Despite progress in primary health care (PHC) since the Alma Ata Declaration in 1978, challenges to the provision
of primary health care in Bangladesh still remain. Although the Government takes lead responsibility for national policy, planning and decision making for all health care and is – through the Ministry of Health and Family Welfare (MoHFW) – the major health service provider, a PHC structure is still non-existent in urban areas. The health system is pluralistic and weak in terms of cross-sectoral operation. Government PHC services are administered in rural areas through the ‘Upazila health complex’, which consists of three tiers: at sub-district level (the Upazila level), the union level, and the ward or community level. These three lower tiers of the health system are intended to reach Bangladesh’s estimated 105 million people living in rural areas, and provide an upward referral system towards more specialised treatment.
Every Upazila complex is required to provide the same suite of services, with their budget allocation based on patient bed numbers in their health facilities, rather than local needs at the community level, including usage and geographical particularities. In reality, there
are uncertainties about how functional community clinics actually are in offering these services, particularly in light of limited staffing and expertise, drug availability, and significant evidence of low usage.