Zafrullah Chowdhury: Champion of health equity

Zafrullah Chowdhury, a surgeon, a public health activist, and a champion of health equity. Born on 27 Dec, 1941 in what is now Raozan, Bangladesh, he died from chronic kidney disease complications on 11 April 2023 in Dhaka, Bangladesh, aged 81 years.

For Zafrullah Chowdhury, no challenge was insurmountable. He left his medical studies to join the 1971 Bangladesh Liberation War as a guerrilla fighter and doctor. He helped found Gonoshasthaya Kendra (GK), which reimagined community health services in Bangladesh and elevated women volunteers. He challenged the prices pharmaceutical companies charged for medicines, pushed for the expansion of educational services, and, when he developed chronic kidney disease, advocated for universal access to low-cost kidney dialysis in Bangladesh. 

"There was absolutely no end to what he would take on", said Beverley Snell, Honorary Coordinator of Health Action International (HAI) Asia Pacific. 

"If there was injustice anywhere, he would be there," he added. 

Chowdhury earned his Bachelor of Medicine, Bachelor of Surgery degree at Dhaka Medical College, but that did not stop him from exposing corruption within the institution. "He said we had to do something, so we started this fight against the problems there", said Abul Qasem Chowdhury, a fellow student at the time. 

Chowdhury went on to complete his MBBS in 1964 and moved to the UK for postgraduate studies in general and vascular surgery. But war erupted between former East and West Pakistan and he returned to join the Bengali nationalist fighters in East Pakistan, who ultimately secured independence. 

"When the revolution happened, he had to be at the forefront," said Anwar Fazal, an international civil society activist who founded HAI, of which Chowdhury was a founding member. 

He soon put his medical expertise to work, helping to build a 480-bed hospital to treat injured fighters and sick refugees. That experience "gave him a very clear idea of the condition of the poor", said Abul Chowdhury, who would later serve as executive director of GK and vice-chancellor of Gono Bishwabidyalay and is now a GK trustee.

After the war ended, Chowdhury and his colleagues moved the field hospital to the rural area of Savar, where it became GK. They transformed it into "an experimental primary health care project [for] poor people in rural Bangladesh", explained Abul Chowdhury, and recruited local women with no medical background to serve as paramedics in the community, "teaching them to provide both preventive and curative services". 

According to Snell, "he said these women need to have the skills the population can't do without". 

The Bangladesh Government would adopt this paramedic model in 1977. "He was an innovator throughout his life", said Lincoln Chen, President Emeritus of the China Medical Board. 

Recognising that international pharmaceutical companies were charging prices that placed basic medications out of the reach of Bangladesh's rural poor, Chowdhury "set up his own generic drug company, which lowered the cost of the drugs", Chen said. 

He also advised the Bangladesh Government on legislation that would codify essential medicines and ban the sale of unnecessary or harmful drugs. And he pressed WHO to craft an Essential Medicines List, which it first published in 1977. 

"He pioneered the global phenomenon that is essential drugs", Fazal said. Chowdhury, who kept the role of Projects Coordinator at GK, oversaw the centre's initiative to introduce a Rural Health Insurance System in 1973 and also guided GK's expansion into primary and secondary education. GK has established 187 schools in rural Bangladesh, a university, Gono Bishwabidyalay, in Savar, a technical college, and an institute of health sciences. 

"He believed that until and unless you educate people, it will be very difficult to improve their condition," Abul Chowdhury said.

Chowdhury also had global impact. "He was absolutely leading in proselytising for the idea of a People's Health Assembly", ensuring that the 2000 gathering, which birthed the People's Health Movement (PHM), took place at GK, said David Legge, Scholar Emeritus in the School of Public Health and Human Biosciences at La Trobe University, Melbourne, Australia, and a founding member of PHM. 

For his many contributions, he received the 1978 Independence Day Award, Bangladesh's highest civilian honour, the 1985 Ramon Maysaysay Award, and the 1992 Right Livelihood Award. He is survived by his wife, Shireen Huq, daughter, Bristi Chowdhury, son, Bareesh Hasan Chowdhury, four sisters, and four brothers. 

"He was a pioneer in primary health care and health equity and health justice for the poor", Chen said. He leaves a legacy of "honesty, speaking truth to power, and a commitment to a better world, which we can all learn from", Legge said.