Dr Zafrullah Chowdhury: The pioneer of primary healthcare in Bangladesh

If disease prevention remains weak, people will keep coming to hospitals. Dr Zafrullah Chowdhury, as a young man, often thought that the way forward and out of the vicious cycle was to strengthen primary healthcare. 

At the time, in the 1970s, Dr Zafrullah Chowdhury embarked on a lifetime in healthcare and humanitarian work and later on, he become one of the first healthcare professionals in Bangladesh to implement the Alma-Ata Declaration. 

For the uninitiated, the 1978 Alma-Ata Declaration was the first international declaration underlining the importance of primary health care. The primary health care approach has since then been accepted by member countries of the World Health Organisation (WHO) as the key to achieving the goal of "Health For All." Bangladesh is a signatory to the Alma Ata Declaration.

The Business Standard spoke to Dr Nizam Uddin Ahmed, executive director of the Shastho Shurokkha Foundation and one of Dr Zafrullah's close associates who spoke about Dr Zafrullah's role behind the 1978 Alma Ata declaration, his early days since the founding of the Gonoshasthya Kendra in 1972 and more. 

Dr Zafrullah's role in the Alma-Ata Declaration and then in implementing it in Bangladesh 

"The Alma-Ata Declaration is popularly known as the birth of public health care in the world. It was articulated after multiple health experts congregated at the International Conference on Primary Health Care in 1978. Dr Zafrullah was in the working group for the declaration and was also present at the conference," said Dr Nizam Uddin Ahmed.

Moreover, Dr Nizam continued, "Dr Zafrullah helped shape the components of the Alma-Ata Declaration in our country with his understanding of public health and visionary thinking. He gave valuable input from his experience in providing health services to mothers and children in conflict situations, as well as people injured in the Liberation War of 1971."

Dr Zafrullah's massive contribution to primary healthcare 

"Before the declaration, in 1971 and the later years, Dr Zafrullah revolutionised health services in Bangladesh through Gonoshasthaya Kendra. He brought health services to the masses.

A low-cost healthcare model was pioneered by Dr Zafrullah in Bangladesh. He implemented the nine components of primary health care from the declaration one by one in Bangladesh through Gonoshasthaya Kendra centres. He researched those components to know how they can be implemented in the country," said Dr Nizam, noting that Dr Zafrullah was crucial in the country's 1979 vaccination programme launch. Bangladesh is now known as the vaccination hero around the world.

Creating awareness of family planning was also one of the things he was incredibly focused on at the time. He thought we could not only ensure food for the people, but we also had to think about their family planning, or else the country would face far greater danger in the coming days, according to Dr Nizam. 

"He used to drive a van by himself and go from district to district to raise awareness about family planning. And through this, we can see how far we have come. In 1971, the average family size was 7.2, which is now under 2. The mortality rate of mothers is now 70% less than it was in 1971," said Dr Nizam. 

And lastly, Dr Nizam noted, by implementing the Alma-Ata declaration, he did not only prove its importance, but he also influenced government policy and now it is in national documents. Dr Zafrullah's prime concern was solving health-related problems for low-income and underprivileged people. 

Dr Nizam shared his account of spending time with Dr Zafrullah during his final moments. Even on his deathbed, he was thinking of the people. "He asked me why the price of paracetamol is so high; as it is manufactured in our country, it should be more affordable," said Dr Nizam. 

From Dr Nizam's days as a graduate student studying public health in the United Kingdom, he remembers finding one of Dr Zafrullah's research works in his textbook. 

"Bangladesh's drug policy is popular around the world. Although it is not in any textbook in Bangladesh, it is taught in the UK and the United States. 

In the UK, the health policy written by Dr Zafrullah is a prime chapter in their textbooks. It is mandatory on the reading list and comes with assessments too. Seeing Dr Zafrullah's brainchild as part of my coursework was indeed a proud moment."

Dr Nizam Uddin Ahmed, Executive Director, Shastho Shurokkha Foundation

Nylah Shah and Syed Dider Hasan are journalists with The Business Standard