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Despite being a resource poor country, Bangladesh has achieved impressive health gains which make it an example for other developing countries. Over the last decades key health indicators like life expectancy and coverage of immunisation have improved significantly while infant mortality, maternal mortality and fertility rates have dropped considerably. But most of these achievements are mainly quantitative while qualitative improvement is negligible. Poor access to services, low quality of care, high rate of maternal mortality and poor status of child health still remain as challenges of the health sector. This article reviews the health programmes undertaken since independence and the system itself to see which aspects of the policy have contributed to these achievements and challenges. The findings show that the healthcare plans and policy have actually helped to expand services causing quantitative advances while managerial weaknesses and governance problems are the main factors inhibiting qualitative improvement. Finally, the article puts forward some suggestions to address these challenges.

As is the case elsewhere in Asia, urbanization is growing at a rapid pace in Bangladesh. With the increased urbanization, the basic amenities of life are not expanding for the urbanites. Rather, the increased populations have been exerting continuous pressure on the existing limited facilities. The poor, who constitute a large portion (45 per cent) of the urban population, are the principal victims of this predicament and are significantly disadvantaged in access to basic services, particularly public health services. Urban governance has yet to be efficient enough to deal with this urgent issue. The country still lacks adequate policy direction for urban public health and the management of existing services is also quite inefficient. This paper attempts to identify the weaknesses of urban governance that result in the poor having inadequate access to public and primary health services by reviewing the existing policies and institutional arrangements for the provision of services and by examining the extent to which they are put into practice in terms of ensuring access to these services for the urban poor. Thus the study seeks to identify the inadequacies of the policies and practices contributing to the lack of primary and public health services for the urban poor. It draws on the findings of an empirical study conducted in four slums of the capital city of Bangladesh.

We examined the quality of publicly provided primary healthcare service in two different rural settings: USA and Bangladesh. Using both primary and secondary data, the quality of primary healthcare services was examined across four dimensions: access, equity, responsiveness and citizen's influence over services. Findings demonstrate that apart from responsiveness, the US underperforms across all other dimensions of quality. Compared with the US, Bangladesh fared worse in almost all indicators other than physically accessibility. Wider political economy factors that shaped the quality of service were the colonial legacy, political competition, the economic system and social inequality. Copyright © 2018 John Wiley & Sons, Ltd.

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