A reform long overdue

The government’s decision to transfer urban primary healthcare services in 12 city corporations and 23 municipalities from the Local Government Division (LGD) to the Directorate General of Health Services (DGHS), along with its plan to establish 170 new urban health centres in Dhaka and Chattogram, marks a turning point for the country’s health sector. For decades, urban primary healthcare has remained fragmented, poorly coordinated, and inadequately integrated into the broader public health system. If implemented properly, these initiatives could help address some of the structural weaknesses that have long plagued healthcare in urban areas.

As health experts have pointed out, inefficient governance has long been one of the biggest weaknesses of urban healthcare delivery. While the health ministry oversees primary healthcare nationwide, urban services have remained under the LGD since the launch of the Urban Primary Healthcare Services Delivery Project (UPHCSDP) in 1998. This dual structure has often led to inadequate coordination, overlapping responsibilities, accountability gaps, and uneven service quality. As a result, urban primary healthcare services still remain inaccessible for many, particularly low-income populations who are often forced to rely on overcrowded secondary and tertiary hospitals even for basic treatment. The government’s stated goal of reducing dependency on higher-level hospitals through stronger urban primary care is therefore very important. Its plan to establish at least one urban primary health and nutrition centre in every ward of Dhaka North, Dhaka South, and Chattogram city corporations could significantly improve access to healthcare for urban residents. Gradually, similar initiatives should be expanded to other urban areas as well.

Unfortunately, our health sector is already struggling with shortages of doctors, nurses, and technical staff, particularly at the primary care level. Without adequate staffing and operational preparedness, transferring the 192 facilities to the DGHS risks creating further disruption if not handled properly. The transition will require careful planning regarding manpower, financing, infrastructure maintenance, procurement systems, and service continuity.

The government must ensure that there is no disruption in services during the handover process. It must also ensure transparency, accountability, proper oversight, and efficient resource utilisation throughout the transition. Above all, the reforms must remain focused on the needs of urban residents who continue to face barriers to accessing affordable and quality primary healthcare. As the country’s urban population is expected to exceed 10 crore by 2050, with Dhaka alone projected to reach nearly three crore residents by 2030, the government can no longer delay prioritising urban healthcare.