Achieving the Promise: Universal Access to Palliative Care in Bangladesh

— Challenges, Conversations, and Community-Based Pathways

As the global community prepares to observe World Hospice and Palliative Care Day (WHPCD) 2025 under the banner “Achieving the Promise: Universal Access to Palliative Care,” this article reflects on the promise within Bangladesh’s context. It explores the realities of palliative care in the country—highlighting gaps and challenges, while spotlighting grassroots innovations that are shaping a more compassionate future.

The transformative power of community engagement, culturally sensitive dialogue, and inclusive policy-making—especially for underserved groups such as the terminally ill, socioeconomically marginalized populations, and non-citizens—are critical to achieving this goal.

Misconceptions, lack of primary care integration, and inequitable access remain major hurdles. Yet, community-based models show that people-centered change is possible. A decade after the 2014 World Health Assembly resolution urged member states to integrate palliative care across the life course, Bangladesh now faces a critical opportunity. To fulfill WHPCD 2025’s call, the country must take bold, collective steps—ensuring dignity, relief from suffering, and holistic support for every individual, regardless of background.

Rethinking Palliative Care in Bangladesh
Beyond Cancer, Beyond Hospitals — Advancing Compassionate, Community-Rooted Care

Palliative care in Bangladesh is still narrowly associated with terminal cancer patients and hospital-based treatment. This limited perception undermines the broader essence of palliative care—a holistic, person-centered model supporting those with life-limiting conditions like heart, kidney, liver failure, or progressive neurological diseases.

Efforts by institutions such as Bangladesh Medical University (Ex.BSMMU) and community-driven projects like Compassionate Korail & Compassionate Narayanganj are challenging these misconceptions. They demonstrate that with training, policy support, and grassroots leadership, palliative services can be effectively provided at the community level—where people live and age.

More than medical relief, palliative care embraces emotional, psychological, social, and spiritual needs. It supports patients and families through uncertainty and transition. It’s not about surrender—it’s about dignity, comfort, and connection. By recognizing palliative care as a compassionate, rights-based approach to health, Bangladesh can lead with empathy, extending support across the full trajectory of illness—not just its final stages.

Creating Space for Conversations That Matter
Breaking the Silence around Death, Dignity, and Choices in Bangladesh

A key but overlooked barrier in Bangladesh is the cultural reluctance to discuss death, suffering, and personal values. In a family-centered society, meaningful conversations about dignity, comfort, and care choices are often delayed until emergencies arise. This silence is rooted in deep emotional, religious, and cultural fears. Many believe talking about death invites it; caregivers fear truth-telling may extinguish hope. As a result, people often die without expressing where they want to die, whether they seek spiritual guidance, or if they prefer to avoid aggressive interventions.

Now, trained community health workers and palliative care assistants are changing this. With compassionate communication tools, they initiate important dialogues early—asking questions like, “What are you afraid of?” or “How do you want to be remembered?” These conversations empower patients, guide families, and shift care toward values and meaning. In a culture shaped by religious traditions and storytelling, community-led models that integrate local wisdom and rituals hold powerful potential. Talking about death doesn’t end hope—it restores control and connection.

 

Local Support Services – and How to Access Them as a Non-Citizen
Bridging Gaps in Palliative Care for Refugees, Migrants, and the Stateless in Bangladesh

Despite the steady growth of palliative care in Bangladesh, non-citizens—including refugees, undocumented migrants, expatriates, and stateless populations—continue to face widespread exclusion. These groups remain especially vulnerable due to their limited visibility in national health planning. The Palliative Care Centre at Bangladesh Medical University (Ex. BSMMU) in Dhaka offers outpatient and limited home-based services, occasionally extending care to non-citizens through collaborations with NGOs. Similarly, Hospice Bangladesh provides home-based support and has cared for international patients in need. Moner Bondhu, a mental health organization, offers multilingual counseling and psychosocial support, including for displaced communities.

In the refugee camps of Cox’s Bazar, Médecins Sans Frontières (MSF) and the Fasiuddin Khan Research Foundation (FKRF)—often in coordination with the International Organization for Migration (IOM)—provide critical palliative and primary care to the Rohingya population, delivering both facility-based and community-level services tailored to displaced individuals’ needs. However, numerous barriers persist: many are denied hospital access due to lack of documentation; essential pain relief, such as morphine, remains inaccessible; and language barriers hinder communication and continuity of care. Even humanitarian providers often remain unaware of the full scope of available services.

