Battle not over: Comprehensive v.s. selective primary health care in Bangladesh

Background: Arguments between comprehensive and selective approaches to primary health care (PHC) that started from the late 1970s was thought to be resolved by integrating strengths of both. The scenario in Bangladesh, one of the contributors to the formation of PHC concept, has not shown a transition towards integration.

Objectives: The research was conducted to examine health policies and programs in Bangladesh, and to identify constraints to establish a comprehensive PHC system.

Methods: Multiple methods were adopted, including literature review, policy analysis and in-depth interviews with policy makers, government officials, advocates, health providers, international agencies and academics.

Results: Health infrastructure building in Bangladesh was originally aimed at achieving comprehensive, universal PHC coverage. However, resources were diverted from strengthening existing structure to donor-prescribed programs, ranging from population control to HIV/AIDS awareness. These selective programs were designed based on mainstream discourses of development agencies, and did not necessarily meet the need of the society. New models were continuously introduced in Bangladesh, which has been long treated as an experimental field by development partners. These programs were supported by local elites and members of emerging non-governmental organizations, who had little interest in the empowerment of the grassroots - a key element to make comprehensive PHC possible. Discontent from different sectors of the society has not grown strong enough to maneuver the current situation.

Conclusion and implications: Health colonization and health anarchy in Bangladesh mutually strengthened, fueling verticalized interventions without participation of grassroots people. Malfunction of the public health services and civil society also hindered the establishment of an integrated PHC system.