribing and price caps — achievements of the 1982 reforms — must be reinstated.
Third, the irrational use of medicines, particularly antibiotics, must be curbed. Stewardship programmes, regulation of over-the-counter sales and investment in rapid diagnostic tools can reduce misuse, saving both money and lives.
Fourth, community-based interventions should be expanded. Organisations such as BRAC and research centres like icddr,b have already shown that they can reach the poorest households with affordable care. A results-based financing model could incentivise such initiatives to deliver essential medicines to remote and underserved populations.
Finally, systematic monitoring is essential. A ‘Medicines Access Scorecard’ tracking prices, stock-outs and affordability at the district level could guide policy and hold government accountable. Linking budget allocations to improvements on this scorecard would keep medicine access at the centre of health reforms.
Bangladesh has proved before that bold policy can transform public health. The National Drug Policy of 1982 remains a benchmark reform; the country’s immunisation drive is admired worldwide. A second wave of reform must now meet today’s realities — chronic disease, antimicrobial resistance and global market pressures — with equal ambition.
Health is not a luxury; it is a human right. No garment worker in Gazipur should have to sell her meagre belongings to complete a course of tuberculosis drugs. No mother in Rangpur should be forced to choose between buying insulin or feeding her children. The promise of universal health coverage will remain hollow unless life-saving medicines are made accessible to every citizen.
As Bangladesh steps into its next phase of economic growth, it must recognise that true progress is not measured by GDP figures or export earnings but by whether ordinary people can obtain the medicines they need to survive. Affordable medicine for all is not an act of charity—it is an act of justice.
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Md Abu Sayed is a student in the Department of Pharmacy, World University of Bangladesh.
