Bangladesh’s health sector stands at an important crossroads. On the one hand, we face the challenge of ensuring quality, accessible and affordable healthcare for a large population; on the other, we must make the best use of limited resources, improve management efficiency, strengthen transparency and accountability, and build the capacity to respond effectively to future pandemics and emerging infectious diseases.
Many of these challenges cannot be addressed simply by building more hospitals, recruiting more doctors or purchasing additional medical equipment.
An effective health system requires us to know where patients are, where health professionals are available, where medicines and hospital beds are located, where disease outbreaks are emerging, how public resources are being spent, and what services people are receiving in return.
In other words, reliable and real-time information is one of the foundations of a modern health system.
With this objective, the Government plans to develop an integrated National Electronic Health System. This is not simply about digitising healthcare; it represents a fundamental reform in health service management, governance and accountability.
The proposed system will have two major components. The first will be a central electronic architecture, or the ‘Brain’, which will serve as the digital backbone of the entire health system. Information from different services, institutions, health professionals and citizens will be securely and systematically connected through this architecture.
The second component will consist of digital platforms directly linked to healthcare delivery.
These will progressively include an Electronic Health Card for every citizen; Electronic Health Records containing relevant medical and health information; an Electronic Referral System connecting different levels of care; a Pharmacy Portal for medicine management; a Laboratory Portal for diagnostic and test information; an Administration Portal for hospitals and other health facilities; and an Ambulance and Emergency Service Platform for coordinating emergency transport and care. Other essential health services will gradually be incorporated into this integrated digital ecosystem according to need and priority.
As a result, wherever a citizen seeks public healthcare in Bangladesh, an authorised healthcare provider will be able to access the relevant health information when needed. Patients will no longer have to repeatedly recount their medical history, unnecessary duplication of diagnostic tests can be reduced, and referrals can become more effective.
At the heart of the proposed electronic health system will be an Electronic Health Card for every citizen, serving as a ‘Mother Card’ for healthcare. The card will be generated through secure and lawful linkages with existing government databases, including the National ID and birth registration systems. This will avoid repeated collection of the same basic information and establish a unique health identity for every citizen.
Beginning at birth, essential information related to vaccination, maternal and child healthcare, diagnosis, laboratory investigations, prescriptions, hospitalisation, referrals and long-term disease management can progressively be linked to this unique health identity. Authorised healthcare providers will therefore be able to securely access relevant information whenever a citizen seeks care.
With health information covering approximately 180–200 million people, this system has the potential to become one of the largest and most important national data infrastructures in Bangladesh.
One of the major weaknesses of Bangladesh’s health system is the absence of an effective referral mechanism. Patients frequently bypass primary healthcare and go directly to district hospitals, medical college hospitals or specialised facilities, creating unnecessary pressure on higher-level institutions.
At the same time, patients often have to carry medical documents and test results from one facility to another, repeat investigations, and experience disruptions in continuity of care.
The proposed Electronic Referral System can fundamentally change this situation. The guiding principle will be: “Patients will not have to carry their information; the necessary information will travel securely with them.” When a patient is referred, relevant health information, diagnostic results and the reason for referral will be transmitted digitally to the receiving facility. The system will also help determine where the required specialist, hospital bed or treatment is available so that patients can be directed to the right facility.
Following treatment at a higher-level facility, relevant information will return electronically to the local health facility, allowing follow-up and long-term care to continue closer to the patient’s home. This will create an effective connection between primary, secondary and specialised healthcare – helping ensure that patients receive the right care, at the right facility, at the right time.
COVID-19 taught us an important lesson: one of the most valuable assets in responding to an epidemic is accurate information at the right time. The earlier we can identify where an infectious disease is emerging, how rapidly it is spreading and which populations are being affected, the faster we can respond to reduce transmission and deaths. This capacity is equally important for dengue, measles, Nipah, influenza and future emerging or re-emerging infectious diseases.
The proposed electronic health system will connect information from hospitals, laboratories, pharmacies and other healthcare institutions through integrated digital architecture. An unusual increase in fever, respiratory infections, deaths or specific diseases in a particular area could therefore be detected rapidly and generate an early warning signal. The same system can support disease monitoring, identification of high-risk areas and rapid deployment of health workers, medicines, vaccines and other essential resources.
The electronic health system will therefore be much more than a platform for storing individual medical information. It will become an important national infrastructure for disease surveillance, pandemic preparedness and health security.
Questions have long been raised about waste of financial and other resources in the health sector, weaknesses in the management of medicines and medical equipment, unusual price variations in procurement, and inconsistencies in inventory and distribution. Technology alone cannot eliminate corruption, but an integrated and transparent digital system can significantly reduce opportunities for irregularities, waste and corruption.
If digital records show how much medicine and equipment was supplied to each hospital, how much was used and how much remains in stock; how many tests were conducted in each laboratory; where and for what purpose an ambulance was used; and what services each facility provided to its patients, the use of public resources will become much easier to track and verify. Irregularities in procurement, supply, inventory, utilisation and service delivery can also be identified more quickly, strengthening both audit and oversight.
