The health system is the societal response to the determinants of health. The effectiveness of a health system depends on the availability, accessibility, affordability and acceptability of services in a form that the people can understand, accept and utilise according to their felt needs. The health system in Bangladesh, with extensive infrastructure in both public and private sectors, is highly pluralistic. The formal health system relies heavily on the government/ public sector for financing and setting overall policies and service delivery mechanisms. The private sector services are too expensive, especially for the poor, and out-of-pocket expenditure for getting healthcare services is very high. Quality of Care (QoC) in both the public and private sectors is poor. Improving health system responsiveness by involving various community actors and applying a bottom-up social accountability approach is crucial. The latter refers to a broad range of actions and mechanisms that citizens, communities and civil society organisations can use to hold public officials and public servants accountable. Social accountability implies the engagement of civic organisations to express demand for public services and extract accountability from local service providers to improve service quality.
Bangladesh Health Watch (BHW), established in 2006, is a multi-stakeholder civil society initiative dedicated to improving the health system in Bangladesh through evidence-based advocacy and appropriate actions for change. Towards this end, BHW has formed eight Regional Forums (RFs) based in eight districts in eight divisions. The RFs comprise different types of stakeholders, including non-government organisatios (NGOs), civil society organisation (CSO) activists/members, youth leaders and citizens of a region based in a district/sub-district/union headquarters. Each RF is hosted by a local NGO/CSO, including a health rights forum of active and informed citizens motivated to improve the quality of health services at the local level.