Negotiating and navigating everyday governance for public health services in Dhaka City’s informal settlements: A political ecology analysis
Article Sidebar
Main Article Content
Abstract
Introduction: In Bangladesh’s complex urban spaces, poor people living in cities’ informal settlements struggle to access affordable public health services. Through a political ecology analysis, this paper explores how residents in informal urban settlements navigate everyday governance to access health services.
Methods: This qualitative participatory research was conducted in two informal settlements in Dhaka city, one of the world’s most densely populated megacities. Stories of 16 families were captured through the Governance Diaries method, where repeated in-depth interviews and group discussions were conducted with each family over a period of four months between February and May 2023. Thematic framework analysis was conducted by applying the Urban Political Ecology (UPE) framework.
Results: Residents employed various strategies to access essential public health services (healthcare, water, sanitation) by navigating local governance networks and negotiating with service providers. Success in these negotiations was shaped by residents’ socioeconomic status, access to information, political affiliations, and social networks. The ability to manage governance mechanisms for accessing public health services relied on three interconnected resources: 1) Financial resources (internal and external financial support); 2) Social resources (social networks - connections with governance actors and NGOs); and 3) Personal resources (negotiation skills, social and political positions, and personal wealth). Limitations in any of these resources restricted access to services.
Conclusion: Personal, social, and financial resources influence the degree to which informal settlement residents can access public health services. Supporting the development of these three resources is crucial for enhancing the ability of diverse residents to engage in local governance networks and improve their access to public health services. Action is required to advance universal health coverage in Bangladesh and ensure that marginalised urban populations have equitable access to essential healthcare services.
Downloads
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors of content published in JCSH retain the copyright to their works.
References
Cornea NL, Véron R, Zimmer A. Everyday governance and urban environments: Towards a more interdisciplinary urban political ecology. Geogr Compass. 2017;11(4):e12307.
Rashid SF, Kabir SS, Ozano K, Theobald S, Aktar B, Siddika A. Scarcity and resilience in the slums of Dhaka city, Bangladesh. In: Manderson L, Burke NJ, Wahlberg A, editors. Viral Loads [Internet]. London: UCL Press; 2021 [cited 2025 Jun 1]. p. 281–300. Available from: https://www.jstor.org/stable/j.ctv1j13zb3.21.
Arefin S, Rashid T. The urban poor in Dhaka: perspectives on the right to the city. JURA [Inter-net]. 2021 Feb 3 [cited 2025 Jun 15];13(1). Available from: http://www.jurareview.ro/chapters/get_chapter/158.
Arias-Granada Y, Haque SS, Joseph G, Yanez-Pagans M. Water and sanitation in Dhaka slums: Access, quality, and informality in service provision. Water Glob Pract [Internet]. 2018 Aug [cited 2025]. Available from: http://www.worldbank.org/research.
Banks N. Livelihoods limitations: The political economy of urban poverty in Dhaka, Bangla-desh. Dev Change. 2016;47(2):266–92.
Rashid SF, Aktar B, Farnaz N, Alam W, Ali S, Manzoor F, et al. Impact of COVID-19: Lived experience of the urban poor in slums during the shutdown [Internet]. Dhaka: BRAC James P Grant School of Public Health; 2020 [cited 2020 Aug 5]. Available from: http://documents.worldbank.org/curated/en/60751153433712.
Rashid SF. Poverty, gender and health in the slums of Bangladesh: Children of Crows [Internet]. 1st ed. London: Routledge; 2024 [cited 2025 Jun 11]. Available from: https://www.routledge.com/Poverty-Gender-and-Health-in-the-Slums-of-Bangladesh-Children-of-Crows/FaizRashid/p/book/9781032740607.
Adams AM, Islam R, Ahmed T. Who serves the urban poor? A geospatial and descriptive analy-sis of health services in slum settlements in Dhaka, Bangladesh. Health Policy Plan. 2015;30(suppl_1):i32–45.
