Champion of people’s health

Published May 19, 2023
The writer is a former SAPM on health, professor of health systems at Shifa Tameer-i-Millat University and WHO adviser on UHC.
The writer is a former SAPM on health, professor of health systems at Shifa Tameer-i-Millat University and WHO adviser on UHC.

DR Zafrullah Chowdhury passed away in Dhaka on April 11, 2023, after an inspiring life. He dedicated himself to the healthcare and development of the poor and voiceless, becoming their carer and voice.

He was born near Chittagong in 1941. As a six-year-old, he saw Partition and as a young man he witnessed major political upheavals: East Bengal was separated from West Pakistan in 1971 after a bloody war that led to the birth of Bangladesh. These political developments turned Dr Chowdhury into a committed nationalist. He took active part in student politics, completed his graduation in medicine and then left for the United Kingdom for post-graduation in surgery. He was there when the war broke out between the two wings of Pakistan. He rushed back to Dhaka, leaving his training halfway to help with the war and take care of those fighting for freedom.

He set up a hospital to take care of injured fighters and refugees. This busy hospital soon turned into a 480-bed field hospital. This was the beginning of Zafrullah Chowdhury’s lifelong crusade for poor people’s healthcare. After the war, the hospital was relocated to the rural outskirts of Dhaka where it soon became Gonoshasthaya Kendra, commonly known as GK (People’s Health Centre).

He realised that the healthcare needs of the people were too many and there were not enough doctors. He initiated short trainings of volunteers, mainly women, who started providing healthcare to the people. Trained paramedics became the main workforce for delivering preventive, promotive, curative and rehabilitative health services. This work continued to expand.

Zafrullah Chowdhury’s lifelong crusade focused on poor people’s health.

Over the last half a century, GK has turned into an enterprise of health facilities and development projects. It now covers all levels of healthcare — from primary- to tertiary-level advanced teaching hospitals. Equity in healthcare is the cardinal principle, with full financial protection for those who cannot pay. Healthcare in GK now means healthcare that is needed by the people and not merely what can be provided.

Zafrullah was active at the local as well as global level. GK’s work and perspective contributed to the International Conference on Primary Health Care in 1978, which resulted in the famous Declaration of Alma-Ata. He contributed to all major global milestones on PHC, health-for-all and universal healthcare agendas since 1978 and was very critical of ‘selective primary healthcare’.

On the 40th anniversary of the Declaration of Alma-Ata, WHO and Unicef convened another global conference on PHC, in the context of the third Sustainable Development Goal which calls for efforts to ensure healthy lives and promote well-being for all at all ages. The conference’s outcome was the Declaration of Astana, which puts special emphasis on three components of PHC: empowering people and communities; multisectoral policy and action; and primary care and essential public health functions as the core of integrated health services.

Empowering people and communities for their health and development was the foundation of Zafrullah’s philosophy. He especially championed women’s empowerment and emphasised women’s mobility. Drivers of rickshaws, cars and trucks in GK are women. Women ride bikes to work. He managed this successfully in a conservative society. He employed a multisectoral approach and addressed other development needs of the people. GK is involved in water and sanitation, agriculture, nutrition, education, employment generation, the manufacture of medicines — the list goes on and on. Public health emergencies are frequent in Bangladesh due to regular floods. GK is always at the forefront of relief efforts. It is now a leading health carer for hapless Rohingya refugees.

In 2000, Zafrullah worked hard to host the first People’s Health Assembly in Bangladesh. He received around 1,000 delegates from across the world at the GK campus. It was a great success. Despite the bitterness between Bangladesh and Pakistan, Zafrullah Chowdhury personally welcomed many of us from Pakistan and took special care of us. This was the most inspiring public health gathering I have attended in my professional life. Halfdan Mahler, who was the director general of WHO in 1978 and the main figure behind the historical International Conference on PHC in Alma-Ata, also attended the PHA and made an inspiring speech. The assembly triggered the Peoples’ Health Movement across the globe.

Zafrullah Chowdhury will be remembered for his revolutionary work on essential medicines. In 1982, as an adviser to the then president of Bangladesh, he introduced the famous National Drug Policy based on the essential medicines concept. In one go, 1,600 non-essential medicines were delisted and a list of only 150 essential medicines was adopted for the country. Big pharma was extremely upset and threatened to pull out from Bangladesh. In view of this situation, Zafrullah quickly set up an Essential Medicines Company which started manufacturing essential medicines. Later, he wrote a book reminiscing about these dramatic events. The book titled The Politics of Essential Drugs — The Making of a Successful Health Strategy: Lessons from Bangladesh is a must-read.

He survived a serious episode of Covid-19 and was suffering from kidney disease and had to have regular dialysis. At 81, in his frail physical condition he continued to work hard on his projects. Due to his unrelenting lifelong work, GK today is a conglomerate of various small and large health-related organisations, including the country’s largest haemodialysis centre which serves 300 patients every day, one of whom was Zafrullah himself.

For his inspiring work he received many honours and awards including Bangladesh’s highest civil award; the Ramon Magsaysay Award from the Philippines; the Right Livelihood Award from Sweden; the International Health Hero Award from the University of Berkeley in the US, and the Ahmed Sharif Memorial Award of Bangladesh.

Zafrullah was soft-spoken but a hard hitter of injustice in any form. He chose to adopt a very ordinary lifestyle and inspired a generation of health workers, turning them into passionate health activists. Through them, his legacy will live on for times to come.

The writer is a former SAPM on health, professor of health systems at Shifa Tameer-i-Millat University and WHO adviser on UHC.

zedefar@gmail.com

Published in Dawn, May 19th, 2023

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