Разнообразие и равенство в сфере здравоохранения и ухода Открытый доступ

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The Need for Regulatory Reform to Improve Rural People's Access to Healthcare: Views of Administrators of the Public-private Mixed Health System of Bangladesh

Ashim Roy

Nearly 35% out of approximately 108 million rural population of Bangladesh live below the poverty level. Resource shortages and limited access to the public healthcare facilities are common in rural areas, accompanied by high out-of-pocket payments and a nominally controlled rapidly growing private market. This study aims to describe public and private healthcare services and to investigate public health administrators’ and private facility owners’ potential explanations of their roles and limitations to ensure rural people’s healthcare needs. An exploratory questionnaire and audit study was conducted in three remote Gaibandha, Naogaon and Joypurhat districts of Bangladesh. 22 public health administrators and 20 private facility owners were the respondents. Audit data on healthcare structure, availability and utilization were collected from the public and private facilities’ records in 2012. Inefficient utilization of available resources in the centrally regulated public health system was found as an obvious problem. This was associated with wide gaps in power between the central and local authorities, and disparities between supply and demand with consequent wastage and misuse of scarce resources. In the private sector, the effectiveness of regulation of cost and quality is sub-optimal. The licensing and accreditation system is outdated; hence, ineffective. Local authorities’ compliance to the stringent central bureaucracy and their satisfaction seem mutually exclusive. Regulatory reform is essential to ensure the rural population’s health and economic protection in healthcare. Thus, optimally utilizing the existing primary health care resources is a high priority. A potential market failure could be prevented and controlled by amending the licensing and accreditation rules involving multisectoral public-private mixed regulatory actors. A ‘deconcentration’ type of regulatory reform with capacity building of the local authority and implementation of reward and sanction-based policy seems a promising strategy to improve the rural population’s health and economic well-being in Bangladesh.