Lewis D, Hossain A. Local political consolidation in Bangladesh: Power, informality and pat-ronage. Dev Change. 2022;53(2):356–75.
Goodfellow T. Political informality: Deals, trust networks, and the negotiation of value in the urban realm. J Dev Stud. 2020;56(2):278–94.
Hossain S. The informal practice of appropriation and social control: Experience from a bosti in Dhaka. Environ Urban. 2013;25(1):209–24.
Banks N, Lombard M, Mitlin D. Urban informality as a site of critical analysis. J Dev Stud. 2020;56(2):223–38.
Anderson C, Joshi A, Barnes K, Ahmed A, Ali M, Chaimite E, et al. Everyday governance in areas of contested power: Insights from Mozambique, Myanmar, and Pakistan. Dev Policy Rev. 2023;41(S1):e12683.
Cornea N. Urban political ecology. Oxford: Oxford University Press; 2019. (Oxford Bibliog-raphies).
Arise Consortium. Improving accountability for equitable health and well-being in urban in-formal spaces. Prog Dev Stud. 2024:1–20.
Abimbola S. Health system governance: A triangle of rules. BMJ Glob Health. 2020;5(8):e003598.
Adams EA, Juran L, Ajibade I. ‘Spaces of exclusion’ in community water governance: A femi-nist political ecology of gender and participation in Malawi’s urban water user associations. Geoforum. 2018;95:133–42.
Aguiar R, Keil R, Wiktorowicz M. The urban political ecology of antimicrobial resistance: A critical lens on integrative governance. Soc Sci Med. 2024;348:116689.
Yiftachel O. Critical theory and ‘gray space’: Mobilization of the colonized. City. 2009;13(2–3):246–63.
Aßheuer T, Thiele-Eich I, Braun B. Coping with the impacts of severe flood events in Dhaka’s slums: The role of social capital. Erdkunde. 2013;67(1):21–35.
Brondizio ES, Ostrom E, Young OR. Connectivity and the governance of multilevel social–ecological systems: The role of social capital. Annu Rev Environ Resour. 2009;34:253–78.
Mitlin D. Politics, informality and clientelism: Exploring a pro-poor urban politics [Internet]. Rochester (NY): SSRN; 2014 [cited 2025 Jun 1]. Available from: https://papers.ssrn.com/abstract=2439239.
Qayums N. Beyond institutions: Patronage and informal participation in Bangladesh’s hybrid regime. New Polit Sci. 2021;43(1):67–85.
Swapan MSH, Khan S. Urban informality and parallel governance systems in Bangladesh. Int Plan Stud. 2022;27(1):1–17.
Zaman S, Hossain F, Matin I. Ethnography of community governance: A case of COVID-19 response of an urban slum in Bangladesh. Community Dev J. 2023;58(2):247–64.
Creswell JW, Creswell JD. Research design: Qualitative, quantitative and mixed methods ap-proaches. Thousand Oaks (CA): Sage; 2018.
Jull J, Giles A, Graham ID. Community-based participatory research and integrated knowledge translation: Advancing the co-creation of knowledge. Implement Sci. 2017;12:150.
Wallerstein N, Duran B, Oetzel J, Minkler M, editors. Community-based participatory research for health: Advancing social and health equity [Internet]. 3rd ed. San Francisco: Jossey-Bass; 2018. Available from: https://eur-lex.europa.eu/legal-content/PT/TXT/PDF/?uri=CELEX:32016R0679.
Ozano K, Alam W, Aktar B, Okoth L, Chumo I, Quach JA, et al. Seven core competencies and conditions for equitable partnerships and power sharing in community-based participatory re-search. BMJ Glob Health. 2024;9(11):e015497.
Aktar B, Ozano K, Rashid SF, Waldman L, Theobald S. Hybrid governance: Negotiating justice for health services in informal urban settlements in Dhaka, Bangladesh. Health Policy Plan. 2025. doi: 10.1093/heapol/czaf08.
