THE health reforms commission in May put forth a set of proposals to transform the healthcare landscape. Major recommendations include the establishment of a permanent, independent health commission, the recognition of primary health care as a constitutional right to be provided free, the decentralisation of health services by setting up health services, an increase in health sector funding, enhanced medicine supply and a national pharmacy network, the development of a nationwide digital health system and the formation of an independent services commission to ensure transparency in recruitment.
The proposals reflect the ambitious vision of structural reforms in healthcare governance. The proposed national health commission is intended not merely as an administrative tool but also as a central driver of systemic changes. Its success, however, will depend on the ability to confront persistent institutional challenges and mobilise sustained political and social support. It is, therefore, instructive to explore how health commissions function globally and to draw lessons from countries as well as international guidelines laid out by the World Health Organisation.
In China, the National Health Commission bears the responsibility of drafting health legislation, policies and long-term plans for public health services development. Pakistan鈥檚 Sindh Healthcare Commission focuses more narrowly on licensing, investigating malpractice and ensuring quality standards. The United Kingdom once ran a dedicated healthcare commission that regulated healthcare providers, assessed services quality, issued performance ratings for NHS organisations and provide patients with information to make informed choices. Many of the roles of the commission, now defunct, have since been absorbed by the Care Quality Commission.
Globally, health commissions, statutory or advisory, have emerged as central actors in steering reforms. Their mandates tend to be broad but share common objectives 鈥� to improve health outcomes, promote equity and enhance the efficiency and responsiveness of the healthcare system. The roles and responsibilities of the bodies often converge around several important areas.
A primary function of the health commissions is the formulation of health policies and strategies. The bodies design national health policies, establish reforms priorities, define long-term objectives and draft legislation. China鈥檚 health commission, for instance, is involved in such legislative and strategic planning processes. Regulation and oversight also fall within the purview of many health commissions, as seen in the Pakistan and the now-defunct UK model, where they managed licensing procedures, monitored compliance and investigated malpractice.
Another central function is the promotion of healthcare quality and patient safety. Through audits, inspections and the dissemination of best practices, commissions help to raise standards of care. They often empower patients by making health system performance data public. Coordination and governance are also important as commissions must bring together diverse stakeholders to foster transparency, accountability and collaboration. The proposed health commission is envisioned as precisely such an oversight body for primary healthcare delivery and governance.
Financial stewardship is another area in which commissions can play a vital role. By advising on health budgets and investment priorities, commissions such as the health reforms commission advocate for increased sectoral funding and more efficient resource allocation. Moreover, health commissions frequently support evidence-based policy-making with robust health information systems. The development of a digital health infrastructure, as recommended in Bangladesh, is essential.
Strengthening primary healthcare is an increasingly common focus, aligning with the WHO鈥檚 global call for universal health coverage. Health commissions can facilitate community participation, focus on prevention and health promotion and ensure that services reach the under-served people. They also work to tackle health inequities by adopting a 鈥榟ealth in all policies鈥� approach that addresses social determinants of health. Many commissions advocate for reforms in recruitment and workforce distribution. The Bangladesh proposal to create an independent commission for healthcare recruitment reflects an awareness of the need for a qualified, well-distributed and ethically recruited health work force.
The global experiences offer both inspiration and cautionary lessons. Among the most notable successes are improvement in care quality and patient safety driven by regulation and inspection. Commissions have also contributed to greater policy coherence by offering expert, evidence-based recommendations and have improved transparency and accountability through independent oversight. Where successful, they have played a crucial role in strengthening primary health care and engaging stakeholders to build consensus on reforms.
These achievements are often tempered with considerable challenges. Political interference remains a common problem. While commissions are often established as independent bodies, they can face pressure from vested interests that undermine their autonomy and credibility. Without operational independence, their ability to make objective recommendations or enforce regulations can be severely compromised.
Resource constraints also pose a significant challenge. Many commissions lack the funding or personnel to effectively fulfil their mandates. Even when well-conceived policies are put forward, the implementation gap often persists, because of bureaucratic inertia, institutional weakness at the local level, or resistance to change. Data limitations further restrict the effectiveness of the bodies, especially where health information systems are under-developed or fragmented.
Another persistent challenge is balancing the competing interests of stakeholders. Health systems involve a wide array of actors, from ministries and professional associations to private providers and patient advocacy groups, whose priorities often diverge. Building consensus in such a landscape is difficult. Finally, sustainability is a concern. Reforms initiated by health commissions require long-term support and adaptive management strategies to remain viable beyond the short political or funding cycles.
Several lessons emerge from the experiences. A clear legal mandate and true operational independence are essential to safeguard the integrity of commissions. Adequate resources and skilled personnel must be made available to allow the bodies to function effectively. Evidence-based recommendations, backed by reliable data, are critical to legitimacy and impact. Engaging stakeholders and maintaining transparent communication help to build support. Phased, adaptive implementation strategies tend to yield more sustainable results. Equity-focused reforms must be prioritised to ensure that healthcare improvements benefit all. Sustained political commitment is also indispensable.
The proposed Health commission represents an important step towards systemic reform in the health sector. If implemented effectively, it could become a cornerstone in the pursuit of equitable, efficient and quality health care for all. Yet, this will require more than just structural design. It will demand enduring political will, institutional capacity and public engagement. The global record shows that health commissions can succeed, but only if they are empowered, well-resourced and anchored in a broader commitment to justice and accountability in health.
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Dr Md Mohsin Ali is a public health and nutrition specialist.
