Born in a war, built for the poor: The half-century mission of Gonoshasthaya Kendra

In the summer of 1971, with East Pakistan in the midst of a liberation war, a young Bangladeshi surgeon named Zafrullah Chowdhury and his colleague Dr MA Mobin set up a makeshift 480-bed hospital in Melaghar, Tripura, just across the border from the fighting. There were five doctors. There were no nurses. Women with no previous training in healthcare were trained within days to help treat patients. And it would become the founding logic of one of Bangladesh's most consequential public health institutions - Gonoshasthaya Kendra.

From a wartime field hospital to a national model

Gonoshasthaya Kendra (GK) is a registered Public Charitable Trust, established in 1972, and one of the oldest non-governmental, non-profit, national-level organisations in Bangladesh. The name translates as "People's Health Centre." 

When the newly independent country's government objected to retaining the name Bangladesh Field Hospital, it was Sheikh Mujibur Rahman who suggested the new name and framed its mandate that Gonoshasthaya Kendra would not only provide treatment, it would also work on health, agriculture, and education. The hospital was relocated to Savar, on 28 acres of land partly donated by local families and partly arranged by the government, and began operations with the motto: "Let us go to the village to build villages."

The institutional philosophy that followed was radical for its time. Zafrullah Chowdhury recognised early that the ratio of qualified doctors to patients in Bangladesh made physician-centred medicine structurally inadequate for a country of its size and poverty. He introduced the concept of paramedics in Bangladesh — young women with secondary-level education who were trained to deliver preventive, primary, and basic curative care directly in villages. 

This model was the first of its kind in the country and was subsequently adopted by the Government of Bangladesh in 1977. GK became the first place outside China to train paramedics seriously.

A programme that influenced global health doctrine

The scale of what GK was doing in Savar did not go unnoticed by the international health community. The centre at Savar was applying the principles of primary health care six years before those principles were formally recognised at the Alma Ata conference. GK's innovative programme was accepted as one of the three main background papers for the Alma Ata Declaration of 1978 — the WHO conference whose declaration of "Health for All" reshaped global public health strategy for the following generation.

The measurable results of the paramedic model influenced its credibility. Thanks to GK's work, infant and maternal mortality rates in their operational area have fallen to approximately half of Bangladesh's national average. Each female paramedic is responsible for two or three villages of roughly 3,000 residents, conducting monthly household visits, tracking pregnancies, vaccinating children, and performing verbal autopsies for every infant and maternal death — a level of community accountability that still does not exist in Bangladesh's national health system.

In 1973, Gonoshasthaya Kendra introduced a Rural Healthcare Insurance System — the first of its kind in Bangladesh. Premiums were calibrated to household income, allowing the poorest families to access the same services as those who could afford to pay more. The system predated the cross-financing models that other institutions would later adopt as their defining innovation. 

As Zafrullah Chowdhury himself articulated the logic, "Ill health is an important factor that forces the poor to remain poor. Even if they make a little bit of money, one episode of illness can wipe them out."

The drug policy that changed a country

GK's most structurally consequential intervention came when Dr Zafrullah Chowdhury spearheaded Bangladesh's 1982 National Drug Policy—the first in Asia to emphasise essential medicines over branded imports—successfully curbing exorbitant pricing by multinational pharmaceutical companies and enabling local generic production to enhance accessibility for low-income groups. The policy prescribed 1,700 dangerous or useless drugs and set a unique example to other countries of how to control a market for therapeutic drugs.

To translate that policy into practice, GK established Gonoshasthaya Pharmaceuticals Limited in 1981 to manufacture high-quality essential medicines at affordable prices. The factory supplies an average of 5% of all of Bangladesh's drugs but as much as 60% of some categories. Its prices have been as much as 60% below those of the multinationals, and this competitive pressure has helped reduce prices more broadly. 

50% of profits are reinvested in the factory, 20% distributed to workers who are mostly local women, and the remaining 30% directed to GK's social programmes.

Scale, reach, and recognition

GK today provides healthcare through seven hospitals and 50 sub-centres. It serves over 1.5 million people across 541 villages in Bangladesh. The network spans the Chittagong Hill Tracts, the riverine chars of Gaibandha and Kurigram, and the offshore islands of Kutubdia and Moheskhali — geographies that remain largely invisible to Bangladesh's formal health system. GK has also been consistently present in disaster response, deploying teams across every major flood and cyclone the country has experienced since 1974, and maintaining active operations in the Cox's Bazar refugee camps serving displaced Rohingya.

The institution received the Independence Award in 1977, Bangladesh's highest state honour, in recognition of its innovative family planning and primary health care programmes. In 1985, Chowdhury received the Ramon Magsaysay Award, Asia's most prestigious civilian prize. In 1992, the Right Livelihood Award — popularly known as the "Alternative Nobel Prize" — was awarded jointly to Chowdhury and Gonoshasthaya Kendra in recognition of their outstanding record of promotion of health and human development. 

Zafrullah Chowdhury was posthumously awarded the Independence Award a second time in 2026, prompting a revision of the award's rules to accommodate the honour.

Zafrullah Chowdhury died on 11 April 2023, at the age of 81. The institution he built survived him.