Citizen Charter for Health Care

Management in Bangladesh

Compiled by:
Prof. Mokaddem Hossain
• A citizen is a participatory member of a political
community. Citizenship is gained by meeting the legal
requirements of a national, state, or local government.
A nation grants certain rights and privileges to
its citizens. In return, citizens are expected to obey
their country's laws and defend it against its enemies.
• Qualities of a good citizen
• Obeys the law / Respects authority.
• Contribute to Society and Community/ Performs Civic
Duty.
• Loves his/her country/ Patriotism.
• Courtesy and respect for the rights of others.
• Trust worthy and Honesty.
• Tolerance.
• Accountability.
• Moral Courage.
• A Citizens' Charter represents the commitment of
the Organisation towards standard, quality and
time frame of service delivery, grievance redress
mechanism, transparency and accountability.
• Various Central Government Ministries/
Departments/ Organisations have brought out
their Citizens' Charters.
• A Citizens' Charter represents the commitment of
the Organisation towards standard, quality and
time frame of service delivery, grievance redress
mechanism, transparency and accountability.
Various Central Government Ministries/
Departments/ Organisations have brought out
their Citizens' Charters.
• A Citizens' Charter represents the commitment of
the Organisation towards standard, quality and
time frame of service delivery, grievance redress
mechanism, transparency and accountability.
• Various Central Government Ministries/
Departments/ Organisations of different
countries including Bangladesh have brought out
their Citizens' Charters.
• It was first articulated and implemented in the UK
in 1991 as a national programme. The
basic objective of the Citizens' Charter is to
empower the citizen in relation to public service
delivery.
 • Why is a Citizen Charter important?
• The citizen's charter is a document that outlines
the service commitment of organizations or
service providers towards providing quality, high-
standard services, including mechanisms for
grievance redressal.
• Citizens' Charters initiative is a response to the
quest for solving the problems which
a citizen encounters, day in and day out, while
dealing with the organisations providing public
services.
• The basic objective of the Citizens Charter is to
empower the citizen in relation to public service
delivery.
• Components of a Good Citizens' Charter
• Details of services including standards, quality,
time frame etc. Particulars of grievance redressal
mechanism and how to access it.
• Additional commitments and expectations from
clients such as compensation in the event of
failure of service delivery.
• The Citizen's Charter is not legally
enforceable and, therefore, is non-justiciable.
However, it is a tool for facilitating the delivery of
services to citizens with specified standards,
quality and time frame etc. with commitments
from the Organisation and its clients
• All public services, from hospitals to prison services,
local government offices to fire services, would have to
publish clear targets for levels of service. NHS patients
would have guaranteed time limits for all
consultations, and there were individual Charters for
schools, housing tenants and motorists.Those bodies
that were meeting their defined standards were
granted a "Charter Mark".
• The charter ensures the following:-
• 1) quality by improving services2) choices for the
user3) standards specifying what to expect within a
time frame4) value for the taxpayers' money5)
accountability of the service provider6) transparency in
rules and procedures7) proper code of conduct and
grievance redressal mechanism.
• The Citizen Charter addresses the Patients’ Rights
for appropriate information to the beneficiaries,
grievance redressal and constitution of Hospital
Management Committee for better management
and improvement of hospital services with
involvement of Local Government and NGOs have
been made as a part of the Global Public Health
Standards (GPHS).
• Standards are the main driver for continuous
improvements in quality. The performance of
Public Health Facilities can be assessed against
the set standards. This would help monitor and
improve the functioning of the Health Facilities in
different locations.
• All public services, from hospitals to prison services,
local government offices to fire services, would have to
publish clear targets for levels of service. NHS patients
would have guaranteed time limits for all
consultations, and there were individual Charters for
schools, housing tenants and motorists. Those bodies
that were meeting their defined standards were
granted a "Charter Mark".
• The charter ensures the following:-
• 1) quality by improving services2) choices for the
user3) standards specifying what to expect within a
time frame4) value for the taxpayers' money5)
accountability of the service provider6) transparency in
rules and procedures7) proper code of conduct and
grievance redressal mechanism.
• Model CITIZEN’S CHARTER for Hospitals.
