Primary Health Care (PHC) System Capacity In Bangladesh

 

Primary Health Care is recognized as the foundation of a resilient health system, yet Bangladesh’ PHC continues to face challenges including fragmented service delivery, weak referral systems, underfunded budgets, and shortages of trained health workers. A study was conducted to provide a comprehensive overview of Bangladesh’s Primary Health Care (PHC) system, as part of a regional evidence-gathering initiative of the WHO’s Asia Pacific Observatory on Health Systems and Policies (APO). Besides PHC system capacity, the study also aimed to identify gaps and opportunities, and inform future regional and sub-regional policy and practice. 

The study employed a mixed-methods approach, combining a rapid review of national policies, strategies, guidelines, program reports, and peer-reviewed literature with semi-structured interviews of national experts, government officials, and PHC implementers. Data were triangulated across sources using a standardized domain framework, and ethical approval was obtained from BRAC University’s Institutional Review Board.

Findings reveal that governance of PHC in Bangladesh is anchored in the National Health Policy (2011) and operationalized through the Essential Service Package (ESP, 2016). However, governance remains fragmented across sector programs, with limited integration of pandemic preparedness and climate resilience. Referral coordination is inconsistent, and quality assurance mechanisms, though supported by national policies, are unevenly enforced, particularly in the private sector.

Human resources for health remain a critical bottleneck. Physician vacancies at union and upazila levels range from 40 to 58 percent, with complete vacancies in Family Welfare Visitor posts. Annual outputs of medical graduates, nurses, and midwives are substantial, yet distribution is uneven, and retention in rural areas remains weak despite incentive schemes. Community Health Workers play a vital role, with approximately 12,000 in the public sector, and 80,000 employed by NGOs, but their integration into formal workforce planning is limited.

Quality of care is guided by national standards and strategic plans, but enforcement is stronger in public facilities than in private ones. Supervision is irregular, accreditation mechanisms are absent, and clinical audits are rarely conducted at the PHC level. Indicators are tracked for maternal, child health, and selected non-communicable diseases, but gaps remain in geriatric and palliative care. Patient empowerment mechanisms exist, notably through the Disability Rights and Protection Act (2013) and targeted strategies for marginalized urban populations, yet implementation is uneven and limited in scope.

In conclusion, Bangladesh’s PHC system demonstrates strong policy foundations and significant workforce investments but continues to face persistent challenges in governance, workforce distribution, quality enforcement, and patient empowerment. To address these, the report recommends the development of a unified national PHC strategy that integrates pandemic preparedness and climate resilience, strengthened workforce planning and retention measures, establishment of a national accreditation and audit system, expansion of quality monitoring to private providers, and enhanced patient empowerment mechanisms with stronger community participation and equity safeguards.