The Public Health Care Bureaucracy: Narratives from Rural Clinics

Abstract

This chapter explores how the localization of health care bureaucracy takes place in local socio-economic and political contexts and is shaped by existing power relations, kin networks, social hierarchy and gendered relations. I describe how the local form of bureaucracy (and modernity) has deepened the existing social inequality, especially the disparity in health. I address the reasons why and how both bureaucrats (care providers) and non-bureaucrats (care receivers) are bound to compromise their position, status and expectations with the structure of local bureaucracy in public health centres in Bangladesh. This chapter demonstrates that, in practice, bureaucracies synthesize several native contexts simultaneously. It also shows that bureaucracy is not autonomous in terms of its forms and actions; it is neither Western nor traditional. Rather, in practice, it is a variable social actuality that combines both the essential elements of rational bureaucracy and the local contexts in terms of discipline and flexibility in everyday actions. I describe how this has mainly resulted from wider sociocultural and historical factors of the locality: the postcolonial political system, extreme social hierarchy, the frustration of the populace towards the imagined state, poor governance and corruption within the country.