Restructuring the health system: experiences of advocates for gender equity in Bangladesh.

This paper illustrates how advocates for gender equity succeeded in influencing the restructuring of the health system in Bangladesh in the mid-1990s but failed to influence its implementation. Using published and unpublished documents and personal interviews, it traces the changing fortunes of health sector reforms and reform advocates from 1995 to 2002 and analyses the major challenges and strategies involved. It explores the gains advocates for gender equity made in the design of the reforms and also their limitations to counter some of the inherent risks. The paper highlights the gaps between the design and implementation of reforms. It argues that the key factor for success during the design of reforms was the participation of civil society, which enabled a large number of women, particularly poor women, to engage with the design of reforms. During the implementation phase, however, reforms became a government-donor driven programme disconnected from civil society and space for women's voices became limited. When a new government assumed power in 2001, opponents of reform succeeded in halting the restructuring of the health system, in part because civil society was no longer engaged with the reform process and registered little protest.