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Abstrait

Challenges of Satisfaction of Key Stakeholders of the District Health System of Bangladesh and Ways to Improve: A Qualitative Study

Ashim Roy, van der Weijden Trudy and Nanne de Vries

Introduction: A qualitative study was conducted investigating insights of the key stakeholders of the Bangladesh’s health system to explore determinants of their satisfaction and strategies for improvement.

Methods: Six homogenous focus group discussions were conducted during January 2016 including district public health administrators, private facility owners, public doctors, private doctors, rural patients, and civil society representatives from three districts. An expert translated video-taped sessions from Bengali into English. Two researchers reached consensus on independently coded validated transcripts. A ‘directed content analysis’ method was used to analyse the data.

Findings: The prime factors of stakeholders’ dissatisfaction were grouped into organizational, political, socioeconomic, market and moral issues. Inefficient management of resources relating to bureaucracy, incompetent local administration, corruption and health-professional politics were the key barriers to satisfaction in the public sector; in the private sector these were deficient market regulation, and social status-gaps. These illustrate inter-sector tensions, an imperfect market and mistrust in healthcare. Risks of health catastrophe were perceived as likely in both sectors.

Conclusion: Decentralization of governance to a multisectoral body with ample resources and empowered of controlling a district public-private mixed health system would reduce authoritative and collaborative gaps, immoral practices and threats of market failure. Reduction of undue political influence and instituting a fair evaluation of performances are crucial to recover public doctors’ and administrators’ motivation and satisfaction. Community involvement in healthcare would improve people’s trust on health system. Establishing balanced competitions between the public and private sectors, and implementing a health insurance system are the priority items to improve efficiency and economic protection in healthcare and finally people’s health.