Bangladesh health sector faces collapse

By Tajul Islam

When Bangladesh’s students took to the streets last year, their demands were clear: dismantle the structures of fascism, restore democracy, and build a government that put the people before politics. Their movement culminated in a historic moment on August 8, when Nobel laureate and Grameen Bank founder Dr. Muhammad Yunus was sworn in as Chief Advisor to the interim government. The appointment followed the dramatic departure of former Prime Minister Sheikh Hasina to India on August 5 under army supervision, a move that signalled the end of her political era. The army chief, General Waqar-uz-Zaman, assured the public that this transition would serve the nation’s best interests.

However, one year later, optimism has given way to disappointment. The interim government, hailed as a product of the people’s movement, now stands accused of the very sins it pledged to eradicate-chief among them nepotism and cronyism. Nowhere is this more visible, or more damaging, than in the health sector, which teeters on the brink of collapse.

The root of the crisis lies in the appointment of Nurjahan Begum as Health Advisor. While she has been a long-time associate of Dr. Yunus, serving at Grameen Bank since its early days in 1976 and later becoming chairman in 2010, she has no academic background, professional training, or policy experience in health or medical administration. Her appointment appears to have been based solely on loyalty and personal history rather than merit or competence.

From the moment she assumed her role, critical decision-making slowed to a crawl. Experts say this lack of leadership has directly stalled progress in strategic planning, infrastructure development, disease prevention, and healthcare management. The situation has reached a breaking point with the unprecedented 18-month delay in approving the Operational Plan (OP) – the backbone of Bangladesh’s health service delivery.

Bangladesh’s health sector operates on rolling five-year strategies under the Health, Population and Nutrition Sector Programs (HPNSP). After the fourth programs ended, preparations for the fifth were underway, involving over a hundred Project Evaluation Committee (PEC) meetings. Yet, despite the groundwork, 38 operational plans remain unapproved-23 for the Health Services Department and 15 for the Health Education and Family Welfare Department.

This failure has brought crucial national health targets to a standstill. Efforts to expand healthcare access, lower maternal and child mortality rates, strengthen family planning services, and improve public health awareness have all stalled. The consequences are immediate and severe: over 25,000 health workers face the loss of their jobs, and many essential services have been either scaled back or shut down altogether.

The ripple effects are being felt across the country’s primary healthcare system. Payments have been halted for 3,855 paid peer volunteers, 1,086 Ansar members, and 350 OP employees under the Department of Family Planning for the past 18 months. The disruption has paralyzed key functions – from maternal and child care to vaccination drives, disease surveillance, and hospital management.

At the community level, shortages of birth control kits and essential medicines have left thousands without access to basic services. In a move that baffled health experts, the Ministry of Health and Family Welfare recently scrapped the existing operational plan in favour of a new two-year project. Officials warn that such a project is unworkable in the short term and will only deepen the crisis. Public health professionals have already sounded the alarm that this policy misstep could derail Bangladesh’s commitments to the Sustainable Development Goals (SDGs).

The issue is no longer confined to professional circles. In July, Hasnat Abdullah, the southern organizer of the pro-government National Citizen Party (NCP), openly called for Nurjahan Begum’s resignation, questioning her qualifications and capacity to manage the nation’s health system. Despite these public appeals, the interim government has taken no corrective action, further fuelling suspicions that personal loyalty is valued above competence.

The Health Advisor’s perceived indifference became a national talking point following one of the country’s most heartbreaking tragedies. On July 21, a Bangladesh Air Force F-7 training jet crashed into Milestone School and College in Diyabari, Uttara, claiming the lives of students and injuring many others. While the nation grieved, Nurjahan Begum was reportedly focused on her own health issues and did not visit the scene. For many, this absence symbolized the government’s detachment from the realities facing ordinary citizens.

If the current trajectory continues, the damage to the health sector could be irreversible. Primary healthcare delivery, disease control programs, hospital administration, medical education, vaccination efforts, family planning initiatives, and public health campaigns are all at risk of grinding to a halt. Infrastructure projects could be abandoned mid-construction, and trained medical personnel may leave the sector entirely due to non-payment and lack of institutional support.

The public health crisis could spill over into economic and social instability. Poor health outcomes reduce workforce productivity, increase healthcare costs, and strain families already battling inflation and unemployment. Moreover, prolonged disruption risks undoing decades of progress in maternal and child health, immunization coverage, and communicable disease control.

Bangladesh stands at a crossroads. The interim government was meant to serve as a bridge toward stability, reform, and good governance. Instead, it has allowed nepotism to undermine its credibility and paralyze essential public services. Replacing unqualified political appointees with competent, experienced professionals in the health sector is no longer a matter of political preference – it is a national necessity.

Failure to act will not only erode public trust but also jeopardize the health of future generations. The people who once rallied to dismantle authoritarianism did not risk their lives and livelihoods to watch their healthcare system collapse under the weight of favouritism. For the sake of Bangladesh’s health, economy, and social stability, urgent reforms are needed – and they must begin with ending the culture of nepotism that has brought the nation’s health sector to the brink.