A MOTHER in Kurigram should not have to travel to Dhaka for treatment that ought to be available at a nearby health centre. Yet every day, thousands of Bangladeshis make similar journeys. They crowd into buses, borrow money from relatives, and spend days away from work and family simply to access services that should exist much closer to home.
The image has become so familiar that it is often accepted as normal. It should not be.
Bangladesh’s public health achievements over the past three decades are among the country’s most important development successes. Life expectancy has increased significantly. Maternal and child mortality have fallen. Immunisation programmes have reached millions of children. Internationally, Bangladesh is frequently cited as evidence that effective public health interventions can be delivered even with limited resources.
But success can sometimes conceal weaknesses. Behind these achievements lies a healthcare system that remains heavily oriented towards treating illness after it occurs rather than preventing it in the first place. The consequences are becoming increasingly visible in overcrowded hospitals, rising treatment costs, and a growing burden of chronic disease.
As policymakers prepare the next national budget, the debate should move beyond whether health deserves greater attention. The more important question is whether Bangladesh can continue relying on hospitals to solve problems that should be addressed much earlier, within communities and at the primary-care level.
The financial reality alone suggests that the current model is becoming difficult to sustain. Public spending on health remains low by international standards. Meanwhile, households continue to finance the overwhelming majority of healthcare costs directly from their own pockets. For countless families, illness is not merely a medical event but an economic shock.
A serious illness frequently forces households to deplete savings, sell productive assets, incur debt, or postpone treatment altogether. Such a financing structure creates inequalities in access and leaves millions vulnerable to financial hardship. More importantly, it undermines long-term economic development.
Health expenditure is often discussed as a social obligation, but it is equally an economic investment. A worker disabled by a preventable stroke, a diabetic patient whose condition progresses because of late diagnosis, or an individual unable to work due to unmanaged chronic illness represents not only a personal tragedy but also a loss of productivity. As Bangladesh pursues upper-middle-income status and seeks to strengthen its human capital base, the economic costs of poor health can no longer be viewed as a secondary concern.
At the same time, the country’s disease profile has undergone a profound transformation. Bangladesh’s health system was largely designed to combat infectious diseases and reduce maternal and child mortality. Those challenges remain important, but they no longer define the country’s primary health burden.
Today, non-communicable diseases such as cardiovascular disease, diabetes, cancer, and chronic respiratory illnesses account for the majority of deaths. These conditions do not emerge overnight. They develop gradually, often over years, influenced by tobacco use, unhealthy diets, physical inactivity, environmental pollution, and increasingly urbanised lifestyles.
Yet many Bangladeshis encounter the healthcare system only after complications have become severe. Hypertension may remain undetected until a stroke occurs. Diabetes may go unmanaged until kidney failure or vision loss develops. By the time patients seek treatment, the disease has often become more difficult and more expensive to manage.
This is where primary healthcare becomes indispensable.
Routine blood-pressure monitoring, diabetes screening, nutrition counselling, smoking-cessation support, and community-based health education are not glamorous interventions. They do not attract headlines in the same way that new hospitals or advanced medical equipment do. Yet they often deliver far greater returns.
A blood-pressure check that prevents a stroke is cheaper than treating the stroke. Early diabetes detection is less costly than dialysis. Effective health promotion reduces the need for expensive medical interventions later. Prevention is not simply good public health policy; it is sound economic policy.
Bangladesh itself has already demonstrated the effectiveness of this approach. The country’s success in reducing child mortality did not originate in specialised urban hospitals. It emerged through community-based services, vaccination campaigns, and frontline health programmes delivered close to where people lived. Millions of children were protected from diseases such as polio, measles, diphtheria, and tetanus because preventive services reached communities before illness could take hold.
Recent concerns over measles outbreaks serve as a reminder that public-health gains require continuous investment and vigilance. They also highlight a broader lesson: prevention works when governments commit resources to it.
Unfortunately, healthcare resources remain concentrated at the opposite end of the system. Urban tertiary hospitals continue to absorb a disproportionate share of attention and demand, while many primary-care facilities struggle with shortages of personnel, medicines, equipment, and diagnostic capacity.
The result is visible in virtually every major public hospital. Facilities designed to provide specialised treatment increasingly function as the first point of contact for patients with conditions that could have been prevented, detected earlier, or managed locally. Overcrowding is therefore not merely a hospital problem. It is evidence of weaknesses throughout the healthcare system.
No number of additional hospital beds can fully resolve this challenge if patients continue arriving with preventable complications and advanced-stage illnesses.
International experience offers useful lessons. Countries that have achieved better health outcomes at lower overall cost have generally done so by strengthening primary care rather than relying exclusively on specialised hospitals. Thailand’s health reforms, for example, demonstrated how strong community-level services can expand access while reducing financial hardship. The United Kingdom’s National Health Service similarly places primary care at the centre of healthcare delivery, ensuring that prevention, diagnosis, treatment, and referral occur through a coordinated system.
Bangladesh does not need to replicate any model wholesale. It already possesses one of the most important ingredients for reform: an extensive network of community clinics, union health centres, and other primary-care facilities. What remains lacking is the political commitment to strengthen these institutions and place them at the centre of health policy.
This requires more than increasing expenditure, although greater investment is undoubtedly necessary. It requires a strategic reorientation of priorities. Essential medicines and diagnostic services must be consistently available at primary-care facilities. Rural health workers require stronger incentives and professional support. Digital health systems should improve continuity of care and patient monitoring. Accountability mechanisms must ensure that services function effectively rather than existing only on paper.
Equally important, Bangladesh should explore sustainable ways to finance prevention. Health taxes on tobacco products and sugary beverages, for example, can simultaneously discourage harmful consumption and generate resources for health promotion programmes. Such measures create a double dividend: improving public health while expanding fiscal space for investment.
The fundamental choice facing Bangladesh is therefore straightforward. The country can continue directing scarce resources towards managing advanced disease in overcrowded hospitals, or it can invest more heavily in preventing illness before it becomes disabling, expensive, and sometimes fatal.
The evidence is clear. Strong primary healthcare saves lives, reduces inequality, protects families from financial distress, and delivers better value for public spending. It is not merely a health-sector reform; it is an investment in economic resilience, workforce productivity, and national development.
Bangladesh’s next major public-health achievement is unlikely to come from constructing larger hospitals alone. It will come from ensuring that people receive quality care before their conditions become medical emergencies, and from making that care available close to where they live.
The real question, then, is not whether Bangladesh can afford to invest more in primary healthcare. It is whether the country can afford not to.
Salina Siddiqua is a postgraduate researcher at the University of York, UK and associate professor of development studies at the University of Dhaka. SM Abdullah is an associate professor of economics at the University of Dhaka. Dr Rumana Huque is a professor of economics at the University of Dhaka.
