In line with its electoral commitment, the BNP government has initiated steps to introduce the national e-Health Card by June this year. It is an important step towards building an effective, modern and integrated healthcare system, the need for which experts have long emphasised, and which the Health Sector Reform Commission recommended.
If implemented properly, a unique e-Health Card could make the country’s healthcare system more efficient, transparent, and accountable. It could improve the quality of healthcare services, ensure continuity of care, and strengthen accountability within the system. In particular, it would enable more effective use of patients’ previous medical histories in diagnosis, control fraudulent patient registrations, establish an effective referral system, introduce family-based defined service packages, and monitor healthcare utilisation and expenditure.
In many countries, citizens are issued either a physical or digital e-health card. These cards usually contain the patient’s name, photograph, health identification number, and a QR code. Healthcare facilities can quickly scan the card to retrieve patient information and access medical histories from electronic health record systems. As a result, healthcare delivery becomes faster, more accurate, and better coordinated.
However, questions may arise regarding the design of such a document: whether it should be a standalone card or whether existing identification numbers, such as the national ID or birth registration, should serve as the unique health identifier. Both approaches have advantages and limitations.
Global experience suggests that in most countries, national identification or birth registration numbers are not used as health identifiers. Instead, a health identification number is created specifically for use within the healthcare system. The main reasons for this approach are to protect personal privacy, ensure data security, and improve the efficiency of health information management. In such systems, national ID or birth registration numbers are generally used only during the registration process for identity verification while a separate health ID is used to manage patient information in hospitals, clinics, and diagnostic laboratories.
Under India’s Ayushman Bharat Digital Mission, citizens receive an Ayushman Bharat Health Account (ABHA) with a 14-digit health identification number that links patients’ medical information across various hospitals and healthcare institutions. Similarly, in the UK’s National Health Service (NHS), every patient is assigned an NHS number, which is used to identify individuals when they access healthcare services. In contrast, some countries, such as Estonia, which have highly advanced digital infrastructures, have integrated the NID number with health information systems. These systems also rely on robust data protection and cybersecurity mechanisms.
However, the most widely accepted approach is to create a dedicated health identification number for and use it on e-Health Cards to protect personal privacy, enhance the security of health information systems, and allow inclusion of individuals who may not yet have NID documents, such as children or other vulnerable groups.
Regardless of the specific card format, introducing an e-Health Card is not merely a card distribution programme; it requires a comprehensive digital health ecosystem with several key components.
First, an electronic medical record (EMR) system is required to digitally store patients’ medical histories, diagnostic tests, medications, and follow-up information. Second, a shared integrated health information platform is needed so that healthcare institutions at different levels—community clinics, union health centres, upazila health complexes, district hospitals, and specialised hospitals—can securely exchange necessary patient information. Third, hospital automation is an important component of this system. To manage hospitals or health facilities digitally, adequate technological infrastructure is required. This includes sufficient computers and other hardware, reliable high-speed internet connectivity, secure servers and data storage systems, and uninterrupted electricity supply. Considering the past uncertainties in electricity and internet services in our country, backup power solutions such as generators or solar energy systems should also be ensured.
In addition, skilled human resources are essential for the effective operation of digital systems. Each health facility should have trained personnel responsible for information management, software operation, and routine maintenance. At the same time, physicians and other healthcare workers must receive appropriate training so that the digital system simplifies their work rather than creating additional burdens.
Ensuring data security and privacy is also crucial for the successful implementation of the national e-Health Card system. Since health data is highly sensitive, strong cybersecurity measures and clear policies governing the storage and use of patient information are necessary. The success of this initiative will also depend largely on governance structures and financing mechanisms. Effective coordination between the Directorate General of Health Services (DGHS) and the Directorate General of Family Planning (DGFP) is essential as healthcare and family planning services are currently managed through separate administrative systems.
At the same time, a strong data governance framework is needed to protect patients’ personal health information and establish clear rules and accountability for data usage. Without ensuring privacy and cybersecurity, public trust in the system cannot be achieved. Equally important is realistic planning for sustainable financing. Producing e-Health Cards alone will not be sufficient. Long-term funding must be secured for infrastructure development, recruitment, training, system maintenance, and regular technological upgrades.
To ensure successful implementation, several practical steps may be taken. Pilot projects could be launched in selected districts to test different components of the digital health system. The new system should be effectively integrated with existing health information systems. Meanwhile, the technological capacity of grassroots health facilities should be strengthened gradually.
Public awareness campaigns are necessary for citizens to understand the benefits of using e-Health Cards and be motivated to access healthcare services.
With appropriate infrastructure, skilled human resources, effective governance, and realistic planning, the e-Health Card initiative has the potential to make Bangladesh’s healthcare system more integrated, efficient, and accessible to the population. Now is the time to ensure that the necessary preparations are in place for its successful implementation.
Dr Syed Abdul Hamid is professor of health economics at Dhaka University, convener at Wellbeing-First Initiative Bangladesh (WFIB), and chief adviser at Universal Research Care Ltd.
Views expressed in this article are the author's own.
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