The Bangladesh Nationalist Party (BNP) has formulated its 2026 National Election Manifesto with the compelling philosophy of “Bangladesh Before All.” Among its most notable pledges are health emergency funding, the introduction of family cards, farmer cards, and e-health cards, the recruitment of 100,000 community health workers, expansion of preventive and maternal-child healthcare, ensuring quality medical services at district and metropolitan levels, and allocating five percent of GDP to the health sector.
These commitments signal an ambitious vision for transforming Bangladesh’s healthcare system. However, the reality on the ground presents formidable challenges.
For years, Bangladesh’s health sector has struggled with neglect, political interference, and weak accountability. Out-of-pocket expenditure still accounts for 73 percent of total health spending, placing enormous financial burden on families. Meanwhile, non-communicable diseases (NCDs) have emerged as the leading cause of death, responsible for roughly 67 percent of all fatalities and 63 percent of disability-adjusted life years. Hypertension, cardiovascular diseases, cancer, diabetes, and respiratory illnesses are rapidly reshaping the country’s health profile.
Human resources remain another critical bottleneck. According to the Bangladesh Health Workforce Strategy 2024, 77,877 sanctioned posts—about 32 percent—remain vacant. Shortages are particularly severe among nurses and midwifery associates (62 percent), doctors (40 percent), allied health professionals (40 percent), and management staff (37 percent). While the BNP manifesto’s pledge to recruit 100,000 additional health workers appears promising, numbers alone cannot guarantee improved services.
Bangladesh already has a substantial frontline workforce. Family Welfare Assistants, Health Assistants, and Community Clinic Health Care Providers play vital roles in delivering primary healthcare. Yet, concerns persist regarding absenteeism, weak supervision, and poor accountability. In many communities, frontline workers are rarely seen, family planning supplies are unavailable, and community clinics operate irregularly (sometimes run by substitute staff rather than designated providers). As a result, patients frequently return home without care, and public trust in the system is eroded.
So, will recruiting more staff solve systemic problems, or simply expand inefficiencies? Without clear planning, strong management training, and effective accountability mechanisms, workforce expansion risks becoming a costly but ineffective move.
BNP’s pledge to establish free, quality primary healthcare, inspired by the UK’s National Health Service (NHS) General Practitioner model, is equally ambitious. The GP model emphasises continuity, accountability, and people-centred care. However, recreating the same success in Bangladesh will require more than structural replication. The proposed reliance on public–private partnerships raises legitimate concerns about maintaining equity, continuity, and accountability—the core strengths of the GP model.
Urban primary healthcare presents additional complexities. Currently, many services fall under local government rather than the Ministry of Health, contributing to the rapid and largely unregulated growth of private clinics. Weak regulatory oversight has allowed malpractice to flourish, including the spread of informal broker networks that steer vulnerable patients towards specific facilities for profit. This not only compromises service quality but also undermines public confidence.
Financing remains perhaps the greatest challenge. The national health budget for FY 2025–26 stands at Tk 41,908 crore, a modest share of total public spending. In contrast, allocating five percent of GDP to health would require approximately Tk 250,000 crore, which is an enormous fiscal leap. While such a commitment is commendable, fulfilling it will demand sustained political will, economic capacity, and careful prioritisation.
The BNP manifesto presents a bold and inspiring philosophy. But philosophy alone cannot heal patients. Real transformation will depend on strengthening accountability, improving governance, enforcing regulation, and ensuring that existing resources function effectively. If the vision of “Bangladesh Before All” is to succeed, harmony must be created between philosophy, policy, and practice. Only then can the promise of healthcare for all become a lived reality rather than an electoral aspiration.
Shaikh Masudul Alam is programme director of Bangladesh Health Watch at Brac James P Grant School of Public Health.
Views expressed in this article are the author's own.
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