Impact Case Study –  A “systems approach”: Building trustworthy relationships between urban marginalised people and service providers to improve healthcare services in Bangladesh

In Bangladesh, equitable access to good quality health services is an urgent public health concern for urban informal settlements that are characterised by poor housing conditions, high population density, lack of basic essential services and tenure insecurity. Residents of these settlements live with continuous structural and spatial vulnerabilities and marginalisation. The most vulnerable groups (MVGs) include daily wage earners, single female household heads, pregnant women, elderly people, persons with disability (PWD), ethnic minorities (e.g. Bihari, Harijan, Muchi, etc.) and climate-vulnerable people. MVGs face the greatest disparities in accessing public services, particularly health services. Power imbalances and inequalities play a significant role in perpetuating these gaps. This case study focuses on how elements of a “systems approach” the facilitated active participation and empowerment of informal and low-income settlement communities and established more trusting relationships with health service providers and duty-bearers.