The health system in Bangladesh, with extensive infrastructure in both public and private sectors, is highly pluralistic.The private sector services are too expensive, especially for the poor, and out-of-pocket expenditure for getting health care services is very high. Quality of Care (QoC) in both the public and private sectors is poor. This is plausible because of the heavy shortage of health workforce and necessary equipment and logistics in the health facilities. These scenarios combine to undermine the efforts to achieve universal health coverage (UHC) by 2030, as committed by the government. The effectiveness of a health system depends on the availability, accessibility, affordability, and acceptability of services in a form which people can understand, accept, and utilize according to their felt needs.

The health system responsiveness (comprising prompt attention, dignity, autonomy, confidentiality, communication, social support, basic amenities, and choice of providers)6 is also poor in Bangladesh. There are huge gaps between what is provided by the health services and what is needed by the community. Improving health system responsiveness by including demand side perspectives from the 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 (CSOs) use to hold public officials and public servants accountable. Social accountability implies the engagement of civic organisations to express demand for public services, including health care services, and extract accountability from local service providers to improve service quality.

Giving voices to the people: Regional Forums (RFs) of the Bangladesh Health Watch (BHW)
Bangladesh Health Watch (BHW), established in 2006, is a Multistakeholder civil society platform dedicated to improving the health system in Bangladesh through an evidence-based advocacy to facilitate actions for change. Under the project “Making Bangladesh’s Healthcare Systems More Responsive and Participatory”, sponsored by Swedish International Development Cooperation Agency (Sida)12, BHW has formed eight Regional Chapters (RC) in eight district centres in eight divisions13. The idea is to give voice to the people, especially from hard-to-reach and remote and rural areas regarding their felt needs for health care services and generate evidence for civil society mobilisation and advocacy through citizen’s platform at the grassroots. Besides giving voices to the people, also help local providers/health system try to respond and solve within their jurisdiction and beyond. The RCs comprises different types of stakeholders including non-government organisatios (NGOs), CSO activists/members, youth leaders and citizen of a region based in a district/sub-district/union headquarters. Each RC is hosted by an NGO/CSO, including a HRF of active citizens who are motivated to play an active role voluntarily in improving the quality of health services at the local level. Some of the chapters have started functioning and some are in the process of development.