Healthcare in the Margins: A Qualitative Study of Healthcare Access and Utilization in Bangladesh’s Informal Urban Settlements

This study investigates healthcare access and health-seeking behavior in informal urban settlements of Bangladesh, focusing on the roles played by key stakeholders in the public, private, NGO, and informal sectors, toward positive health outcomes. Utilizing data gathered from service mapping (N = 5), validation sessions (N = 5) and case studies (N = 15) in five informal urban settlements. The study uncover many important barriers to healthcare access, with those linked to economic and infrastructural shortcomings emerging as particularly critical. Although healthcare is available, public hospitals are overcrowded and have long waiting lists. Poorer patients are often mistreated and fees at private health facilities are unaffordable for many residents. Culturally relevant alternatives, often referred to as informal healthcare providers play an important role in these communities. Local unlicensed pharmacies and Traditional Birth Attendants (TBAs) are particularly prominent. However, they often offer services that include risks such as over-prescribing and insufficient training. Factors including financial stress, low health literacy, and a fragmented healthcare system drive health inequities. This study underscores the importance of enhancing health literacy and education to enable marginalized groups to make effective health choices. The study provides fresh insights into the healthcare needs and associated inequities in these informal urban settlements. These findings reinforce the relevance of SDG 3 goals by emphasizing the need for inclusive, equitable, and community-oriented healthcare approaches to ensure healthy lives and promote well-being for all.