THE global discourse, as highlighted by the International Labour Organisation, has rightly recognised the ‘care economy’ as a vital pillar for the future of decent work. This economy, spanning both paid and unpaid labour, from a nurse in a hospital ward to a family member tending to an elder, is facing a worldwide crisis of recognition, resources and rights. For a country like Bangladesh, with a population exceeding 168 million, this global concern is far from abstract; it is an immediate, lived reality. The nation’s aspiration for sustainable development is deeply tied to its capacity to address the severe deficits in its care infrastructure. At the centre of both the crisis and the potential solution stands the Bangladeshi nurse, the quiet yet indispensable pillar of the country’s healthcare system.
In Bangladesh, the notion of ‘taking care’ unfolds in a context of relentless pressure and chronic scarcity. The healthcare sector is forced to grapple with the dual challenge of combating persistent communicable diseases such as tuberculosis while simultaneously confronting the rise of non-communicable conditions including diabetes, hypertension, and cardiovascular diseases. This complex and evolving disease landscape pushes an already strained health system to its limits. The statistics tell a stark story. The World Health Organisation recommends a doctor-to-nurse ratio of 1:3.5, yet Bangladesh’s reality stands inverted at roughly 1:0.4. In practice, this means that for every ten doctors, there are only four nurses, creating a workload that is simply unmanageable for those at the frontline of care.
This shortage shapes the daily reality of nurses across the country. They are the primary providers of direct, personal and relational care, but the crushing patient load often leaves them physically and emotionally exhausted. Studies reveal that doctors in tertiary hospitals, themselves under immense pressure, can spend an average of just 48 seconds with each patient. It is the nurse who must then fill the void, managing not only medical tasks but also offering emotional reassurance, guidance and education to patients and their families. This work is carried out with remarkable dedication, but too often without adequate time, institutional backing, or societal recognition.
The challenges, however, extend far beyond individual effort. They are rooted in deep structural problems that define the state of healthcare in Bangladesh. The country faces an acute shortage of health professionals across the board. With only seven doctors per 10,000 people, compared with the WHO recommendation of 22.8, the system is chronically under-resourced. This shortfall is particularly pronounced in rural areas, where the majority of Bangladeshis live, widening the divide in access to care between urban and rural populations. At the same time, the absence of a comprehensive public insurance scheme has resulted in an alarming dependency on out-of-pocket spending, an estimated 74 per cent of total health expenditure. For countless families, this means that a medical emergency can quickly spiral into a financial catastrophe. Such pressure often translates into frustration and aggression towards nurses, who are the most visible faces of the system.
Working conditions for nurses further exacerbate the strain. Excessive workloads have become a major source of stress and burnout, compounded by low wages and the absence of proper risk allowances, a problem laid bare during the Covid-19 pandemic. Beyond financial concerns, many nurses also face social stigma and safety issues in the workplace. Female nurses in particular report feeling unsafe during night shifts, citing the risk of harassment and the lack of secure facilities such as dressing rooms and toilets. These factors collectively erode morale and discourage many from staying in the profession. At the same time, a proliferation of unregulated private pharmacies and diagnostic centres has complicated the healthcare landscape, undermining public trust and making the work of trained nurses even more difficult.
As Bangladesh looks to the future, it must also prepare for a new set of challenges emerging within the care economy, particularly those shaped by technology and evolving social needs. One promising yet complex frontier lies in the application of Artificial Intelligence in healthcare. The government’s ‘Digital Health Strategy 2023–2027’ signals a decisive move in this direction. AI has the potential to transform healthcare delivery: autonomous systems could enhance caregiver productivity, AI-powered diagnostic tools such as CAD4TB are already assisting with tuberculosis screening, and clinical natural language processing could significantly reduce the administrative burdens on nurses, freeing them to spend more time with patients. Yet, while optimism about AI runs high, so too do the challenges. Weak digital infrastructure, unreliable connectivity, and an acute shortage of data science skills could easily blunt these innovations. For AI to succeed, it must complement rather than replace the human touch that lies at the heart of care.
Another urgent but often neglected dimension is mental health, particularly among adolescents. Bangladesh’s vast young population faces mounting academic pressure, social anxiety, and the psychological effects of prolonged screen exposure and shifting family dynamics. Encouragingly, a number of institutions are beginning to respond. The National Institute of Mental Health now operates a ‘Child, Adolescent and Family Psychiatry’ unit, while private centres such as MindSheba and Bangladesh Psychiatric Care are providing therapy and counselling grounded in Cognitive Behavioural Therapy. Importantly, these initiatives recognise that adolescent mental health is not an isolated issue, it requires active involvement from families, schools and communities.
The country must also strengthen care for persons with disabilities, an area that has long depended on the dedication of the non-profit sector. More than 16 million Bangladeshis live with disabilities, and organisations working with differently abled individuals have pioneered holistic models of support that go beyond medical treatment. They provide physiotherapy, assistive technology such as prosthetics and Braille materials, and inclusive education and employment opportunities. Their community-based rehabilitation approach offers a powerful example of how care can be transformed from a matter of household responsibility into a process of genuine social inclusion and dignity.
Addressing Bangladesh’s care crisis, therefore, requires a multi-layered response that engages public institutions, private initiatives and families alike. Strengthening hospital care must go hand in hand with expanding quality care outside hospital walls. The formalisation of home-based care services is an essential part of this process. Social enterprises such as Home & Community Care Ltd are already leading the way by training and deploying background-checked caregivers who assist with everything from companionship and hygiene to clinical procedures such as tube feeding and oxygen management. These initiatives not only ease the burden on families and hospitals but also create new, formal employment opportunities within the care economy.
Public–Private Partnerships can also play a strategic role in addressing funding and infrastructure gaps. The government’s PPP Authority has rightly identified healthcare as a key area for collaboration. Such partnerships have shown promise in specific cases, such as expanding affordable dialysis services. However, their success depends on accountability, transparency, and trust. When profit motives overshadow public welfare, as seen in recent protests over fee hikes in PPP-run facilities, the credibility of these partnerships suffers. For PPPs to work, they must remain firmly anchored in the principle of equitable access to care.
Ultimately, no reform can succeed without recognising and investing in the true heart of the care economy, the nurse. This investment must be comprehensive, extending beyond recruitment to ensuring fair wages, proper benefits, and meaningful risk allowances. It must also guarantee safe and respectful workplaces, free from harassment and equipped with gender-sensitive facilities. Nurses should receive advanced training in new technologies such as AI-based patient monitoring, as well as in specialised fields including geriatric, palliative and mental health care. Most importantly, society must elevate the status of nursing itself. Public campaigns that celebrate the profession’s essential contribution to national well-being can help dismantle stigma and foster pride among current and future nurses.
The global framework of the care economy offers Bangladesh a valuable lens through which to shape its development agenda. By addressing systemic shortages, investing in its nursing workforce, embracing technology thoughtfully, and building an inclusive care ecosystem, the nation can transform its current crisis into an opportunity for progress. The care economy is not merely a sector, it is the foundation upon which the health, dignity and social cohesion of Bangladesh will rest in the years to come.
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Manik Esahak Biswas is a social development worker.
