World heart day: Drug shortage risks hypertension control effort

• BHCI helped 56% of 5.17 lakh patients control blood pressure
• Medicine supply broke down after funding ended in June 2024
• Tk 100cr allocated but projects still awaiting approval

The government's Bangladesh Hypertension Control Initiative (BHCI), which has significantly improved hypertension control nationwide, is now facing a major setback as medicine supply to patients remains disrupted due to a funding crisis.

The World Health Organisation (WHO), in its Global Report on Hypertension 2025 published last week, praised the initiative for "demonstrating a strong and scalable impact in improving hypertension management and control".

Under the programme, registered patients with hypertension and diabetes receive free check-ups and medicines at Upazila Health Complexes (UHCs) and select district hospitals. Between October 2018 and June 2024, 56 percent of 5.17 lakh treated patients achieved blood pressure control at implementing facilities, the WHO report noted.

But medicine supply was disrupted after the expiry of the Fourth Health, Population, and Nutrition Sector Programme (HPNSP) in June 2024. The programme previously funded the supply of medicines and equipment to Non-Communicable Disease (NCD) corners in hospitals.

Health officials warn that the disruption is increasing patients' out-of-pocket costs, raising the risk of life-threatening complications from sudden interruptions in medication, and potentially undoing the initiative's gains as many may discontinue treatment.

Shakil Mahmud, a diabetes patient from Moulvibazar's Kulaura, went to the UHC yesterday to collect his medicines.

Speaking to our Moulvibazar correspondent, he said, "I go once every month and am given medicine to last the whole month. But yesterday they gave me medicine for only 13 days and told me to return on the same date next month."

This means Shakil will now have to buy the remaining medicines for the month from his own pocket.

Hypertension, or high blood pressure, is defined by WHO as pressure in the blood vessels of 140/90 mmHg or higher. Uncontrolled hypertension can lead to heart attacks, heart failure, and strokes. Cardiovascular diseases were the leading cause of death in Bangladesh in 2021, accounting for 36 percent of all deaths, according to the Health Sector Reform Commission citing Global Burden of Disease data.

WHO reports that 2,83,800 people died of cardiovascular diseases that year.

Of 22.8 million adults aged 30–79 with hypertension in 2024, 19.2 million had uncontrolled blood pressure, says the WHO report.

Of them, 11.8 million (52 percent) were diagnosed, 9 million (39 percent) were on treatment, and just 3.6 million (16 percent) had their condition under control.

Against this backdrop, Bangladesh is observing World Heart Day today under the World Heart Federation's theme, "Don't Miss a Beat".

In 2018, nearly 20 million adults in Bangladesh were living with hypertension, yet only 38 percent were receiving treatment and just 15 percent had it under control, WHO said. The health ministry launched the BHCI that year, setting up NCD corners at hospitals with three-member teams including a medical officer who treated hypertension and diabetes patients and provided five types of medicines free of cost.

At present, NCD corners operate in 416 UHCs and 30 district hospitals, according to an official of the Non-Communicable Disease Control (NCDC) Programme of the Directorate General of Health Services. Of the 18 lakh patients registered through the NCD corners, 8–9 lakh are hypertension patients and the rest diabetic, the official, preferring anonymity, said.

The Community Clinic Health Support Trust also started providing two types of medicines for hypertension and diabetes from community clinics in 2023. Patients who maintain controlled blood pressure for three consecutive months are referred to a community clinic, where they receive a steady supply of medicines.

Funding for medicine and equipment came from the Fourth HPNSP, which expired last year. The interim government later scrapped the proposed Fifth HPNSP, deciding instead to take up two projects to complete unfinished tasks under the Fourth HPNSP and ensure continued medicine supply. However, these projects have yet to be approved.

As a result, NCD corners and community clinics have been struggling to supply medicines to patients since late last year.

Several Upazila Health and Family Planning Officers (UHFPOs) told this correspondent that the supply situation remains difficult. A UHFPO in Jhenaidah said they currently have three out of the five listed medicines and have been facing shortages for seven to eight months. Another UHFPO in Gopalganj said only two medicines are available.

Both said DGHS initially instructed them to purchase medicines from hospital funds but later assured them that central supplies would resume. Two officials of the NCDC Programme said the health ministry has allocated Tk 100 crore to the state-run Essential Drugs Company Limited (EDCL) and has already sent a requisition.

One of the officials said the company will provide the medicines in phases and that it may take two to three months for supplies to return to normal.

An official from the Community Clinic Health Support Trust and a Community Health Care Provider in Barishal said medicine supply at community clinics there has almost returned to normal after government funds were allocated.

This correspondent could not reach Prof Syed Zakir Hossain, line director of the NCDC Programme, Prof Abu Jafor, director general of DGHS, or Saidur Rahman, secretary of the Health Services Division, for comments.