Harnessing pluralism for better health in Bangladesh
This review was published in The Lancet [© 2013 The Lancet] and the definite version is available at: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)62147-9/abstract?rss=yes
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© 2013 The Lancet
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| Accesso online: | http://hdl.handle.net/10361/7643 http://doi.org/10.1016/S0140-6736(13)62147-9 |
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10361-76432018-03-27T04:59:32Z Harnessing pluralism for better health in Bangladesh Ahmed, Syed Masud Evans, Timothy G Standing, Hilary Mahmud, Simeen James P Grant School of Public Health, BRAC University Health services Primary healthcare Pluralism Bangladesh This review was published in The Lancet [© 2013 The Lancet] and the definite version is available at: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)62147-9/abstract?rss=yes How do we explain the paradox that Bangladesh has made remarkable progress in health and human development, yet its achievements have taken place within a health system that is frequently characterised as weak, in terms of inadequate physical and human infrastructure and logistics, and low performing? We argue that the development of a highly pluralistic health system environment, defi ned by the participation of a multiplicity of diff erent stakeholders and agents and by ad hoc, diff used forms of management has contributed to these outcomes by creating conditions for rapid change. We use a combination of data from offi cial sources, research studies, case studies of specifi c innovations, and in-depth knowledge from our own long-term engagement with health sector issues in Bangladesh to lay out a conceptual framework for understanding pluralism and its outcomes. Although we argue that pluralism has had positive eff ects in terms of stimulating change and innovation, we also note its association with poor health systems governance and regulation, resulting in endemic problems such as overuse and misuse of drugs. Pluralism therefore requires active management that acknowledges and works with its polycentric nature. We identify four key areas where this management is needed: participatory governance, accountability and regulation, information systems, and capacity development. This approach challenges some mainstream frameworks for managing health systems, such as the building blocks approach of the WHO Health Systems Framework. However, as pluralism increasingly defi nes the nature and the challenge of 21st century health systems, the experience of Bangladesh is relevant to many countries across the world. Published 2017-01-23T08:49:45Z 2017-01-23T08:49:45Z 2013 Article Ahmed, S. M., Evans, T. G., Standing, H., & Mahmud, S. (2013). Harnessing pluralism for better health in bangladesh. The Lancet, 382(9906), 1746-1755. doi:10.1016/S0140-6736(13)62147-9 01406736 http://hdl.handle.net/10361/7643 http://doi.org/10.1016/S0140-6736(13)62147-9 en http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)62147-9/abstract?rss=yes © 2013 The Lancet |
| institution |
Brac University |
| collection |
Institutional Repository |
| language |
English |
| topic |
Health services Primary healthcare Pluralism Bangladesh |
| spellingShingle |
Health services Primary healthcare Pluralism Bangladesh Ahmed, Syed Masud Evans, Timothy G Standing, Hilary Mahmud, Simeen Harnessing pluralism for better health in Bangladesh |
| description |
This review was published in The Lancet [© 2013 The Lancet] and the definite version is available at: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)62147-9/abstract?rss=yes |
| author2 |
James P Grant School of Public Health, BRAC University |
| author_facet |
James P Grant School of Public Health, BRAC University Ahmed, Syed Masud Evans, Timothy G Standing, Hilary Mahmud, Simeen |
| format |
Article |
| author |
Ahmed, Syed Masud Evans, Timothy G Standing, Hilary Mahmud, Simeen |
| author_sort |
Ahmed, Syed Masud |
| title |
Harnessing pluralism for better health in Bangladesh |
| title_short |
Harnessing pluralism for better health in Bangladesh |
| title_full |
Harnessing pluralism for better health in Bangladesh |
| title_fullStr |
Harnessing pluralism for better health in Bangladesh |
| title_full_unstemmed |
Harnessing pluralism for better health in Bangladesh |
| title_sort |
harnessing pluralism for better health in bangladesh |
| publisher |
© 2013 The Lancet |
| publishDate |
2017 |
| url |
http://hdl.handle.net/10361/7643 http://doi.org/10.1016/S0140-6736(13)62147-9 |
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