Hybrid Governance: Negotiating Justice for Health Services in Informal Urban Settlements in Dhaka, Bangladesh

This paper examines the complex governance landscape of public health service delivery in the informal urban settlements of Dhaka, Bangladesh, through the application of Hybrid Governance and Urban Political Ecology (UPE) frameworks. Rapid urbanization and insufficient state capacity have led to the development of informal settlements, where conventional governance structures are absent. In this context, hybrid governance systems emerge, which are characterized by collaborations and conflicts among formal authorities, non-state and informal actors, and local community members. In-depth empirical data were drawn from multi-method qualitative research applying community-based participatory research (CBPR) approaches, conducted between 2021 and 2023, in two informal urban settlements in Dhaka, Bangladesh. This paper introduces a “Multi-layered Hybrid Governance” (MHG) framework that explains the complex governance arrangements of public health service delivery in informal urban settlements. The MHG framework features the fragile yet resilient nature of collaborations between formal authorities (state-level governing bodies), formal governance actors (elected local government representatives) and their informal representatives (community leaders, local elites), private service providers (including NGOs), and community members, revealing how public health services are negotiated and legitimized within these informal contexts. The findings suggest that hybrid governance is a form of community resilience that can enhance service delivery in the absence of effective state intervention. However, it can also reinforce existing inequalities and introduce new challenges to residents, especially to those without political connection or strong social networks. This paper urges policymakers and researchers to look beyond conventional health governance models and recognize the limitations of the existing systems. By presenting the MHG framework as an analytical tool for learning health systems from the perspectives of those on the margins, we advocate for more inclusive, resilient governance approaches for promoting justice and ensuring sustainability within fragmented urban health systems.