The critical role of youth engagement in reforming local healthcare

Ensuring local healthcare needs through community involvement is vital for Universal Health Coverage. Photo: Unicef

Most countries, including Bangladesh, have ratified Universal Health Coverage (UHC) as a target under the Sustainable Development Goals (SDG). According to the World Health Organization (WHO), UHC means "access to key promotive, preventive, curative, and rehabilitative health interventions for all at an affordable price." In essence, UHC is achieved when every citizen can access necessary health services without facing financial hardship.

While access to health services and financial protection are central to UHC, community involvement is also vital for its success. Community engagement, defined as the inclusion of communities in designing and implementing health programs, is essential to ensuring that healthcare addresses local needs. 

However, there is sometimes a tendency to reduce UHC to financial arrangements, overlooking the importance of community participation.

In Bangladesh, there have been efforts to involve communities in healthcare delivery, though involvement in planning and monitoring remains limited. Bangladesh Health Watch (BHW), a civil society initiative, advocates for health reforms and change. 

Over the past few years, BHW has been piloting a sustainable community engagement model in eight districts, covering each division in the country.

Last week, I had an opportunity to visit some of the BHW activities in Netrokona district. One of the engagements was a multi-stakeholder meeting/public hearing of the District Health Rights Forum, a platform of eminent civil society members in the district, with the superintendent and other senior members of the district hospital. 

The forum also invited a few patients to listen to their opinion on the services offered by the hospital. The learning from the meeting was invaluable as the participants narrated their own experiences. I thought this was a good example of an accountability mechanism at the grassroots level. 

After a formal presentation on the state of health and the expectations from hospital administration, the participants were encouraged to share their own experiences. While some of them commended the recent improvement in selected areas such as cleanliness, fixing of doors in the wards, separate queues at the registration area, and use of ID cards by hospital functionaries, a great majority sounded their continued frustrations. 

Some of the common complaints included undue priorities given to the more influential patients in drug distribution, an aya pushing injections (instead of a nurse), continued tyranny of the drug company representatives, rent-seeking for services provided, and misbehaviour by the hospital staff. 

A participant who happened to be a leader of the July Anti-discrimination Movement narrated her own story. When she brought her deceased brother for a postmortem, she was asked to pay Tk15,000. After negotiations, it was settled for Tk5,000. 

The superintendent, who listened patiently, was in a state of denial. In some cases, he sympathised and expressed his helplessness in combating the woes the patients faced. The meeting ended with a new commitment from the authorities to improve the quality of services in the hospital. This resonated well with my visit to the district forum in Khagrachhari last year. 

It was good to see how the forum in Netrokona, sponsored by BHW through its local partner Sabalamby Unnayan Samity (SUS), has set in place some accountability mechanisms for the health sector in the district.

The other purpose for which I was eagerly looking forward was the opportunity to meet some of the local organisers of the July Anti-discrimination Movement and to get their wisdom on strengthening the accountability mechanism.

At a meeting organised by SUS, several young activists joined, three of whom were local samannayak or coordinators. At the outset of the meeting, they clarified that they didn't want to be identified as samannayak but rather as 'rights vigilant student activists'. 

Of the three, one was a final-year undergraduate student in English literature, the second one was a final year diploma student in livestock, and the third one was a first-year undergraduate student in Bangla literature.

All of us on the visiting team were deeply impressed by talking to them. They were articulate, knowledgeable, and conscious of broader rights issues. 

We found them pulsating with energy and deep commitment for society. They were aware of the work of the local Health Rights Forum and expressed keen interest in taking it forward. 

However, they were also mindful of their limitations but wished to be considered as associates in this important work. They would also be happy to work as a group in achieving some of the health systems goals, such as activating the different management committees at various levels of primary health care, including the community clinics. 

The youths at the helm of the July Anti-discrimination Movement are the movers of the political changes unleashed at the national level. A question that has been whirling in our minds is how such an indomitable energy can be used to contribute to problem solving at the local levels. 

After this trip to Netrokona, I tend to believe more and more that the youths at the local levels are capable and willing to help initiate the necessary reforms at the grassroots level. As they said, they are ready to assist civic platforms such as the District (and Upazila) Health Forum in carrying forward the movement for intended changes. 

While the leadership in Dhaka takes time to talk about reforms at the national level, we shouldn't let this opportunity at the local level go to waste and just go by.

Sketch: TBS

Ahmed Mushtaque Raza Chowdhury is the convener of Bangladesh Health Watch. 

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.