Building public trust in the healthcare system: A path to effective reform

Rebuilding and sustaining trust in healthcare requires addressing interpersonal, institutional, and systemic dimensions. Photo Credit: TBS

Trust is the cornerstone of an effective healthcare system. When people trust healthcare providers and institutions, they are more likely to utilise available facilities, comply with medical advice, and engage in preventative care. Conversely, a lack of trust leads to the underutilisation of healthcare services and exacerbates inequality, leaving vulnerable populations at greater risk.

In moments of physical and mental danger, people seek assurance that healthcare professionals and institutions will prioritise their well-being. This expectation encompasses not only the provision of competent and compassionate care but also the ethical use of resources without exploitation for commercial or political gain. 

Trust, therefore, is the collective judgement and perception of a population regarding the integrity, competence, and commitment of its healthcare system.

Catalysts of public trust in healthcare

Public trust in healthcare hinges on several interrelated factors, broadly categorised into interpersonal, institutional, and systemic trust. 

Interpersonal trust involves patients' confidence in the professional competence of healthcare workers, including their ability to diagnose, treat, and manage health conditions effectively. 

Transparent and empathetic communication, coupled with cultural sensitivity, fosters a strong connection between healthcare workers and patients, ensuring equitable access to care. 

Protecting patients' privacy and maintaining confidentiality further strengthens trust, as does providing equal treatment regardless of socioeconomic status, gender, or ethnicity. 

Institutional trust depends on operational transparency, where institutions openly share information about policies, procedures, and performance metrics. Ethical practices that prioritise patient welfare over financial or political interests, along with affordable and geographically accessible services, are essential to maintaining trust. 

Systemic trust is built on the foundation of policy effectiveness, with comprehensive and well-implemented healthcare policies reflecting a government's dedication to public health. 

Accountability mechanisms that address grievances and rectify errors reinforce public confidence, while efficient crisis management, such as during pandemics, demonstrates the resilience and reliability of the healthcare system.

Challenges to building trust

In the context of Bangladesh, several factors contribute to the erosion of public trust in the healthcare system, presenting significant challenges to achieving equitable and effective care. One of the primary issues is corruption and mismanagement, which manifest in various forms such as financial irregularities, resource misallocation, and unethical practices. 

These problems not only compromise the efficiency of healthcare institutions but also create an environment where patients and their families lose confidence in the system's integrity. For example, instances of bribery for accessing basic services or the misappropriation of funds intended for public health initiatives undermine the core purpose of the healthcare system.

Another critical challenge is the stark inequality in service delivery, particularly affecting marginalised communities. 

In Bangladesh, disparities in the availability and quality of healthcare services are evident between urban and rural areas. While urban centres like Dhaka and Chattogram have access to relatively advanced medical facilities, rural and remote Chittagong Hill Tracts (CHT) regions often suffer from inadequate infrastructure, a shortage of qualified healthcare professionals, and limited access to essential medicines.

Such inequities perpetuate mistrust, as marginalised groups feel neglected and underserved by the system.

Poor communication is another significant barrier to trust-building within the healthcare system. 

In Bangladesh, disparities in the availability and quality of healthcare services are evident between urban and rural areas. While urban centers like Dhaka and Chattogram have access to relatively advanced medical facilities, rural and remote Chittagong Hill Tracts (CHT) regions often suffer from inadequate infrastructure, a shortage of qualified healthcare professionals, and limited access to essential medicines.

Many patients in Bangladesh experience misunderstandings or lack adequate information about their treatment plans due to ineffective communication by healthcare providers. Cultural and linguistic differences, coupled with a hierarchical patient-provider dynamic, exacerbate this issue. The absence of clear and empathetic communication often leaves patients feeling alienated and sceptical about the care they receive.

Negative experiences, including cases of medical malpractice and negligence, further erode public trust. 

High-profile incidents, such as incorrect diagnoses, surgical errors, or avoidable fatalities, tend to gain widespread attention and create a ripple effect, tarnishing the reputation of the entire healthcare system. 

The lack of robust grievance mechanisms and accountability structures means that patients often have no recourse to justice, deepening their disillusionment. 

Collectively, these challenges highlight the pressing need for systemic reforms to address the underlying causes of mistrust in Bangladesh's healthcare system. Without addressing these issues comprehensively, efforts to improve healthcare delivery and ensure equitable access will remain ineffective.

Solutions to rebuild and sustain trust

Rebuilding and sustaining trust in healthcare requires addressing interpersonal, institutional, and systemic dimensions. 

Enhancing interpersonal trust involves investing in continuous professional development to improve healthcare workers' technical skills and patient interaction, promoting empathy through medical education, and enforcing policies that guarantee privacy, informed consent, and non-discrimination to strengthen patient rights. 

Strengthening institutional trust necessitates improving governance through transparent decision-making and accountability mechanisms, equipping hospitals and clinics with adequate staffing and resources to enhance service delivery, and conducting regular audits with public reporting to foster accountability. 

Building systemic trust requires inclusive policy-making that engages communities and stakeholders in healthcare reform to ensure policies address real needs. 

Establishing robust oversight through independent regulatory bodies ensures compliance with ethical and operational standards, while proactive planning and clear communication during emergencies restore faith in the system's ability to manage crises.

Public trust serves as both a prerequisite and a product of a functional healthcare system, underpinning its ability to deliver effective, equitable, and patient-centred care. In the absence of trust, even the most well-intentioned reform efforts risk falling short of their objectives, as public scepticism can undermine the utilisation of healthcare services and adherence to medical advice. 

Thus, building and maintaining trust must be a deliberate and integral component of healthcare reform.

At the interpersonal level, trust requires a focus on fostering respectful and empathetic relationships between healthcare workers and patients. This involves investing in continuous professional development to enhance both technical expertise and communication skills, as well as incorporating training on cultural sensitivity and ethical practice. 

Healthcare providers must demonstrate not only competence but also a genuine commitment to patient welfare, treating individuals with dignity and ensuring their rights to privacy and informed consent are upheld.

Institutional trust hinges on the governance and operational integrity of healthcare organizations. Transparent decision-making processes, public disclosure of institutional performance metrics, and adherence to ethical standards are critical to earning and sustaining public confidence. 

Furthermore, ensuring equitable access to adequately resourced facilities, regardless of geographic or socioeconomic disparities, reinforces the credibility of healthcare institutions. Institutions must also establish effective grievance mechanisms to address patient concerns promptly and fairly, signalling a commitment to accountability and improvement.

Systemic trust reflects the public's confidence in the healthcare system as a whole, which is largely shaped by the effectiveness of government policies and oversight mechanisms. Inclusive policymaking that involves diverse stakeholders, including marginalised communities, ensures that healthcare reforms address real and pressing needs. 

Independent regulatory bodies should oversee compliance with ethical and operational standards, thereby safeguarding the integrity of the healthcare system. Additionally, governments and healthcare authorities must demonstrate their capacity to manage crises effectively, as proactive planning and clear communication during public health emergencies are pivotal to restoring and reinforcing trust.

By prioritising transparency, equity, and accountability across all levels of the healthcare system, governments and healthcare providers can cultivate an environment where trust flourishes. This, in turn, facilitates greater engagement with healthcare services, improved health outcomes, and progress toward a more just and equitable society. Trust is not merely an outcome of a functional healthcare system but a fundamental enabler of its success, requiring continuous effort and commitment from all stakeholders.

Sketch: TBS

Sumit Banik is a public health activist and trainer. 

Disclaimer: The views and opinions expressed in this article are those of the author and do not necessarily reflect the opinions and views of The Business Standard