Bangladesh may have a Ministry of Health and Family Welfare, but some may argue that it functions more like a “Ministry of Hospitals”, with greater emphasis on treatment infrastructure than preventive healthcare. This imbalance, however, is not unique to Bangladesh.
Noncommunicable diseases (NCDs) now account for almost two-thirds of all deaths in the World Health Organization (WHO) South-East Asia Region, with nearly half occurring prematurely among people aged 30 to 69.
Yet health systems worldwide spend only around 3-5% of their health budgets on prevention while facing mounting costs from treating complications.
The observation comes from an article by MA Muhit, State Minister for Health and Family Welfare of Bangladesh, published by the World Economic Forum.
In Bangladesh, NCDs account for 70% of all deaths. About 14 million adults live with diabetes, making Bangladesh home to the world's seventh-largest diabetes population, while the most recent national health survey found that nearly one in four women and one in six men have high blood pressure.
However, 43% of women and 51% of men with raised blood pressure are unaware of their condition. The same is true for roughly seven in 10 people with high blood sugar.
Only about one in five adults with high blood pressure knows they have the condition, takes appropriate medication and keeps it under control. For diabetes, only about one in 20 people have their blood sugar under control.
Many people learn about their health problems only after developing complications such as a stroke, heart attack or kidney failure. When that happens, the financial burden falls on households.
Ordinary Bangladeshis pay roughly three-quarters of the country's health expenditure out of pocket, one of the highest proportions in the world, with almost no insurance coverage to cushion the cost.
A study published this year in Health Economics Review found that a family living with an NCD spends around $69 more a year on healthcare than a comparable family without the disease, with three-quarters of the additional spending going towards medicines.
The study also found that among the poorest households, having an NCD increases the risk of falling into poverty by almost four percentage points.
A chronic illness in Bangladesh is therefore not only a medical problem but also a direct pathway into poverty and a persistent drain on development gains built over decades.
The government is implementing substantial reforms to change this trajectory.
Under the National Health Compact, Bangladesh has committed to reducing premature mortality from NCDs from 24.6% to 15% by 2030 and making primary healthcare free.
Three commitments underpin these targets.
The first is the addition of 100,000 community health workers.
The second is establishing a fully functional and adequately staffed prevention-focused primary healthcare unit in every union and urban ward.
The third is creating a national digital health ecosystem anchored by an e-health card for every citizen by 2028 and linked to a shared health record that can be accessed by any health facility.
Funding has also followed these commitments. This year's budget nearly doubled the health allocation to around 1% of gross domestic product, from 0.58%.
The question now is how these commitments will translate into better healthcare for a rural household.
Since 2023, the government's National NCD Control Programme has worked with the non-government network BRAC, whose community health workers serve more than 20 million households, and Medtronic LABS, which develops digital health platforms for primary care.
Together, they have built a connected pathway that follows an individual from the first household visit through long-term treatment.
Screening itself is not new, but it has largely been opportunistic, focusing on people who visit clinics or take part in periodic community campaigns. The new approach involves systematically screening entire communities.
Patients are referred to facilities according to the urgency of their cases. Those requiring closer attention receive regular follow-up through tele-counselling calls, while stable patients collect medicines and are monitored closer to home through community clinics.
A single digital record is opened during the first household visit and follows the individual throughout their healthcare journey. Health workers can see the chain from screening to outcome in real time.
Community health workers have systematically screened more than 470,000 adults. One-third were found to have elevated blood pressure or blood sugar, with 20% of those readings at life-threatening levels.
More than 142,000 patients have enrolled in the programme. Among those whose readings were repeated after six months, the proportion with blood pressure within a safe range increased by 17 percentage points to 52%.
For blood sugar, the proportion rose by 11 percentage points to 34%. Although this represents an improvement, it remains lower than the progress recorded for blood pressure.
These improvements could potentially prevent strokes, heart attacks and kidney failure. A sustained 10-point reduction in blood pressure reduces the risk of a heart attack or stroke by about one-fifth.
The data also highlights fundamental challenges within the health system.
Only 22% of referred patients could be tracked into government facilities, while roughly half of enrolled patients have a documented six-month reading.
An independent evaluation by BRAC James P Grant School of Public Health found that many referred patients turn to private providers, often when medicines become unavailable locally. Advice on nutrition, tobacco use and exercise, which can be as important as medication, is also rarely provided as part of routine care.
The lack of data reflects both a genuine gap and the invisibility created when patients move between primary healthcare centres, public hospitals, private providers and pharmacies. As a result, recorded linkages and follow-up may underestimate the care patients actually receive.
Measuring continuity of care is progress, but the current system largely stops at the public sector. A shared record — through the e-health card and the connected digital ecosystem around it — is needed to follow patients across the healthcare system, ensure referrals are completed and allow providers to act on a full rather than partial medical history.
The task now is to standardise and scale up this and similar programmes nationwide, moving from individual projects to a system in which community-based prevention and screening become routine components of primary healthcare.
This requires giving health workers the tools to address a household's full health needs in a single visit rather than relying on separate protocols and forms for each disease. Artificial intelligence could help prioritise households, reduce documentation burdens and tailor counselling.
None of this will work without the basics that are already receiving investment: sufficient numbers of trained health workers and a reliable, affordable supply of essential medicines.
Global frameworks such as the WHO's HEARTS technical package for cardiovascular disease management and its Package of Essential Noncommunicable Disease Interventions point towards the same approach. Bangladesh's contribution is to test these models at national scale, supported by new technology.
Across South Asia and much of Africa, similar elements are coming together: large community health workforces, national digital identity systems and governments facing fiscal pressure to prevent disease rather than treat it at a later stage.
In such settings, shared digital records and systematic screening could provide a similar model.
Whether Bangladesh becomes a “Ministry of Health” rather than a “Ministry of Hospitals” will depend on whether prevention and care are accessible and affordable for ordinary households.
Tracking patients' healthcare journeys, measuring outcomes to guide ongoing programmes and moving beyond individual projects can help achieve that goal. That is the standard against which the reforms are intended to be judged.