Palliative Care for All: A Vision for Bangladesh’s Health System

In Bangladesh, where the healthcare system is primarily focused on curative treatments and emergency care, palliative care remains an overlooked and under-prioritised area. Despite the growing need for end-of-life care due to the rising burden of Non-Communicable Diseases (NCDs) and an aging population, access to quality palliative care is limited.

The recently concluded ‘Compassionate Narayanganj: Building an Integrated Age-attuned Model of Supportive Palliative Care in Bangladesh’ project has brought significant learning and insights that can guide us toward integrating palliative care into the national healthcare system.

Current Context and the Rising Need for Palliative Care in Bangladesh

With the increasing prevalence of chronic illnesses such as cancer, heart disease, and respiratory issues, along with the growing aging population, the demand for palliative care is rapidly increasing. According to the World Health Organization (WHO), over 72% of deaths in Bangladesh are caused by NCDs. However, the healthcare system is heavily treatment-focused, often neglecting the quality of life and pain management for patients at the terminal stage.

Moreover, Bangladesh’s socio-economic context adds further complexity to the issue. The majority of the population resides in rural areas with limited access to specialised healthcare services. Additionally, financial constraints, lack of awareness, and social stigma around death and dying make palliative care even more inaccessible.

Key Challenges and Strategic Way Forward for Integrating Palliative Care in Bangladesh

Despite the World Health Organization’s resolution on palliative care in 2014, Bangladesh has yet to develop a national policy or strategic framework for the integration of palliative care. This absence of a policy hinders the establishment of a structured and sustainable service delivery model. One of the most pressing challenges is the lack of skilled human resources. There is a significant shortage of trained healthcare professionals—including doctors, nurses, and community health workers—capable of delivering quality palliative care.

Limited training opportunities and the absence of a structured curriculum further exacerbate this issue. Additionally, access to essential medicines, particularly opioids for pain management, remains limited due to strict regulatory barriers and inadequate distribution systems. Cultural barriers also pose a significant challenge, as discussions around death and end-of-life care remain taboo in many parts of Bangladesh, discouraging families from seeking the support they need. Moreover, inequitable access to healthcare, especially between urban and rural areas, leaves marginalised communities without the necessary services.

In this context, the ‘Compassionate Narayanganj’ project, supported by the Worldwide Hospice Palliative Care Alliance (WHPCA) implemented by AYAT Education and BSMMU in collaboration with the Directorate General of Health Services (DGHS), stands out as a pioneering initiative. Running from March 2022 to March 2025, the project adopted a community-driven approach to palliative care by integrating community health workers, trained volunteers, and healthcare professionals to provide home-based services.

Key outcomes of the project include building the capacity of community health workers and nurses, forging strong partnerships with local government bodies and the NCDC programme of DGHS, and raising public awareness to challenge social stigma around death and dying.

Looking ahead, a strategic roadmap is essential for scaling up palliative care across Bangladesh. First and foremost, the government must develop and implement a comprehensive national palliative care policy that provides clear strategic directions and guidelines for integrating services across all levels of the healthcare system.

Capacity building is equally critical—palliative care must be incorporated into the medical and nursing curriculum, and robust training programmes should be introduced for community health workers and volunteers to expand service outreach. Specialised palliative care units should be established in public hospitals, starting at the district level and in city health centres, to ensure availability of pain management, counseling, and home-based support.

Community-based models, like the one developed under the Compassionate Narayanganj project, must be scaled to other districts through local government and civil society engagement. Additionally, policy advocacy and awareness campaigns are necessary to normalise conversations around death and end-of-life care, with active media involvement and community dialogue playing key roles.

Finally, ensuring access to essential pain management drugs, especially opioids, requires regulatory reform and improved distribution systems to guarantee availability, particularly in rural and underserved areas. By addressing these challenges and adopting a strategic, inclusive approach, Bangladesh can build a compassionate and effective palliative care ecosystem for all.

The journey toward integrating palliative care into Bangladesh’s national healthcare system is undoubtedly complex and challenging. It is a path shaped by resource constraints, systemic limitations, cultural taboos, and a lack of coordinated national action.

However, recent developments such as the Compassionate Narayanganj project have shown that with the right approach—one that is compassionate, inclusive, and grounded in community engagement—transformative progress is possible.

In Bangladesh, where the majority of the population resides in rural and underserved areas, access to specialised healthcare remains a privilege for a few. For patients living with life-limiting illnesses, this inequity becomes even more profound, as palliative care services are either unavailable or inaccessible.

Furthermore, the healthcare system has long been oriented toward curative treatment, with minimal attention to holistic care that includes pain relief, psychosocial support, and dignity at the end of life. Cultural sensitivities around death and dying add another layer of complexity, as these conversations are often avoided within families and communities. In this context, the introduction and expansion of palliative care require not only medical infrastructure but also deep societal transformation.

The Compassionate Narayanganj project, implemented by AYAT Education and BSMMU in collaboration with DGHS, represents a crucial step forward. Over a three-year period, the project has demonstrated the power of community-based palliative care by training community health workers and volunteers, establishing local partnerships, and directly reaching patients in their homes.

It has created a localised model that adapts palliative care to the realities of the Bangladeshi context—leveraging existing public health infrastructure, empowering communities, and fostering collaboration with local governments. This approach is not just about healthcare delivery; it is about restoring dignity, empathy, and humanity to patients and families navigating some of life’s most difficult moments.

Yet, scaling such efforts across the country will require more than isolated projects. Bangladesh must now prioritise the development of a comprehensive national policy on palliative care. This policy should provide strategic direction, allocate resources, and embed palliative care into the existing health system at all levels—from tertiary hospitals to union-level health centers.

Simultaneously, there is an urgent need for capacity building, including integrating palliative care into medical, nursing, and public health curricula, and expanding training opportunities for grassroots healthcare providers.

Moreover, community engagement must be at the heart of this movement. Changing attitudes toward death and dying requires public awareness, education, and open dialogue. Community leaders, religious institutions, and media can play a pivotal role in reshaping the narrative around palliative care, breaking taboos, and encouraging families to seek support when needed.

Lastly, ensuring the availability of essential medicines, particularly opioids for pain relief, must be addressed through regulatory reforms and improved distribution mechanisms. No patient should be denied relief from suffering due to policy gaps or logistical barriers.

In summary, while the road ahead is not easy, it is navigable. Bangladesh has a unique opportunity to lead by example in South Asia by building a palliative care system that is sustainable, culturally inclusive, and rooted in community needs. By learning from successful models like Compassionate Narayanganj, and through political commitment, strategic investment, and collective advocacy, the nation can ensure that every person—regardless of age, gender, or socio-economic status—has the right to live and die with dignity, compassion, and peace.