Social Accountability in Bangladesh’s Health Sector

Social accountability as a means of promoting good governance for access to drugs in the health sector in Bangladesh

Summary:

There are many reasons why healthcare providers should be accountable to the communities they serve. This includes enhancing the trust that underpins the patient-health worker relationship and its therapeutic process; strengthening popular support for healthcare, and above all ensuring that care that is provided in ways that benefits patients and communities rather than those providing care.

In Bangladesh, our research will examine Public Hearings (PHs), a means of community monitoring of health services. These are intended to promote transparency and accountability of public authorities and align their activities with the needs of communities. The Public Hearings are conducted in partnership with the Anti-Corruption Commission (ACC), a statutory body of the GoB. Any adult Bangladeshi citizen is eligible to be a member of committees, which should include people from across society. However, there is currently almost no empirical research on the reach, process, and consequences of the hearings for evidence-based evaluation.

We believe that better representation will enhance the ability of the PHs to ensure accountability and reduce scope for corrupt behaviour.

The corruption issue

Access to affordable medicines in Tanzania, Nigeria and Bangladesh is known to be poor. Among the reasons for this is the presence of corruption at all levels of the supply chain. Each country has nascent mechanisms in place to provide a degree of social accountability, that, if effective, should reduce the space for corrupt behaviour and from incompetence and inefficiency that compound the problem. Yet these mechanisms are often weak.

Theory of Change:

  • IF: We can widen participation in the existing Public Hearings, giving voice to the most marginalised, and strengthen mechanisms that hold those in charge to account
  • THEN we can improve access to essential medicines by improving drug supply chains
  • BECAUSE we will have created effective mechanisms that will hold health officials accountable, where they must respond or lose “face”.

Research Methods:

The research will combine qualitative and quantitative methods such as: Focused literature/document reviews, consensus building techniques, qualitative and key informant interviews and focus group discussions, retrospective and prospective analysis of public hearings, questions will be incorporated in the quantitative provider survey of 400 households. In Bangladesh, we will work in the central region (Dhaka division), northern (Rangpur or Rajshahi division) and southern provinces (Barisal Division) to capture population and health system diversity.

Main Partners: The London School of Hygiene and Tropical Medicine (LSHTM) and James P Grant School of Public Health (JPGSPH).

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