Health for All or Market for All? Bangladesh's Primary Health Care At Stake

Background:

Public health infrastructure in Bangladesh has been widely established to ensure health for all. The existing scenario, however, is dominated by service-oriented non-governmental organizations (NGOs) in their own health setups.

Objectives:

To delineate how actors in credit-lending and health sector formed a structural barrier to achieve health for all.

Methods:

Data was obtained, verified and analyzed from observation and in-depth interviews in a 7-month field trip in 2009.

Results:

Participation of NGOs dated back to the beginning of the country since 1970s. They run different programs, targeting various segments of the population. However, service provision, foreign patronage and providing microcredit are common characters they share. As demand for health became higher, a market niche was distinguished by international, local and even grassroots players. Thus donors influenced policy making and promoted NGOs to operate hospitals and clinics, subcontract health services or sell health commodities. NGOs also encouraged their clients who had no training to run private health facilities. The practice is an ongoing process of privatization, enabling NGOs to exploit the situation without a sense of promoting public health, trained providers or proper monitoring, which may cost lives of people and the whole system. Rather than serving a humanitarian cause, the role played by NGOs in collaboration with aid agencies is motivated by economic interest. Their engagement is not to ensure health for all, but rather, market for all.

Conclusion:

Donors’ top-down policy interference combining with local NGOs’ bottom-up approach has created a dangerous trend of health privatization. Instead of demanding health – a public good - from the state, one has to seek care from the market, now extended its reach to the poor population. In the process, the mass people largely lost their chance to empower and mobilize themselves to fulfill their own health rights.

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