Bangladesh has been a model of health progress in the Global South. Over the past decades, the country of 171 million — 25% of whom are under age 14 — has seen significant improvements in life expectancy, maternal and child health care as well as in the management of infectious diseases. It’s a model of health progress.
Now the country is writing the next chapter in its political history. Prime Minister Sheikh Hasina has resigned and Nobel laureate Muhammad Yunus is leading an interim government. Major political transitions often pose a significant risk to hard-earned successes in health care in the Global South.
To ensure the preservation and advancement of the country’s public health achievements, global health organizations must urgently unite to support Bangladesh during this critical time: the World Health Organization and UNICEF, along with leaders from non-governmental, philanthropic and research institutions who implement global development policies.
The progress in Bangladesh over the past decades has been remarkable — a testament to the resilience and resourcefulness of its people.
A series of studies published in The Lancet illustrated how life expectancy in Bangladesh increased by 28% over the last three decades, from approximately 58 years in 1990 to 74 years in 2019, while the age-standardized all-cause mortality rate reduced by 53%, going from 1,500 deaths per 100,000 population in 1990 to 715 deaths in 2019.
These public health accomplishments were made in a country with a GDP per capita of 2,688.31 USD and a 2.36% health expenditure as a share of the gross domestic product For context, other lower-middle-income countries spend 4 to 6% of their GDP on health and are often not able to accomplish such dramatic improvements in health and population outcomes.
During my medical training, I spent several years in Bangladesh’s Dhaka district. I witnessed how high-quality research, international cooperation and funding, focus on women’s empowerment and innovative community-based health-care approaches led to these results. In clinical medicine, the most impactful example of Bangladesh leading the development of lifesaving medications has been the discovery and widespread implementation of the oral rehydration solution — a simple beverage composed of salt, sugar and water – that has dramatically decreased mortality rates from cholera in children and [ALSO DECREASED DEATH AMONG ...?, along with adults and children with non-cholera diarrheal diseases.
The World Bank has partnered with Bangladesh for 50 years, committing around $40 billion in grants and concessional credits — loans that often have more favorable terms than those available from commercial lenders — to ensure improved treatment, prevention and referral services for routine and life-threatening infectious diseases, including mosquito-borne diseases like dengue that are on the rise in this time of climate change.
The rapid expansion of the country’s population and economy has also led to unique health system challenges. While deaths from infectious diseases, including tuberculosis, have decreased, the country still must confront communicable diseases even as recent years have seen an exponential increase in mortality from non-communicable illnesses including diabetes and Alzheimer’s — leading to what epidemiologists refer to as a “double burden.”
Additional, health system challenges include understaffed health-care facilities and prohibitive out-of-pocket expenses that impede access to equitable care.
As is expected in any sudden political transition, the interim government is rightly focused on establishing law and order. However, while navigating these challenges they also need to ensure the delivery of essential health services, which provides an opportunity for global health organizations to play a vital role during this transition. These organizations should protect existing progress and helping sustain momentum on crucial initiatives.
The World Bank’s $200 million investment to improve primary health care, such as screening for hypertension, for vulnerable populations in the cities and urban areas that was approved in August 2023 is at a crucial implementation stage. Continued engagement — such as assistance with monitoring and evaluation assessments, guidance on building primary health care centers and helping align the initiative’s goals with national health priorities — can help keep such endeavors on track despite changes in government.
Global health organizations have a history of supporting countries during such critical times. For example, during a similar crisis in Sri Lanka in 2022, the Global Fund to Fight AIDS, Tuberculosis and Malaria approved $989,687 in emergency funding to ensure access to and distribution of essential medicines.
The World Health Organization (WHO) can also play a significant role in providing strategic assistance for strengthening the health system in Bangladesh — particularly in formulating health policies and addressing workforce shortages. WHO is already collaborating with the Ministry of Health and Family Welfare in Bangladesh to create the first national medical education strategy aimed at addressing the country’s severe shortage of trained health-care workers by investing in the development of curriculum, accreditations, and faculty, with the goal of improving the quality of medical education by collaborating on health workforce research studies and assembling local and international experts.
While policy improvements are necessary, I have witnessed the resilience and adaptability of the people of Bangladesh. During the infamous Savar building collapse that killed more than a thousand garment factory workers, I was volunteering with the International Committee of the Red Cross in Dhaka, providing basic clinical care and teaching preliminary disaster management techniques to Bangladesh Red Crescent Society staff members. Even though it was one of the worst industrial disasters the country had faced, and resources were scarce, people from all social and economic backgrounds came together to volunteer and rescue as many people as physically possible from the rubble of the collapsed factories.
Global leaders must support Bangladesh during this transitional period to ensure political stability and sustained progress in the health sector. They should ensure diplomatic efforts for a peaceful transition of power and advocate for unfaltering international aid and investment. It is crucial to prevent the deterioration of the public health infrastructure in Bangladesh and take global action to support its health achievements. The time for enabling this nation to maintain and build upon its remarkable public health achievements is now.
Dr. Junaid Nabi is a public health researcher specializing in health-care reform and innovation. Previously a SAARC scholar in Bangladesh, he conducted research on global health and provided disaster management training in Dhaka. He is a senior fellow at the Aspen Institute and a Millennium Fellow at the Atlantic Council.
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