Negociar y navegar la gobernanza cotidiana para acceder a servicios públicos de salud en los asentamientos informales de la ciudad de Dhaka: Un análisis desde la ecología política
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Introducción: En los complejos espacios urbanos de Bangladesh, las personas que viven en asentamientos informales enfrentan grandes dificultades para acceder a servicios públicos de salud asequibles. A través de un análisis de ecología política, este artículo explora cómo los residentes de estos asentamientos urbanos informales navegan la gobernanza cotidiana para acceder a servicios de salud.
Métodos: Esta investigación cualitativa y participativa se llevó a cabo en dos asentamientos informales de la ciudad de Dhaka, una de las megaciudades más densamente pobladas del mundo. Las historias de 16 familias se recopilaron mediante el método de *Governance Diaries*, que consiste en entrevistas en profundidad repetidas y discusiones grupales realizadas con cada familia durante un periodo de cuatro meses entre febrero y mayo de 2023. El análisis temático se realizó aplicando el marco de la Ecología Política Urbana (EPU).
Resultados: Los residentes emplearon diversas estrategias para acceder a servicios públicos esenciales de salud (atención médica, agua, saneamiento) negociando con proveedores de servicios y movilizando redes locales de gobernanza. El éxito de estas negociaciones estuvo determinado por el nivel socioeconómico de los residentes, su acceso a información, afiliaciones políticas y redes sociales. La capacidad de gestionar los mecanismos de gobernanza para acceder a servicios públicos de salud dependió de tres recursos interrelacionados: 1) Recursos financieros (apoyos económicos internos y externos); 2) Recursos sociales (redes sociales y conexiones con actores de gobernanza y ONG); 3) Recursos personales (habilidades de negociación, posiciones sociales y políticas, y patrimonio personal).
Las limitaciones en cualquiera de estos recursos restringieron el acceso a los servicios.
Conclusión: Los recursos personales, sociales y financieros influyen en el grado en que los residentes de asentamientos informales pueden acceder a servicios públicos de salud. Fortalecer estos tres tipos de recursos es esencial para mejorar la capacidad de los distintos residentes de participar en las redes locales de gobernanza y mejorar su acceso a los servicios públicos de salud. Se requiere acción para avanzar hacia la cobertura universal de salud en Bangladesh y asegurar que las poblaciones urbanas marginadas tengan acceso equitativo a servicios esenciales de atención médica.
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