Abstract:
Primary Health Care (PHC) is considered to be a crucial model for achieving the health developmental goal of 'health for all' (Chowdhury, 1990; Perry, 2000). In line with the Alma Ata Declaration on PHC, the Government of Bangladesh has adopted the policy of providing quality PHC to achieve health for all, with special focus on the rural population including the poor. This research aims at better understanding of the ways health professional power may impact on the quality of primary health care services in public health facilities. Evidence suggests that health care providers' exercise of power in Bangladesh, as in other developing countries, has a negative influence on health care services (Rahman, 2010). Previous studies have mainly focused on service utilisation (Islam, Chowdhury, & Farjana, 2008), the collection of 'unofficial' user fees (Killingsworth et al., 1999), the influences of socio-demographic variables on the health status of people (Zainab, Sharmin & Islam, 2001; Islam et al., 2008); and have tended to ignore issues of power and the quality of health care. This research applies narrative interview method as power is embedded in day-to-day relationships. Users from rural communities are invited to voice experiences and viewpoints regarding power and the quality of health care. I argue that professional power influences the quality of health services in important ways and poor quality is not merely due to resource constraints. The study suggests that providers' medical power, reflected in provider-centric care and inadequate consultation time, causes patient dissatisfaction. Also, providers' management power appears to be associated with mismanagement of scarce resources. The research further indicates that a powerful informal network of health service providers helps sustain professional dominance in the context of weak user resistance. I propose that community actions aimed at improving PHC quality may translate growing individualistic resistances to professional power into collective resistance.
