It’s heartening to witness — what appears to be a rather rare display of interagency cooperation — when nearly three dozen government ministries recently signed a joint declaration to tackle the rising burden of non-communicable diseases (NCDs) in Bangladesh.
Gracing the symbolic signing ceremony, the head of the transitional government, Prof Yunus, rightly pointed out that NCDs have become the most pressing issue in national health management, with their impact extending beyond the health sector to affect Bangladesh’s overall economy, social security, and sustainable development.
NCDs are long-term health conditions that are not passed from person to person. These include heart disease, cancer, diabetes, chronic respiratory diseases, and mental health disorders. With 69% of healthcare costs paid out of pocket in Bangladesh, thousands of families face severe financial hardship. NCDs are not just a medical challenge — they are a socioeconomic threat, straining the health system, increasing poverty, and jeopardizing national development.
There is no denying that the prevention and control of NCDs go beyond the mandate of the health ministry, requiring coordinated action across all sectors of government and society.
But a reality check would help us understand how much the health administration itself is doing its part — and that’s rather disheartening.
Our poor health budget, its negligible allocation to noncommunicable diseases, and the unenthusiastic approach of health agencies — none of these help much in effectively fighting the curse of NCDs.
Over the past year or so, the supply of many essential drugs prescribed for NCDs — including those used to control hypertension — to the grassroots level, from upazila health complexes to community clinics, has dried up due to the government’s failure to provide timely budget allocations. Hundreds of low-paid healthcare providers working in over 14,000 community clinics have gone unpaid for several months.
The state-run Essential Drugs Company Limited (EDCL) — which supplies medicines to several hundred NCD corners established in government hospitals and thousands of community clinics across the country — is literally running dry for lack of funds. In recent months, EDCL has written to the government’s health department requesting the necessary financial support.
Official statistics show that more than half a million people die each year in Bangladesh due to NCDs. These deaths account for 71% of all disease-related fatalities. In contrast, Bangladesh allocates only 5.3% of its national budget to health, and of that, barely 5% goes to NCDs. This hardly helps address the NCD-related death burden, given the scale of the crisis.
As Bangladesh’s health budget remains one of the lowest in South Asia, allocating only a tiny fraction of it to NCDs has failed to make a significant impact. In this context, providing budgetary support to grassroots health service providers and supplying basic medicines to patients at the community level are steps in the right direction.
However, the failure to sustain this budgetary support for millions across Bangladesh is proving costly — particularly in a country where citizens shoulder the majority of healthcare expenses while the government covers only a small share.
The government’s healthcare financing strategy for 2012–2032 explicitly targets tripling the health budget from the current 5% to 15% and reducing citizens’ out-of-pocket (OOP) healthcare expenditure from 64% to 32%.
Unfortunately, we are not on track to achieve these goals. In fact, OOP expenditure has risen from 64% to 69% — one of the highest rates in the world.
According to the latest available figures, nearly one in four adults in Bangladesh is hypertensive — often a precursor to heart disease, stroke, kidney failure, and loss of vision. More alarming is that many hypertensive individuals are unaware of their condition.
A report released this year by the World Health Organization states that half of Bangladesh’s hypertensive population (aged 30 to 79) do not know they have hypertension — highlighting the acute inadequacy of disease screening in the country.
The report adds that only 39% of patients with high blood pressure are receiving some form of treatment, and just 16% are able to keep their blood pressure under control.
Over a quarter of a million people in Bangladesh died of heart ailments in 2024, according to the WHO, and 52% of these deaths were triggered by hypertension. Only 17% of Bangladesh’s health facilities have arrangements for hypertension screening and related protocols, while 29% have some level of trained healthcare personnel.
The government needs to urgently revisit the overall health situation — particularly the rising number of NCD-related deaths — as a top priority. It must ensure that public health investments are aligned with its stated policies and long-term targets.
If the government cannot shift the burden of health expenditure from the public to the state, more people will continue to fall back into poverty under the weight of medical costs.
People in Bangladesh spend 44% of their total health expenditures on medicines alone. Ensuring the continued free provision of essential drugs to the rural and urban poor through upazila health complexes, community clinics, and NCD corners could ease the crushing burden of medicine costs.
Drawing from the 2022 Bangladesh Bureau of Statistics (BBS) household survey, the policy think tank Bangladesh Institute of Development Studies (BIDS) found that over six million people fell below the poverty line in the previous year due to high medicine costs.
Reaz Ahmad is Editor, Dhaka Tribune.
