‘Nothing About Us Without Us’

 Citizens’ Hearings on the health of the world’s women and children

A total of six Citizens' Hearings were held in different parts of the country, in Khulna, Mymensingh, Joypurhat, Cox’sbazar, Bhandaria and Dhaka over the last several months. Various sections of the citizenry including NGOs and civil society, teachers, local government representatives, community leaders, government officials, academicians, journalists, religious leaders took part in the hearings. 

The recommendations coming out of the citizens hearings were thorough and comprehensive. For instance, child marriage, lack of resources at the health facilities, scarcity of physicians, lack of awareness on the part of people in rural areas, accountability of health service providers, institutional delivery, role of media have been mentioned time and again at all the hearings


CITIZEN-LED RECOMMENDATIONS

The recommendations coming out of the citizens hearings were thorough and comprehensive. Noticeably, there have been a number of suggestions that were made at all the hearings. For instance, child marriage, lack of resources at the health facilities, scarcity of physicians, lack of awareness on the part of people in rural areas, accountability of health service providers, institutional delivery, role of media have been mentioned time and again at all the hearings.

Recommendations from all Hearings:

  • Awareness about the facilities available as well as importance of availing those services is often lagging among mass people, particularly women. For instance, the importance of vaccination is not often properly appreciated. Pregnant women attend ANC sessions but found reluctant about the PNC ones. The same is noticed regarding the course of folic acid tablet. Counselling service could be introduced to encourage pregnant women to pursue health seeking behaviour.
  • There should be strict monitoring system in place to watch over the functioning of community clinics. Lack of resources and poor accountability of the community clinics sometimes discourage people to go to the community clinics. There can be an MBBS doctor at every community clinic at least once a week. Government should focus on improving the existing ones instead of building new ones. Moreover, the community groups and support groups need to be activated and strengthened to create accountability of health care facilities at grassroots level.
  • Ensure and increase institutional delivery at Upazilla and Union level with community skilled birth attendants, recommended at the Mymensingh hearing. Establishment of child- friendly and breast feeding corners in every Upazila and Union level health facilities was also suggested at the Mymensingh hearing. There was also suggestion for establishing SAM (Severe Acute Malnutrition) corner in every Upazila and district level hospital.  
  • As more and more women are working the number of day-care centers should be increased. Child-friendly spaces should be set up in large number so that working mothers can put their young children there. Special program should be introduced to garments where a large number of women work in close proximity. 
  • Nutrition, child and maternal health issues need to be included in text book curriculum of schools and madrasas. Teachers can play an important role by sensitizing students about healthy living and proper nutrition.
  • Special programs should be taken for indigenous people and those who live in hilly areas, coastal belt and char areas.
  • The poor can be provided health card which would enable them to get free treatment while the solvent people should bear the expense for the treatment they receive.
  • Inter -ministerial, inter-sectoral and GO-NGO coordination around child and maternal health issues need to established and strengthened, recommended the hearing at Bhandaria, while law maker Saber Hossain Chowdhury, at Dhaka hearing, outlined a model of accountability mechanism through a partnership among the stakeholders.
  • Saber suggested to build a team comprised of health care seekers, physicians, researchers, GO and NGO officials, civil society representatives including media personnel and public representatives including the law makers to improve the capacity and efficiency of our health sector.
  • In many cases it is found that common people do not have the tendency to seek for health care. We need to create awareness in responding to the case of experiencing irregularities in getting health services.
  • Comparative studies should be done for estimating justified budget allocation for health sector. We will need to gather information and findings from every sphere of the society and to disseminate them.
  • Parliament would be the centre of implementing the SDG in health sector. The law makers, in the parliamentary standing committee on health ministry, can make the government and the health ministry accountable by conducting similar hearings in the parliament.
  • Lawmakers can pursue for increased budget allocation for health sector.
  • Qualitative analysis of the budget expenditure should get priority in assessing the progress of government programs.
  • We need to ensure accountability of the NGOs of health sector as well.
  • Child marriage has direct bearing on women and children’s health, so greater efforts need to be put in to reduce child marriage rate. Introducing a national database for birth registration would help to reduce child marriage.
  • Ensure discussion about child and maternal health in every faith based institutions so that people grow aware of these issues.
  • Ensure health insurance for every citizen (Universal Health Coverage), suggested at the Joypurhat hearing.
  • Lunch E-health services (skype, other telemedicine) for people living in rural and remote places.
  • Ensure food safety and security. Strengthen measures to control adulterous food which poses serious threat to child and maternal health.
  • Media need to be sensitized so they help create public awareness on child and woman health.

Observations/ Challenges

  • City corporations are responsible for urban health which has been found impractical through the experience.
  • We need to find out the ways to ensure the presence of physicians at the facility centers.
  • Representatives from the young citizens said at Dhaka hearing that the duty doctors often were not available at their chambers in public hospitals causing severe sufferings of the patients in long queues.
  • People, living one-step outside the hospital premises, do not get health care in the urban areas, why and how could it be solved?
  • People are forced to go to private hospital as they do not get well-behave in public hospitals causing a rise in cost.
  • Standard of treatment in private hospitals in question!
  • People, the center of initiatives in health sector, are often missing in framing policies, strategies and programs and in implementing them.
  • Can volunteering and non-binding approaches from the stakeholders other than the government bring any significant changes to the health sector scenario?

Read the full Bangladesh Country Report from the Global Citizens' Hearing Report now.