• Access to services in all general hospitals and
clinics. It should provide medical care to all
patients who come to hospital. Emergency
services are available 24 x 7 without any
discrimination.
• The management of this hospital should be
responsible for ensuring the delivery of
services.
• Standards of Services: All hospitals should
provide quality of services on the minimum
assured services set by Public Health
Standards (PHS).
 Patient’s Rights in the Hospital
• 1. Right to access to all the services should be
provided by the Hospital
• 2. Right to Information - including information
relating to your treatment
• 3. Right of making decision regarding treatment
• 4. Right for privacy and confidentiality
• 5. Right to religious and cultural freedom
• 6. Right for Safe and Secure Treatment
• 7. Right for grievance redress mechanism
• 8. Right to Emergency Care
• Referral Services to higher centre in case
facilities for treatment should be available in
the hospital.
• Round the clock ambulance services with
basic life support.
• In serious cases, treatment/management gets
priority over paper work like registration and
medico-legal requirement’s provision should
be there. The decision rests with the treating
doctor.
• OPD services should be available on all
working days excluding weekly and Gazetted
Holidays.
• Various outpatient services should be
available in the hospital are detailed below (as
available):
• Diagnostic services List of tests must be
available with charges are displayed at
respective departments and enquiry counter.
• Provision of Tests should be free for Below
Poverty Line (BPL) patients. Charges can be
waived on showing proof of BPL.
• Complaints & Grievances
• Every grievance will be duly acknowledged.
• Hospital management should settle patient’s
genuine complaints within earliest possible time
of its receipt.
• Suggestions/Complaint boxes are also supposed
to be provided.
• Provision of enquiry counter in the hospital.
• The grievance address committee will address the
grievances of the patients.
• Name, designation and telephone number of the
nodal officer concerned should duly be displayed
at the Reception.
 • Casualty & Emergency Services Facilities
• All Emergency Services are available round the
clock.
• Specialist doctors are available on call from
resident doctors.
• Emergency services should available for all
specialities as listed in the OPD Services.
• Medico legal services should also be available.
• Laboratory Services Timings - Routine tests
should be done in following specialities - a. Bio-
chemistry b. Microbiology c. Haematology d.
Cytology e. Histopathology including Clinical
Pathology.
 Citizen Charter for Health Care Services in
Bangladesh
• In Bangladesh, the Ministry of Health and Family Welfare
(MOH&FW) has introduced Citizen Charter at of all its
health care facilities. As a part this initiative, important
information for patients related to health services will be
displayed in health facilities ranging from tertiary level
hospitals to primary health care centers.
• The clearly visible information promotes citizens’ rights to
information and further encourages claiming rights to
services.
• When a patient arrives at any point of service (e.g. medical
college hospital) he/she can see clearly displayed
information about topics such as types of emergency care
available, service provisions of this particular facility, the
nature of outpatient and inpatient care, the availability of
drugs, and the number of service providers at any point.
• Further, the displayed information informs
patients about their entitlements to get services
and commodities with privacy and confidentiality.
• As part of Citizen Charter, facility managers must
show increased care towards women and infants
through measures such as supplying safe drinking
water, and providing breast feeding corners and
clean lavatories; none of this was available in the
recent past.
• A list of available drugs are also displayed in each
ward in inpatients department of hospitals, along
with information about user fees or cost of
services.
• An additional component of this initiative is
that all government facilities now have
information corners in order to help patients
get proper services. Patients are also given
methods for registering complaints if
sanctioned services are not available or any
disagreement arises.
• During a recent visit to some government
facilities, it was clear that there had been big
changes from before the Citizen Charter. It is a
positive step for accessing information about
quality services and to reduce inequities in
health care.
• However, it was noticed discrepancies between
displayed information and practical
implementation (though this is expected to be
overcome soon).
• It is further expected that all the stakeholders will
come forward to exercise the citizen charter.
• This will help to improve relation among patients
and providers/managers and contribute to the
better utilization of scarce resources in the
Bangladesh health system.
• An individual monitoring and evaluation system
can be commissioned to assess the outcome of
this Citizen Charter initiative to strengthen the
health care system (center for Health Market
Innovation, 2012).