Loureiro M, Joshi A, Barnes K, Chaimite E. Governance diaries: An approach to governance research from the ground up. Brighton: Institute of Development Studies; 2020.
Swain J. A hybrid approach to thematic analysis in qualitative research. SAGE Res Methods Cases. 2018.
Bingham AJ. From data management to actionable findings: A five-phase process of qualitative data analysis. Int J Qual Methods. 2023;22.
Goldsmith LJ. Using framework analysis in applied qualitative research. Qual Rep. 2021;26(6):2061–76.
Truelove Y, Cornea N. Rethinking urban environmental and infrastructural governance in the everyday. Environ Plan C Polit Space. 2021;39(2):231–46.
Abdallah W, Chowdhury S, Iqbal K. Access and fees in public health care services for the poor: Bangladesh as a case study. Oxf Dev Stud. 2022;50(3):209–24.
Binyaruka P, Balabanova D, McKee M, Hutchinson E, Andreoni A, Ramesh M, et al. Supply-side factors influencing informal payment for healthcare services in Tanzania. Health Policy Plan. 2021;36(7):1036–44.
Schaaf M, Topp SM. A critical interpretive synthesis of informal payments in maternal health care. Health Policy Plan. 2019;34(3):216–29.
Shafique S, Bhattacharyya DS, Anwar I, Adams A. Right to health and social justice in Bangla-desh. BMC Med Ethics. 2018;19:61.
Adams AM, Islam R, Yusuf SS, Panasci A, Crowell N. Healthcare seeking for chronic illness among adult slum dwellers in Bangladesh. PLoS One. 2020;15(6):e0233635.
Heynen N, Kaika M, Swyngedouw E. Urban political ecology: Politicizing the production of urban natures. In: In the nature of cities. Abingdon: Taylor & Francis; 2006. p. 1–20.
Mojumder MJH, Panday PK. GO–NGO teamwork for strengthening local governance. South Asian Surv. 2022;29(1):81–102.
Rahman S, Tasnim F. The role of NGOs in ensuring local governance in Bangladesh. Asia Pac J Reg Sci. 2023;7(3):1007–34.
Abimbola S. The foreign gaze: Essays on global health [Internet]. Marseille: IRD Éditions; 2024 [cited 2025 Jun 20]. Available from: https://books.openedition.org/irdeditions/60564.
Lewis D. Organising and representing the poor in a clientelistic democracy. J Dev Stud. 2017;53(10):1545–67.
van de Pas N, de Kort D, Koster M, van Meijl T. The political potential of urban informality in the Global North. J Dev Soc. 2022;38(2):224–43.
Ranganathan M. ‘Mafias’ in the waterscape: Urban informality and public authority in Banga-lore. 2014;7(1).
Hackenbroch K, Hossain S. The organised encroachment of the powerful. Plan Theory Pract. 2012;13(3):397–420.
Rahman S, Tasnim F. The role of NGOs in ensuring local governance in Bangladesh: from the perception of other actors of governance. Asia Pac J Reg Sci. 2023 Mar 30 [cited 2025 May 23];1–28.
Taufiq HA. Role of NGOs in fostering equity and social inclusion in cities of Bangladesh: The case of Dhaka. Fifth Annual International Conference on Sustainable Development (ICSD) [18-19 September, 2017], The Earth Institute, Columbia University: New York, USA; 2017. Availa-ble from: https://ssrn.com/abstract=3912509.
BBC News. A card that fosters national identity in Bangladesh [Internet]. 2012 Jun 19 [cited 2025 Jun 20]. Available from: https://www.bbc.com/news/world-asia-india-18261373.
Roy A. Urban informality: The production and regulation of space. In: Wright JD, editor. Inter-national encyclopedia of the social & behavioral sciences. 2nd ed. Oxford: Elsevier; 2015. p. 818–22.