Bangladesh’s health sector has long been weighed down by a complex set of interlinked challenges — persistent shortages of infrastructure and skilled personnel, rising out-of-pocket expenditure, uneven quality of care and a steady erosion of public trust. Health is therefore no longer a purely sectoral concern; it has become a crucial indicator of state capacity and political credibility. In this context, the recommendations of the Health Sector Reform Commission warrant close scrutiny, not only as a diagnosis of systemic failure but as a structured roadmap for reform.
The commission’s proposals are anchored in three core principles: the recognition of health as a fundamental right, the establishment of strong and transparent administrative and regulatory frameworks and the enforcement of governance, accountability and ethical standards across the system. When political parties’ health-related election manifestos are examined through this framework, areas of convergence emerge alongside notable limitations.
The Bangladesh Nationalist Party’s health manifesto demonstrates considerable alignment with the commission’s structural agenda. Its commitments include recognising health as a basic right, introducing universal health coverage through a national health insurance scheme, strengthening service delivery from primary to tertiary levels, ensuring access to essential medicines and expanding digital health services such as health cards and referral systems. These proposals closely reflect the commission’s emphasis on system strengthening and service integration, indicating an acknowledgement of the need for a coordinated, state-led health framework.
However, the commission goes further by explicitly calling for independent regulatory authorities, autonomous hospital governance and the insulation of health administration from political interference. On these critical issues, the BNP manifesto remains cautious and less explicit. This does not necessarily imply resistance, but it does raise questions about political willingness to curtail discretionary power and enforce institutional accountability — issues central to meaningful and sustainable reform.
By contrast, Jamaat-e-Islami’s articulation of health policy places stronger emphasis on ethical values, social responsibility, equitable access for the poor and moral integrity in medical practice. These concerns resonate with the commission’s recognition of ethics and equity as essential components of a functional health system, creating a degree of normative alignment.
Yet contemporary health systems require more than ethical intent alone. Clear positions on financing mechanisms, insurance models, regulatory authorities, hospital management structures and procurement transparency are indispensable for effective governance. On these operational dimensions, Jamaat’s health vision remains insufficiently articulated, limiting its ability to translate moral commitments into actionable public policy.
This comparative assessment raises a broader political question: do election manifestos, particularly on public health, meaningfully influence voter behaviour? Can they increase or reduce electoral support?
Bangladesh’s electoral history suggests that manifestos, in isolation, rarely determine election outcomes. Voter decisions are more commonly shaped by political identity, leadership perception, past performance and the broader electoral environment. However, issues such as health, education and employment increasingly matter to a segment of undecided or ‘silent’ voters — particularly among urban and semi-urban middle classes and younger voters — because these concerns directly affect everyday household experience.
From this perspective, the BNP’s health manifesto arguably holds greater potential to attract voter interest, as it speaks more directly to tangible concerns such as treatment costs, hospital access, availability of medicines and financial protection through insurance. These are issues grounded in lived reality. Yet this potential is constrained by several practical considerations.
First, do voters actually read election manifestos? In practice, most voters in Bangladesh do not have direct access to these documents. Manifestos are neither widely disseminated nor consistently presented in simplified, citizen-friendly formats. Consequently, their content reaches voters primarily through speeches, slogans, media summaries and informal discussion rather than through systematic engagement.
Second, is the electorate uniformly equipped to analyse structural differences between policy proposals? Bangladesh’s electorate is highly diverse in terms of education, exposure and political literacy. While some voter groups may engage with policy distinctions, many rely on broader narratives, reputational cues and trust signals rather than technical policy detail.
Under such conditions, election manifestos are unlikely to produce dramatic shifts in voting patterns. Their real value lies elsewhere: in preventing vote erosion, reinforcing credibility among undecided voters and establishing a baseline of policy seriousness. A coherent and implementable health manifesto may not win an election on its own, but it can contribute to sustaining political trust.
In this sense, the Health Sector Reform Commission’s proposals offer an opportunity for all political parties. Those that meaningfully align their manifestos with these recommendations, and, crucially, demonstrate credible commitment to implementation, stand to gain not only policy legitimacy but also public confidence.
Ultimately, health sector reform is not about manifesto language or electoral arithmetic alone. It concerns the lives, dignity and security of citizens. If health is treated as a genuine political priority, its impact will extend well beyond votes, shaping the long-term relationship between the state and its people.
Dr Syed Md Akram Hussain, member of Health Sector Reform Commission, is a professor of clinical oncology at Bangladesh Medical University.
