In Bangladesh, falling sick often means facing a financial crisis. A recent report published by The Daily Star reveals that nearly 65 percent of healthcare needs remain unmet, while rising medical costs continue to push ordinary families deeper into hardship. For millions of ordinary citizens, especially those living in rural and marginalised communities, healthcare has become less a public service and more a personal finance battle. Families are selling their assets, taking on loans, or simply avoiding treatment because they cannot afford it.

Yet, amid this worsening situation, we often forget a fundamental truth: healthcare is not charity. It is a constitutional responsibility of the state and a basic right for citizens. A democratic state cannot distance itself from the responsibility of ensuring accessible, affordable, and equitable healthcare for all. Unfortunately, the current trajectory of Bangladesh’s health system suggests that this obligation is frequently treated as secondary.

Bangladesh has made undeniable progress in several health indicators over the decades. Maternal mortality has declined, immunisation coverage has improved, and life expectancy has increased. But beneath these successes lies a structural weakness that receives far less attention.

The country’s healthcare system remains heavily dependent on direct payments from citizens. According to various public health studies, Bangladesh has one of the highest rates of out-of-pocket healthcare expenditure in South Asia. This means that people pay from their own pockets at the time of illness instead of receiving protection through a strong public system or health insurance mechanism.

A poor family may survive poverty for years, but a single hospital stay can push them into long-term financial hardship. In remote regions, the burden becomes even more painful. Patients often travel long distances, lose working days, pay transportation costs, and still struggle to receive quality care after reaching a facility. In many public hospitals, shortages of medicines, diagnostic services, trained personnel, and patient-friendly management continue to frustrate citizens. As a result, many people turn to expensive private healthcare providers, even when they cannot afford them.

A central issue is our narrow understanding of what “health sector development” means. Many policymakers and even elected representatives tend to equate progress with visible infrastructure: constructing new hospitals, increasing the number of beds, or recruiting more doctors and nurses. While these are certainly necessary, they are not sufficient. A healthcare system must be evaluated by whether ordinary people can access timely, affordable, and quality care without suffering financially.

The reality is that Bangladesh’s healthcare challenges are deeply systemic. Building more hospitals without improving governance, accountability, referral systems, primary healthcare, and financial protection mechanisms will not solve the crisis. In many cases, new infrastructure is added without addressing the inefficiencies already embedded in the system. Patients continue to wait for hours, face informal costs, and struggle to navigate fragmented services. Rural healthcare facilities often remain understaffed or under-equipped despite ambitious policy announcements.

Another concern is the absence of meaningful public discussion on healthcare reform at the national level. In parliament and public discourse, many critical health issues receive limited attention compared to political theatrics or short-term controversies. Healthcare should not become an occasional discussion during outbreaks or emergencies; it should remain at the centre of national development planning.

Bangladesh already has a growing body of public health researchers, academics, and practitioners who are producing valuable, evidence-based recommendations. Unfortunately, policy decisions do not always reflect these findings. Research on healthcare financing, community-based care, digital health systems, workforce distribution, and universal health coverage should play a far greater role in shaping national reforms. Public health expertise must move beyond conference rooms and become part of practical policymaking.

There is also much to learn from neighbouring countries. Several South Asian nations, despite having comparable economic constraints, have expanded community health protection schemes, decentralised primary healthcare, and strengthened public financing mechanisms. Bangladesh does not need to copy such schemes, but it must study successful regional models and adapt them to local realities.

Most importantly, a shift in mindset is necessary for true reform. Citizens should not feel abandoned during illness. Access to treatment should not depend on geography, political connections, or financial capacity. A mother should not fear hospital costs more than her child’s disease. A day labourer should not have to choose between buying medicine and feeding his family.

Bangladesh has demonstrated its ability to achieve remarkable social progress when political commitment aligns with public need. The same urgency is now required for improving healthcare. What Bangladesh needs is a people-centred health system grounded in equity, accountability, and financial protection. In a democratic society, health is not a privilege for the fortunate few. It is a right that must be protected with seriousness, humanity, and long-term vision.