When it comes to public healthcare, Bangladesh is suffering not just from a collection of unused hospital buildings, but also a systemic and nationwide atrophy of health service delivery. Locked hospitals or clinics are the most visible symptoms of a deeper, more dangerous problem. Beneath the rusted gates and dusty corridors of “ghost facilities” lies a chronic failure of governance characterised by manpower deficits, almost-institutionalised absenteeism, and a public health system that has been structurally cannibalised to act as a predatory referral funnel for private profit. Across the country, a large number of fully constructed health facilities—monuments of wasted public capital—stand idle. At the same time, those that remain open often operate as vacuous proxies of their intended purpose.
This crisis of non-functionality is no longer anecdotal. A report published by The Daily Star on January 10, 2026 documents a staggering reality: at least 80 government health facilities across 18 districts remain completely inactive despite being fully commissioned at a substantial cost. The figure would certainly be far higher if all the districts were surveyed. These idle structures range from specialised 20-bed trauma centres and dedicated children’s hospitals to community clinics and essential staff quarters. While some were completed as recently as in 2024, others have stood as architectural cadavers for more than a decade. The buildings did not fail structurally; they are intact and standing. Rather, the state failed to animate them.
The reasons cited by health officials—shortages of manpower, lack of equipment, and missing operating budgets—are deeply revealing. These are foundational prerequisites of healthcare planning that were ignored from the project’s inception. A hospital built without a recruitment plan is not an “incomplete project”; what it reflects is a serious failure of planning and coordination, in which infrastructure development has been decoupled from the institutional and human resource capacities required to make such facilities functional. Perhaps this is what happens when the system prioritises “bricks and mortar” as a means of budgetary disbursement, political optics, and rent-seeking. In contrast, the long-term work of staffing, training, and maintaining accountability is administratively demanding. So, you end up in a situation where the state builds the shell but exorcises the soul of the service.
The human cost of this situation is captured in the tragedy of Talia village in Gazipur. Here, a 20-bed hospital completed in 2020 at a cost of approximately Tk 20 crore has never treated a single patient. The local community donated their ancestral land in good faith, believing their sacrifice would secure the health of their children. Instead, the state returned a locked gate. Similar stories resonate from Rangpur to Savar. Roadside trauma centres remain shuttered while highway fatalities mount; paediatric wards overflow in urban centres while rural children’s hospitals remain unused. This is not an accidental error in government machinery; it is the machine working as intended to satisfy infrastructure targets while ignoring human outcomes.
The crisis extends far into the heart of the system. Even where clinics are officially open, service delivery is compromised by the corrosive practice of “dual loyalty.” Many government-employed doctors regard their public duty as an inconvenient burden while treating private practice as their real profession. Patients in public hospitals frequently report being rushed, ignored, or treated with indifference, only to be told—either explicitly or through heavy suggestion—to visit the same doctor’s private chamber. This is a predatory “referral funnel” where the public sector is used to harvest patients for the private market.
This redirection of care creates a two-tiered reality. The poor, who frequent public facilities because they lack alternatives, are nudged towards expenses they cannot afford. When a government doctor encourages a patient to take tests at a particular private diagnostic centre, the public service is effectively being cannibalised from the inside. This decay is exacerbated by widespread absenteeism among doctors and support staff, who, due to lack of oversight, often remain absent from duty.
The argument that the nation is “too poor” to ensure functional hospitals is dismantled by the examples of countries with comparable or even lower GDPs. Vietnam, for instance, integrated its health expansion with strict commissioning mandates. No district hospital or community centre is declared operational until the necessary doctors and nurses are physically present and the supply chain is established. In Vietnam, non-functionality is treated as an administrative failure, not a standard condition.
Sri Lanka offers an even more striking contrast. Despite enduring significant fiscal constraints and political upheavals in recent times, its public health system remains a pillar of the state. Public service is treated as a non-negotiable professional obligation, with a clear separation maintained between public duty and private practice. Patients are not pushed out of public hospitals to generate private income. Sri Lanka’s maternal and child health metrics can rival those of much wealthier nations.
Even Rwanda, which manages health services with a fraction of the resources available to many Asian nations, demonstrates the power of localised accountability. In the Rwandan model, local administrators are held personally and professionally responsible when a facility fails to provide service. Attendance and supply metrics are monitored in real time. Similarly, Nepal has addressed its complicated geography through compulsory rural service requirements for new medical graduates, ensuring that even remote hospitals have a human presence.
To move from this moral failure to functional governance, no health facility should receive final funding until a sanctioned staff list is physically present on-site. Furthermore, the referral funnel must be dismantled through digital oversight. Implementing biometric attendance and real-time patient feedback loops would make it impossible for doctors and staff to be ghosts in the system. Most importantly, there must be a forensic audit of every official who approved the construction of the 80 facilities identified in The Daily Star report without a corresponding staffing plan.
When we allow empty hospital buildings to decay while the sick and vulnerable travel miles in desperation, our conscience rots. Fifty-four years after independence, people are still struggling for the most basic healthcare. This is not a failure of resources but that of governance, and an indictment of a development model that values the cold concrete over the living citizen.
Dr Abdullah A Dewan is professor emeritus of economics at Eastern Michigan University in the US, and a former physicist and nuclear engineer at Bangladesh Atomic Energy Commission. He can be reached at [email protected].
Views expressed in this article are the author's own.
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