Amid these challenges, AYAT Education is actively engaged in palliative care initiatives, working not only to raise public awareness but also to advocate for the development of inclusive palliative care policies, guidelines, and media engagement at both local and national levels. Bridging the care gap for non-citizens will require Bangladesh to invest in multilingual service directories, mobile outreach programs for migrant communities, and culturally sensitive models of care. Ultimately, palliative care must transcend citizenship—it is a universal human right rooted in dignity, compassion, and the shared value of care for all.

The Importance of Advance Care Planning

Empowering individuals to make choices before crisis strikes

Advance Care Planning (ACP) remains largely unfamiliar in Bangladesh, where no formal legal framework exists for living wills or surrogate decision-makers. As a result, critical end-of-life decisions are frequently made during moments of crisis, often leading to unwanted medical interventions and family conflicts. A systematic review titled “Advance Care Planning in Low- and Middle-Income Countries: A Systematic Review” highlights common barriers across similar contexts, including cultural reluctance to discuss death, lack of provider training, and absence of supportive policies.

The study emphasizes that effective ACP implementation requires not only legal and policy support but also community engagement and healthcare workforce capacity building. Introducing ACP through clinical practice and community health initiatives in Bangladesh can empower patients to express their preferences early, avoid treatments that do not align with their values, and preserve dignity. To achieve this, Bangladesh must prioritize developing supportive policy frameworks, training healthcare providers in compassionate communication, and raising public awareness—encouraging open conversations about future care choices and what matters most to individuals.

 

Breaking Down Myths and Misconceptions about Palliative Care
Challenging stigma and reshaping perceptions to make compassionate care accessible for all in Bangladesh

Widespread misconceptions remain a major obstacle in Bangladesh. Many see palliative care as a “last resort” or “giving up,” delaying referrals and hindering acceptance. Even among doctors, studies like the 2020 PaCKs survey reveal misunderstandings—associating palliative care only with terminal cancer. These false beliefs prevent timely access to care that can greatly improve quality of life. Nationwide education campaigns—for both the public and professionals—are essential. By reframing palliative care as life-affirming and proactive, Bangladesh can normalize it as essential, not exceptional.

 

Realizing the Promise in Bangladesh

Advancing Compassionate, Inclusive, and Rights-Based Palliative Care for All

Bangladesh has made promising strides in community-based palliative care, with grassroots initiatives proving that home-based, compassionate care is both feasible and impactful. However, recent findings underscore the urgent and unmet needs that still persist, particularly among low-income populations.

The study titled “Palliative care needs and quality of life among adults with advanced chronic illnesses in low-income communities of Bangladesh” reveals that 10.3% of surveyed patients—primarily those with cancer (87%) and chronic kidney disease (53.3%)—were identified as needing palliative care. These individuals reported high levels of suffering, with nearly half experiencing family anxiety (48.6%), severe worry about illness (22.4%), severe pain (15.5%), and even existential distress, such as feelings of life being unworthy (9.4%). Patients with poor functional status (ECOG 3–4) were significantly more likely (58%) to require palliative support compared to those with better performance levels (24%), and among those in need, a staggering 70.1% rated their quality of life as poor or very poor—contrasted with 23.8% among those not requiring palliative care. These statistics highlight the systemic gaps that continue to undermine equitable access to palliative care in Bangladesh, including the absence of a national policy framework, a shortage of trained professionals, limited opioid availability, and persistent stigma within both public perception and clinical practice. Additional barriers, such as weak referral systems, urban-centric services, and poor integration into primary healthcare, further marginalize rural and vulnerable communities.

To fulfill the vision of World Hospice and Palliative Care Day (WHPCD) 2025 and achieve universal access, Bangladesh must recognize palliative care as a basic human right. This requires a multi-pronged approach: fostering early, values-based communication between patients and caregivers; ensuring care is inclusive, community-driven, and reaches underserved populations including the rural poor and non-citizens; integrating Advance Care Planning (ACP) into national health policy and practice; and confronting stigma through continuous education and awareness. Realizing the promise of palliative care is not merely a public health objective—it is a profound moral imperative. As Bangladesh moves toward WHPCD 2025, it must do so with renewed determination to guarantee dignity, compassion, and equitable access for all, regardless of diagnosis, geography, or citizenship.

Author: Sumit Banik is a Public Health Activist and Writer specializing in health system strengthening and palliative care. Since beginning his career at icddr,b in 2009, he has gained extensive field-level experience across Bangladesh. A strong advocate for increased government investment, rural health infrastructure, and equitable access, Sumit champions inclusive, visionary policy reforms to advance public health. He played an active role in the Compassionate Narayanganj Initiative under the WHPCA project. You can reach the author via E-mail: sumitbd.writer@gmail.com