Ensuring access of common people to public health centres

Bangladesh is such a country where poverty prevails at its gravest rate, income inequality is enormous, governments have been really inefficient here historically and the effective literacy rate is low. Basic primary health-care services are not accessed equally; marginalised people of rural Bangladesh are treated in a highly discriminatory nature to access the health facilities.
Here, it is not race or cast that are the basic things behind this; the basic thing is that in a given corrupt socioeconomic background, where 'transparency' and 'accountability' are rarely practised (especially in the public health centres). This is a typical scenario.
But I think and believe that, if the illiterate or even voiceless poor people get the notion about what 'transparency' and 'accountability' are, they will somehow manage their rights to be served equally. This may take time, but presumably will happen surely.
Still on the ground I stand strongly is that as 'conscientisation' (awareness might be an easier term, but to me 'conscientisation' catches the thing better) among the mass of the people about the above stated has made the magic.
But there are already a number of awareness programmes focusing on health issues that are being implemented by the development agencies in rural Bangladesh. In this situation, what new awareness programme am I shouting for?
In spite of some very rare exceptions, all the health awareness programmes have aimed to improve the knowledge level on health and hygiene issues; they have not been aimed to promote the knowledge that primary health care facilities are a right for all. Very often, the common people just think that they are getting the facilities (no matter how small an amount they receive) just because they are lucky enough. Thus, they do not demand equitable access to health facilities.
In this situation, the corrupt doctors do not serve the common people well, take bribes, do not maintain office time at the public health centres (rather they prefer to run private clinics for their own profit during their office time; of course, all are not corrupt, but this is mostly the general picture). Common people most often do not complain about this simply because lack of awareness.
Common people should know that primary health facilities are not only their right, but also that the providers are bound to be 'transparent' and 'accountable' to the people.
This is where our research challenge appears. I really do not know the answer, but I have some ideas about it. As the general people are still effectively illiterate, the awareness programme should have the form of visualisation rather than some boring notices at the centres. Media can work tremendously in this case, especially the electronic media (radio and television).
But as a poverty-ridden country, these components are still not accessed by the common people. I would like to share my views in this regard. One experimental hospital should be equipped with pictures that will tell everything to the illiterate people. Middlemen take money from the common people to supply the information. Information should have a pictorial form so that anyone can get the information.
The experimental health centre can be compared to a control health centre where no such interventions are being implemented to know the net benefits of it. Spill-over or demonstration effects can be calculated by comparing them with a nearby health centre (without such interventions) treated as experimental control.
This is said very easily. But as a real action research this will be really tough to design and administer (and ethics should be maintained strictly). But I know that if our researchers take the risks we can depict the real picture and suggest the way out of it.
The writer is a Research Associate of Human Development Research Centre (HDRC). This essay has been selected and published in an international anthology by the Global Forum for Health Research, one of the largest and reputed forums for health research in the world. The writer can be contacted through his e-mail [email protected]