The proposed digital health system will therefore not only improve the efficiency of service delivery; it can become a powerful instrument for reducing waste and irregularities and strengthening transparency, good governance and accountability.
Bangladesh is not starting its digital health journey from zero. The Directorate General of Health Services, Directorate General of Family Planning, Directorate General of Nursing and Midwifery and other health-sector institutions already operate a number of information systems. The objective is not to discard these systems indiscriminately and impose an entirely new structure. Instead, existing systems will be carefully reviewed for their technical capacity, functionality, security and usability.
Systems that are effective, secure and capable of being integrated with the new national digital architecture will be strengthened and connected to it. Unnecessary duplication will be rationalised, while new digital solutions will be developed where important gaps remain.
The core digital infrastructure – the “Brain” of the National Electronic Health System—will be an asset of the Government of Bangladesh, and its intellectual property rights will remain with the Government. Rather than becoming permanently dependent on a foreign company or private technology provider, a dedicated team of Bangladeshi software engineers will be responsible for building, improving, securing and maintaining the system.
Strategic stewardship at the national level will be linked to the Prime Minister’s Office, while the Ministry of Health and Family Welfare and its directorates will play the central role in defining health-sector requirements and in the use and operational implementation of the system.
A database containing the health information of approximately 180–200 million people will be one of Bangladesh’s largest and most sensitive national information assets. Privacy and data security, role-based access, encryption, traceable records of data use, regular security assessments, disaster recovery and strong data-governance arrangements must therefore be built into the architecture from the outset. Clear rules and accountability mechanisms must determine who can access citizens’ health information, when, for what purpose and to what extent.
Alongside technological capability, the security of citizens’ information, national data sovereignty and public trust must remain fundamental principles of the system.
A national system of this scale and complexity cannot realistically be introduced across the entire country at once. Our approach will therefore be to build first, test on a limited scale, learn from experience and then expand progressively.
A project currently going through the approval process, financed jointly by the Government of Bangladesh and the Asian Development Bank, is planned to provide the principal initial financing for this initiative. In the first phase, the national digital health architecture and associated service platforms will be piloted in Bogura, Sirajganj, Narsingdi, Jhalakathi, Noakhali and Khulna.
These six districts will serve as testing and learning grounds. We will assess not only whether the technology works, but also whether it is practical for doctors, nurses and other health workers; whether patients benefit; whether referrals become more effective; whether data quality and accuracy improve; and whether managers can make faster, evidence-based decisions. Lessons from the pilot and an independent assessment will guide necessary adjustments before the system is progressively scaled up nationwide.
Another central objective of this initiative is to develop Bangladesh’s own technological, public health and digital health capacity. Bangladesh has highly capable software engineers, data scientists, physicians, public health specialists and digital health professionals. At the same time, many Bangladeshi technology and health professionals are working at senior levels around the world.
We want to create a national platform where Bangladeshi talent at home and across the diaspora can work together for Bangladesh, while building the skills and institutional capacity needed within the country for the long term.
Our intention is not to purchase an off-the-shelf system developed by a foreign company and simply install it in Bangladesh. The system should be custom-built for Bangladesh, reflecting the needs of our people, the realities of our health system and our vision for its future. Keeping the architecture, technological knowledge and intellectual property within the country will reduce long-term dependence on foreign technology, strengthen data sovereignty and security, and build our own capacity to operate and continuously improve the system.
This vision is captured in our national commitment:
“Made in Bangladesh, Made for Bangladesh, Made by Bangladeshis.”
This is more than a slogan. It represents our commitment to technological self-reliance, national capacity and building a modern Bangladesh through the talent of our own people.
The purpose of a digital health system is not to create more software. Its fundamental purpose is to provide better, faster and more accessible healthcare to people. Wherever citizens go in Bangladesh, their relevant health information should be securely available; doctors should be able to access essential medical histories quickly; patients should be referred to the right facility; unusual disease patterns should be detected early; and policymakers should be able to make decisions based on reliable information rather than assumptions.
Our goal is therefore not simply to build an Electronic Health System. It is to build a health system in which continuity of care is ensured for every citizen, every service is traceable, the use of every resource can be verified, and accountability is strengthened at every level.
Such a system can improve quality and efficiency, reduce opportunities for waste and corruption, and strengthen Bangladesh’s preparedness for future epidemics and health emergencies. The technology will belong to Bangladesh, the security and control of the data will remain in Bangladeshi hands, and the capacity to sustain it will be built through our own talent.
“Made in Bangladesh. Made for Bangladesh. Made by Bangladeshis.”
The author is Special Assistant to the Prime Minister on Health Affairs (with the rank of State Minister) and Adviser to the Chairperson of the Bangladesh Nationalist Party (BNP).
