Bangladesh’s health sector stands at an important crossroads. On the one hand, we face the challenge of ensuring quality, accessible, and affordable healthcare for a large population. On the other, we must make the best use of limited resources, improve management efficiency, strengthen transparency and accountability, and build the capacity to respond effectively to future pandemics and emerging infectious diseases. Many of these challenges cannot be addressed simply by building more hospitals, recruiting more doctors, or purchasing additional medical equipment. An effective health system requires us to know where patients are located, where health professionals are available, where medicines and hospital beds are located, where disease outbreaks are emerging, how public resources are being spent, and what services people are receiving in return. For that, the government plans to develop an integrated National Electronic Health System. This is not simply about digitising healthcare; it represents a fundamental reform in health service management, governance, and accountability.
The proposed system will have two major components: the first will be a central electronic architecture, which will serve as the digital backbone of the entire health system. Information from various services, institutions, health professionals, and citizens will be securely and systematically integrated through this architecture. The second component will consist of digital platforms directly linked to healthcare delivery. These will progressively include an electronic health card for every citizen; electronic health records containing relevant medical and health information; an electronic referral system connecting different levels of care; a pharmacy portal for medicine management; a laboratory portal for diagnostic and test information; an administration portal for hospitals and other health facilities; and an ambulance and emergency service platform for coordinating emergency transport and care. As a result, wherever a citizen seeks public healthcare, an authorised healthcare provider will be able to access the relevant health information needed. Patients will no longer have to repeatedly recount their medical history, unnecessary duplication of diagnostic tests will be reduced, and referrals will become more effective.
At the heart of the proposed electronic health system will be an electronic health card for every citizen. The card will be generated through secure and lawful linkages with existing government databases, including the National ID and birth registration systems. Beginning at birth, essential information related to vaccination, maternal and child healthcare, diagnosis, laboratory investigations, prescriptions, hospitalisation, referrals, and long-term disease management can progressively be linked to this unique health identity. The system will also help determine where the required specialist, hospital bed or treatment is available so that patients can be directed to the right facility. Following treatment at a higher-level facility, relevant information will return electronically to the local health facility, allowing follow-up and long-term care to continue closer to the patient’s home. This will create an effective connection between primary, secondary and specialised healthcare, helping ensure that patients receive the right care, at the right facility, at the right time.
Questions have long been raised about waste of financial and other resources in the health sector, weaknesses in the management of medicines and medical equipment, unusual price variations in procurement, and inconsistencies in inventory and distribution. Technology alone cannot eliminate corruption, but an integrated and transparent digital system can significantly reduce opportunities for irregularities and waste. If digital records show how much medicine and equipment were supplied to each hospital, how much were used and how much remain in stock; how many tests were conducted in each laboratory; where and for what purpose an ambulance was used; and what services each facility provided to its patients—the use of public resources will become much easier to track and verify. Irregularities in procurement, supply, inventory, utilisation, and service delivery can also be identified more quickly, strengthening both audit and oversight.
Strategic stewardship at the national level will be linked to the prime minister’s office, while the Ministry of Health and Family Welfare and its directorates will play the central role in defining health-sector requirements and in the use and operational implementation of the system. Privacy and data security, role-based access, encryption, traceable records of data use, regular security assessments, disaster recovery, and strong data-governance arrangements must therefore be built into the architecture from the outset. Clear rules and accountability mechanisms must determine who can access citizens’ health information, when, for what purpose and to what extent. Alongside technological capability, the security of citizens’ information, national data sovereignty, and public trust must remain fundamental principles of the system.
A national system of this scale and complexity cannot realistically be introduced across the entire country at once. A project currently going through the approval process, financed jointly by the government and the Asian Development Bank, is planned to provide the principal initial financing for this initiative. In the first phase, the national digital health architecture and associated service platforms will be piloted in Bogura, Sirajganj, Narsingdi, Jhalakathi, Noakhali, and Khulna. We will assess not only whether the technology works, but also whether it is practical for doctors, nurses, and other health workers; whether patients benefit; whether referrals become more effective; whether data quality and accuracy improve; and whether managers can make faster, evidence-based decisions.
Another central objective of this initiative is to develop Bangladesh’s own technological, public health, and digital health capacity. The technology will belong to Bangladesh, the security and control of the data will remain in Bangladeshi hands, and the capacity to sustain it will be built through our own talent. This will reduce long-term dependence on foreign technology, strengthen data sovereignty and security, and build our own capacity to operate and continuously improve the system. Our goal is therefore not simply to build an electronic health system, but to build a health system in which continuity of care is ensured for every citizen, every service is traceable, the use of every resource can be verified, and accountability is strengthened at every level.
SM Ziauddin Hyder is special assistant to the prime minister on health affairs and a former senior health and nutrition specialist at the World Bank Group.
Views expressed in this article are the author's own.
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