Harnessing pluralism for better health in Bangladesh

Bangladesh has made great health achievements in recent days despite a health system which is weak in terms of physical and human resources, and low-performing. But, then, how did all this happen? To answer this paradox, we presented evidence from review of available docs, published and un-published, and our experiences from long term engagement with the health sector of Bangladesh. We defined pluralism as the presence of many stakeholders and agents (public, private, NGOs; formal and informal etc.) working together to improve the health of the people in Bangladesh.

We argue that the development of a highly pluralistic health system environment, which allowed multiple actors and agents to function under a diffuse management, has created conditions for rapid change and innovation e.g., using semi-literate village women to deliver primary health care services at people’s door-steps.  We have used three case studies to show how this process has evolved. These are: access to essential drugs, scaling up tuberculosis treatment and urban primary health care project.

However, not all actions by the different stakeholders are acceptable or welcome. There is problem of governance and regulation which have adverse effects on people’s well-being. One example is overuse and misuse of drugs, especially by the informal providers.

Therefore, pluralism requires active management because a balance of positive outcomes cannot be taken for granted. We identified four key areas where this management is needed: participatory (inclusive) governance, accountability and regulation, information systems, and capacity development.

We conclude by saying that we want to shift from ‘pluralism in practice’ to ‘best practices in pluralism’ and make experiences of Bangladesh relevant to many similar countries across the world.