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Improving governance and local level planning through community mobilisation: lessons learnt from Bangladesh

Author(s) Rumana Huque1
Affiliation(s) 1Department of Economics, University of Dhaka, Dhaka, Bangladesh.
Country - ies of focus Bangladesh
Relevant to the conference tracks Advocacy and Communication
Summary Poor governance in the health sector is negatively influencing service delivery mechanisms in Bangladesh, which in turn results in low utilization of public facilities. Although the principle of strengthening effectiveness and accountability of service provision through ‘participation’ has been introduced in the recently created Community Clinics and the associated Community Groups (CG) in rural Bangladesh, reviews to date have shown very slow progress in this area. The current project strengthened capacity of CGs through providing skilled based training. This enhanced the voice of citizens which inturn improved governance at CCs.
What challenges does your project address and why is it of importance? Poor governance in the health sector is negatively influencing service delivery mechanism in Bangladesh, which in turn results in low utilization of public facilities. Non-availability of drugs and commodities, imposition of unofficial fees, lack of trained providers and weak referral, feedback and monitoring systems contribute to low use of public facilities in Bangladesh. A number of other factors also adversely influence the service delivery mechanism. One such challenge is the inadequate participation of civil society in decision making processes. Evidence suggests that closed decision making processes in unequal societies can result in priorities that are biased towards elite interests and not adapted to the needs and priorities of the poor, which may have a negative impact on equity and social justice. Although the principle of strengthening effectiveness and the accountability of service provision through ‘participation’ has been introduced in the recently created Community Clinics and the associated Community Groups in rural Bangladesh, reviews to date have shown very slow progress in this area. Out of 13000 Community Groups very few are functional, leading to inadequate participation of the poor in local level planning or initiating accountability.
How have you addressed these challenges? Do you see a solution? The project has strengthened the Community Groups through providing skilled based training to its members in four upazilas in two districts. It provided relevant information and data including potential sources of funding and information on changes in rules and regulations to CG members. The process contributed to developing self confidence among people in discussing and analysing issues, identifying a problem, visualizing disparities, understanding their entitlements, identifying their duty bearers, articulating issues, developing plans as a team to address their problems, and communicating this properly to the appropriate forum/platform. The project has created a better referral linkage of Community Clinics with Upazila Health Complex (UHC). The patients they refer get special attention and preference at UHC. Due to the monitoring of CG, CC remains open from 9 am to 3 pm six days a week. The greatest success the development of coordination between health care providers and clients, people now conceive as public health care facilities as being their property, the reputation of the CG members in the community has gone up and the utilisation of services and respect for providers at CC has also increased.
How do you know whether you have made a difference? Clearly this project created opportunities for capacity strengthening of the local political leaders as well as community representatives so that they become better informed on health issues. It contributed to facilitating the relationships of citizens with health providers and governments. This in turn has given a platform to improve the quality of information available to citizens and to raise their voices. The project has created a sense of ownership among the citizens in functioning CG's. Interaction between service providers and patients became informal which increased access to services. It reduced the ‘illegal’ operations such as absenteeism and misuse of drugs.
Have you or the project mobilized others and if so, who, why and how? The project has created a link between Community Clinics, which is under Ministry of Health and Union Council members, who are under Local government. Union Council Members now attends the monthly meetings of the CG and monitor their functioning.
When your donor funding runs out how will your idea continue to live? The project will be sustainability even if donor funding is withdrawn, as the community group members are adequately trained and have been empowered to conduct the activities without third party facilitation. A mechanism to generate fund through community mobilisation to meet some expenses as also been created.

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