Bangladesh's healthcare system has expanded considerably over the decades, yet one of its most persistent weaknesses remains largely unchanged: there are simply not enough health professionals to meet the needs of its vast population. A new global study published in The Lancet Public Health offers a sobering reminder of this structural deficit. In 2023, Bangladesh had an estimated 56.7 health workers per 10,000 people, well below the South Asian average of 68.6. The figures are more than statistics; they reveal a healthcare system struggling to match growing demand with adequate human resources.
The study, based on estimates covering 20 health-worker categories across 204 countries and territories between 1990 and 2023, also exposes an imbalance within Bangladesh's health workforce. The country had only 7.9 doctors and 5.7 nursing personnel per 10,000 population, while the corresponding density of pharmacists and pharmaceutical assistants was considerably higher, at 11 per 10,000. Community health workers numbered 7.1 per 10,000, whereas midwifery personnel and dentists and dental assistants stood at only 1.7 and 1.2 respectively.
The imbalance deserves closer attention. A healthcare system cannot function effectively simply by increasing the number of professionals in one particular category. Doctors, nurses, midwives, pharmacists, community health workers and other professionals perform complementary roles. An abundance of one group cannot compensate for a shortage of another. Bangladesh's relatively high density of pharmacists, for instance, cannot be a substitute for the inadequate supply of nurses and doctors at the bedside or midwives in maternal healthcare.
Perhaps the more troubling aspect is that the shortage is not evenly distributed. In urban centres, especially Dhaka and other major cities, patients can often find specialists, private hospitals and diagnostic facilities, although affordability remains a major barrier. In rural and upazila areas, however, access to qualified medical professionals remains far more difficult. This urban-rural divide means that the national average itself may conceal a much harsher reality for people living outside the major cities.
The suggestion of encouraging diploma-level doctors at the upazila level therefore merits serious consideration. If properly trained, regulated and brought within the government health system, such professionals could help address the shortage of primary healthcare providers. Yet the policy must be designed carefully. Rural healthcare should not become a second-tier system in which poorer citizens receive less qualified services simply because they live far from cities. The objective should instead be to build a dependable primary healthcare network in which different categories of professionals work within clearly defined responsibilities and under effective supervision.
Bangladesh's problem is also one of investment. For years, health spending has often been viewed primarily as an expenditure rather than an investment in human capital. That perception needs to change. A doctor, nurse, midwife or community health worker is not merely an employee of the health sector; each is an essential component of the country's productive capacity. A healthier population is better able to work, learn and contribute to economic growth.
The global picture reinforces the urgency. Between 1990 and 2023, the world's health workforce nearly tripled, rising from 40.9 million to 122.1 million. Yet this remarkable expansion has not eliminated inequality. The world still needs an estimated 34.4 million additional health workers to achieve a Universal Health Coverage with an effective coverage index score of 80 out of 100. Nurses and midwives account for the largest portion of this deficit, with 23.9 million additional workers needed globally. South Asia alone requires an estimated 10 million more nurses and midwives and 2.6 million doctors.
The gender dimension is equally significant. Women accounted for more than 70 per cent of the global increase in the health workforce between 1990 and 2023. They constituted 80.7 per cent of nurses, 96 per cent of midwives and 89.5 per cent of community health workers in 2023. Yet women remained underrepresented among physicians and in leadership positions. Bangladesh, too, needs to ensure that women entering the health profession are not held back by inadequate workplace facilities, inflexible schedules, insufficient maternity support or limited opportunities for advancement.
Ultimately, Bangladesh's healthcare challenge cannot be solved merely by building more hospitals or purchasing more sophisticated equipment. Buildings and technology can only go so far without people to operate them and care for patients. The country needs a long-term health workforce strategy encompassing expanded medical and nursing education, better training facilities, competitive remuneration, safe working conditions and incentives for professionals to serve in underserved areas.
Equally important is the proper implementation of the National Health Policy 2011. Policies matter only when they are translated into sustained institutional action and adequate budgetary commitments. Bangladesh has already demonstrated that it can expand its network of community health workers and pharmaceutical services. The next task is to correct the imbalance by investing more decisively in doctors, nurses and midwives.
Healthcare ultimately begins not with infrastructure but with human beings caring for other human beings. Bangladesh's relatively low health-worker density is therefore not merely a sectoral weakness; it is a warning about the country's broader development priorities. If universal health coverage is to become more than an aspiration, health professionals must be treated as indispensable human capital. The real measure of progress will not simply be how many hospitals Bangladesh builds, but whether there are enough competent and committed people inside them to serve every citizen with dignity and care.
