BANGLADESH stands at a critical moment in its public health journey. For decades, the health system has been heavily skewed, treating illnesses after they appear, while prevention and health promotion remain significantly underinvested. The situation is worsened by a fragmented and often non-functional primary health care system in most rural areas, where community clinics and union-level facilities struggle with incoordination between health and family planning directorates and shortages of staff, equipment, and continuity of care. In municipalities and cities, the picture is even more concerning.
A functional primary health care service simply does not exist, leaving millions, especially the poor, women, children, and the elderly, to navigate an unregulated and expensive urban health market on their own. Yet it is preventive, promotive, and community-based health services that determine whether families stay healthy, avoid costly medical bills, and remain productive members of society. As the country grapples with rising non-communicable diseases, ageing populations, widening inequalities, and growing financial strain on households, intensifying community-based health service delivery is not just a policy choice; it is a national imperative.
Bangladesh now experiences an alarming rise in non-communicable diseases. According to the World Health Organization estimates, NCDs such as heart disease, stroke, diabetes, chronic respiratory diseases, and cancers account for more than 66 per cent of all deaths in the country. These conditions develop silently over years due to poor diet, inactivity, hypertension, tobacco use, air pollution, and unmanaged stress.
Most of these risk factors can be addressed early through strong community-based services, including regular screening, counselling, early diagnosis, lifestyle guidance, and follow-up care. Studies show that early detection of hypertension and diabetes at the community level can reduce severe complications like stroke and kidney failure by up to 30 to 40 per cent, drastically lowering the need for expensive hospital treatment.
Community-based health workers also play an essential role in reaching women, children, and the elderly groups who often face barriers to accessing care. Bangladesh continues to record concerning levels of maternal anaemia, childhood stunting, and unmet need for family planning.
The 2022 Bangladesh Demographic and Health Survey reported that 24 per cent of women of reproductive age are undernourished and 31 per cent of children under five are stunted. Many of these conditions can be prevented through routine counselling on nutrition, pre- and post-natal care, breastfeeding support, home-based visits, and early childhood stimulation programmes, services best delivered at the community level.
Perhaps the strongest argument for strengthening preventive and promotive health services lies in the economics of health. Bangladesh has one of the highest rates of out-of-pocket health expenditure in Asia. According to the Bangladesh National Health Accounts 2023, households pay around 68 per cent of total health spending from their own pockets. As a result, nearly five million people are pushed into extreme poverty every year due to catastrophic health expenses.
Community-based prevention can dramatically reduce this burden. Managing diabetes early, for example, is far cheaper than treating diabetic foot infections or kidney failure. Preventing high blood pressure costs a fraction of what is spent on cardiac events and hospital stays. Every taka invested in preventive services saves multiple takas in treatment, transport, hospitalisation, and lost wages.
What Bangladesh needs now is a decisive shift in health policy. Community health workers should be trained in NCD screening, nutrition counselling, elderly care, and digital record-keeping. Each ward and union must have a functional primary care unit offering basic diagnostics, telemedicine links, and referral systems. Preventive services, including immunisation, growth monitoring, antenatal and postnatal care, health education, early screening, etc., must be integrated into a unified community platform supported by digital dashboards. Most importantly, preventive and promotive care must be recognised as the backbone of Bangladesh鈥檚 health strategy, not an afterthought.
This shift would reduce the nation鈥檚 disease burden, protect families from financial hardship, and ultimately build a healthier, more productive workforce. It would also ensure that women, children, and other vulnerable populations receive the care they need close to home that is safe, affordable, and without fear of financial ruin.
The Bangladesh Nationalist Party believes in a health system that protects people before they fall sick. The party promotes a system where prevention is prioritised, care is accessible, and no family becomes destitute because of illness. Preventive and promotive health services are the foundation for achieving BNP鈥檚 31-point state reform agenda, which prioritises human well-being, equity, and a modern health system rooted in primary care. By detecting risks early, reducing disease severity, and ensuring timely access to community-level services, prevention becomes essential to realising BNP鈥檚 fundamental goal, ie, no citizen should die before receiving quality treatment.
Tarique Rahman and the BNP have, therefore, placed the strengthening of preventive and promotive health services at the core of their health reform vision. Their commitment puts community-based care at the heart of improving service quality, reducing out-of-pocket costs, and making healthcare affordable and accessible for all citizens, particularly women, children and other vulnerable populations.
If Bangladesh is to build a healthier and more resilient future, the transformation must begin at the community level, where health truly starts.
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Dr Ziauddin Hyder is an adviser to the chairperson of the Bangladesh Nationalist Party and a former health and nutrition specialist at the World Bank Group, Washington DC.