The fifth pillar is where things get more complicated, and more interesting. It commits to establishing a National Health Security Office to manage a National Health Fund and lead what it calls strategic purchasing, while targeting vulnerable groups, urban slum residents, widows, people over 70, people with disabilities, for prioritized services.

This is not a new idea in Bangladesh. A draft National Health Protection Act has existed since 2014, proposing something similar: a National Health Protection Authority, a health card system, and lists sorting citizens into income categories, below poverty, marginal income, middle income, and above, to determine who gets subsidized care (Draft National Health Protection Act, 2014). The draft law even requires annual audits and treats misuse of the system as a punishable offense. More than a decade later, the compact is effectively picking up where that draft left off, this time with an actual signed commitment and a 2030 deadline attached.

Here's the part I keep coming back to. Any list sorting citizens into income categories is a judgment call, whether or not anyone calls it that. Someone, or something, decides who counts as "below poverty level" versus "marginal income," and that decision determines who gets a subsidized health card and who doesn't. If this system gets digitized without checking for bias first, and I've seen this exact pattern before in disaster aid allocation, it risks locking in existing unfairness at a much larger scale and a much faster pace than a paper-based system ever could. The bias-correction techniques I used to fix historical unfairness in post-flood aid rankings, adjusting a model so it stops treating location as a shortcut for actual need, apply directly to this kind of eligibility list too.