Decentralized Provision of Primary Healthcare in Rural Bangladesh – a Study of Government Facilities

Alia Ahmad, Manik Bose () and Therése Hindman Persson
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Alia Ahmad: Department of Economics, Lund University, Postal: Department of Economics, School of Economics and Management, Lund University, Box 7082, S-220 07 Lund, Sweden
Manik Bose: World Fish Center, Postal: World Fish Center, Penang, Malaysia
Therése Hindman Persson: Dovre Group

No 2007:11, Working Papers from Lund University, Department of Economics

Abstract: Bangladesh has made significant progress in health indicators in recent years in spite of her low level of income. This is mainly due to the commitment of the state supported by donors in providing preventive care with respect to child health and family planning. However, there are serious problems related to both access and quality of curative care that hurt the poor most. Infrastructures for service delivery exist at local level in rural areas but they function inefficiently. This paper deals with the systemic weaknesses of decentralized service provision of primary healthcare in Bangladesh and focuses on accountability links between different actors and functions of delegation, finance, performance, information and enforcement. The study is based on facility- and household-based data collected during 2005 in Khulna Division. The main findings of the study are: the health system in rural areas represents deconcentration rather than decentralization of central government functions where inter-sectoral discipline works poorly; local health providers are not accountable to local government, and poor citizens/clients are neither aware of their rights nor are capable of expressing their needs as effective channels do not exist.

Keywords: decentralization; accountability; governance; primary healthcare (search for similar items in EconPapers)
JEL-codes: I12 I18 (search for similar items in EconPapers)
Pages: 45 pages
Date: 2007-06-18, Revised 2007-06-26
New Economics Papers: this item is included in nep-cwa, nep-dev and nep-hea
Note: In footnote 1 the Conference in Bergen will be held in November
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