The recent deaths of six children at Ad-Din Hospital, reportedly linked to oxygen-related deficiencies and failures in maintaining minimum healthcare standards, have once again exposed critical weaknesses within Bangladesh’s health system. The public response has been swift and emotional, and rightly so. Citizens expect hospitals entrusted with the lives of vulnerable patients to comply with the highest standards of safety and quality. The government’s decision to initiate action against hospitals found to have violated established standards has therefore been welcomed by many. No healthcare institution, irrespective of its reputation or ownership, should be exempt from scrutiny where preventable deaths occur.
However, the tragedy at Ad-Din Hospital also raises a broader question: should accountability stop at the level of individual healthcare institutions, or should it extend to the wider health system and those responsible for its governance? This question becomes even more pressing when viewed against another recent national tragedy: the deaths of more than 650 children during the measles outbreak. While the immediate causes differed, both events point to the same underlying concern – whether Bangladesh possesses sufficiently robust systems of health oversight, preparedness, quality assurance, and accountability. Health audit is not about blame. It is about protection.
In many developed countries, independent accreditation and quality assurance mechanisms play a crucial role in ensuring patient safety. Hospitals undergo periodic external reviews, emergency preparedness protocols are tested, equipment maintenance systems are audited, and patient safety indicators are continuously monitored. The purpose is simple: to identify weaknesses before they result in preventable deaths. Bangladesh currently lacks a strong, independent, and credible national health audit system with sufficient authority and institutional autonomy. Existing inspection arrangements often suffer from resource limitations, inadequate follow-up mechanisms, and occasional political influence. Consequently, failures are frequently identified only after tragedy strikes.
The deaths at Ad-Din Hospital illustrate why this model is inadequate. If oxygen systems, staffing arrangements, emergency response protocols, and equipment maintenance had been subjected to rigorous independent audits, deficiencies might have been identified earlier. Similarly, the measles outbreak raises broader public health audit questions. Were vaccine stocks sufficient? Were surveillance systems functioning effectively? Were immunisation coverage gaps being monitored adequately? Were warning signals acted upon promptly? These are not merely technical questions; they are governance questions.
Political and administrative responsibility does not necessarily imply personal wrongdoing. Rather, it reflects the obligation of leaders to ensure that systems under their authority function effectively. In democratic societies, such responsibility extends to ministers, advisers, senior bureaucrats, programme managers, and institutional leaders.
The administration led by Dr. Muhammad Yunus assumed responsibility for governing the country during a period of extraordinary transition. Any fair assessment must acknowledge the challenges involved. However, continuity in essential health services remains non-negotiable. Children cannot postpone vaccination because of political transitions. At the same time, accountability must not become selective.
If hospital administrators can be investigated and sanctioned for violations of healthcare standards, then significant public health failures must also be subject to independent review. Public confidence depends upon the consistent application of standards, regardless of institutional position. The objective should not be political retaliation, but institutional learning, transparency, reform, and prevention.
Bangladesh should therefore consider establishing an Independent National Health Audit and Accreditation Commission through legislation. Such an institution should function autonomously and report regularly to Parliament and the public. Its mandate should include regular audits of public and private hospitals, investigations into major adverse events, evaluations of emergency preparedness systems, assessments of patient safety practices, and reviews of national public health programmes. Importantly, audit findings should not simply be archived.
Institutions found to have violated minimum safety standards should face meaningful consequences. These may include corrective action plans, financial penalties, suspension of specific services, withdrawal of licences in severe cases, and referral for legal proceedings where negligence is established. Accountability without enforcement lacks credibility.
Yet Bangladesh need not develop such systems entirely on its own. The country should actively invite internationally recognised health audit and accreditation organisations to operate within Bangladesh. Institutions from countries such as Canada, Australia, the United Kingdom, and Singapore possess extensive expertise in healthcare quality assurance and patient safety. Partnerships with these organisations could accelerate capacity development, introduce internationally accepted standards, and strengthen public confidence in the health system. Canada, in particular, offers valuable lessons. Independent accreditation bodies have contributed significantly to improving healthcare quality and fostering a culture of continuous improvement. Bangladesh could adapt similar models to its own context.
Such initiatives should also be viewed as economic opportunities. The healthcare sector represents an increasingly important area for foreign direct investment (FDI). International investors seek stable regulatory environments characterised by transparency, predictability, and credible quality assurance mechanisms. A robust health audit framework would signal that Bangladesh is serious about healthcare excellence. International hospital chains, specialised medical centres, diagnostic service providers, and healthcare technology companies may become more willing to invest where internationally recognised accreditation systems exist.
Improved standards could also enhance Bangladesh’s potential as a destination for regional medical services. Thousands of Bangladeshis seek treatment abroad each year, resulting in substantial outflows of foreign exchange. Strengthening domestic healthcare quality could help retain some of these expenditures while attracting patients from neighbouring countries. Most importantly, stronger audit systems would save lives. They would help identify faulty oxygen systems before children die, expose gaps in immunisation programmes before vaccine-preventable diseases spread widely, and strengthen preparedness before emergencies escalate into crises. The recent tragedies should therefore serve as catalysts for transformative reform.
Bangladesh has previously demonstrated remarkable success in public health. Immunisation programmes, reductions in maternal and child mortality, and community-based healthcare initiatives have earned international recognition. Precisely because Bangladesh possesses such capabilities, complacency is unacceptable. The lives lost at Ad-Din Hospital demand accountability. The hundreds of children lost during the measles outbreak deserve independent examination. The families affected deserve answers, and the nation deserves reforms that reduce the likelihood of recurrence.
Ultimately, the purpose of accountability is not punishment alone. Accountability also serves a preventive function. It creates incentives for compliance, encourages vigilance, promotes transparency, and strengthens public trust. A health system without accountability risks normalising preventable harm. Conversely, a system grounded in independent audit, evidence-based decision-making, and consistent enforcement becomes safer, stronger, and more resilient.
One path leads towards selective responses triggered by public outrage following tragedy. The other leads towards institutionalised accountability through independent health audits, international partnerships, effective regulation, and meaningful consequences for violations of established standards. The second path is undoubtedly more demanding. It requires political courage, investment, and leaders willing to submit institutions under their authority to independent scrutiny. Yet it is also the path most likely to protect future generations.
The establishment of an independent health audit system, strengthened by international collaboration and supported by strategic foreign investment, may well become one of the most important health reforms of our time. The nation cannot bring back the children it has lost. But it can honour their memory by ensuring that future tragedies are prevented through vigilance, accountability, and the unwavering pursuit of safer healthcare for all.
The writer is the Former Ambassador and Secretary to the Government of Bangladesh, and Former Senior Public Health Policy Adviser and WHO Representative to UN ESCAP
