From home to clinic and from family planning to family health: client and community responses to health sector reforms in Bangladesh.

Debates about the future of Bangladesh’s government health program are not happening in an empirical vacuum; there is relevant evidence to be gleaned from the NGOs’ experience. In this comment we highlight some of the lessons learned from the NGO process that may inform the critical decisions and processes ahead as the government designs and implements reforms under the HNPSP. Our recommendations are based on data from a recently completed three-year multimethod qualitative study examining NGO program implementation and the ways in which clients communities and program staff have responded to policy changes and adapted to new service delivery norms and practices. For our study we collected data from five USAID–run NGO sites two urban and three rural from January 1998 through July 2000 (with retrospective questions about the time frame prior to and during the initial transition period which began in 1997). This comment is based on data from approximately 500 in-depth semistructured interviews conducted with clients clinic staff and community members (which included some husbands of female clients). (excerpt)