Factors Influencing Inequity in Access to Urban Health Service Delivery in Low Resource Setting Country Bangladesh

Background: Health is considered as constitutional and fundamental right for general people in Bangladesh. Due to poor socio-economic conditions, income disparities, and socio-cultural barriers, many poor people have limited accessibility in health services and also unable to afford quality health care. This study attempts to examine the factors associated with accessibility and affordability of urban health services. Methodology: This is an explanatory research which is being carried out using mixed research approach. Primary data was collected using simple random sampling technique from 150 household’s residents in Sylhet City who have experience in receiving services from the urban public health care centers. This study uses a structured interview schedule including both open ended as well as close ended questions. Moreover, descriptive statistics is used for analyzing field data for understanding accessibility of health services. Results: Data shows 56% respondent think that urban poor people have inadequate accessibility of health services as they have different types of financial difficulties including maintaining medical expenditure. The health system prevail discrepancy between mentioned services in citizen charter and availability of services as education and the existence of superstitions significantly impact on access to public health care but religion and age have a little impact in getting health services. Most of the respondents either satisfied (47%) or highly satisfied (29%) with the cordiality of senior consultants, and almost half of the respondents assumed the standard of cabin service is satisfactory (44%) as well as highly satisfactory (2%); however, wealthy and powerful people of the society always get privileges over disadvantaged people paying extra money or social network to get a cabin. Unfortunately, the professionalism of nurses and 4th class employees of public hospitals are not satisfactory. Moreover, there exists a high level of corruption and bureaucratic resistance in public hospitals which hinders equal access of general people to get services. The economic and cultural factors in this research are not highly influential issues for access to health care, but adequate information is one of the challenges for access to health care. Besides, administrative factors in this study have significant influence on the accessibility of health services. Conclusion: Equal access to health services from public providers are prime need and right for every resident in Sylhet city. Reform in health system management and service provision are useful for promoting accessibility in health services. Therefore, expansion of health coverage, introduction to health insurance scheme, empowerment of urban poor, and ensuring efficient and accountable health service management in public hospital must be ensured for developing adequate health services.