Engaging and Mobilizing Stakeholders for TB Service Contracting in Bangladesh - Case Study

With rapid economic growth, Bangladesh has attained lower middle-income country status and aims to become an upper middle-income country by 2031 and a high-income country by 2041. This improvement in economic status will affect Bangladesh's eligibility for international development support, and many development partners will eventually reduce their funding for the health sector. The National TB Control Program (NTP) is largely funded and technically supported by the Global Fund to Fight AIDS, Tuberculosis and Malaria, the US Agency for International Development (USAID), and other international donors. The NTP is in the process of mobilizing domestic resources for the TB response to cover existing funding gaps and gradually complement and eventually replace the Global Fund and other donor funds. The government has extensive experience contracting with the private sector, but there is little precedence or experience with government contracting of health services or with non-governmental organizations (NGOs) and civil society organizations (CSOs). The capacity of both the government agencies and NGOs to manage contracts under the public procurement system needs to be strengthened. USAID's HS4TB project developed a stakeholder engagement plan (SEP) for building buy-in for the establishment of government-led contracting of TB services in Bangladesh. The SEP's implementation has helped introduce the concept to a critical mass of stakeholders, including policymakers in the health and non-health sectors, planners, implementers, and stakeholders from relevant development and implementing partners. Through a strong governance approach and continued engagement, orientation, and advocacy, the position and perceptions of stakeholders have shifted to a better understanding of the benefits of, and rationale for, health services contracting in the evolving economic context of Bangladesh. The SEP includes objectives such as identifying, categorizing, and mapping the stakeholder landscape related to TB service contracting, maintaining an up-to-date contact list of change agents, understanding the level of engagement and influence of important stakeholders, and providing clear messages for policymakers, government officials, NGOs/CSOs/private sector representatives, and other stakeholders. The SEP helps guide the Health Economics Unit (HEU) and the NTP in how best to approach each stakeholder related to government-led contracting of TB services. The SEP development process was guided by globally recognized best practices for communication and advocacy-related plans, including the SMART Advocacy approach. The advocacy cycle consists of nine steps divided across three phases: build consensus, focus efforts, and achieve change. Foundational TB contracting documents, including an Assessment Report on Contracting of TB Services and a Roadmap & Action Plan for Contracting of TB Services, provide recommendations on systems improvements and outline concrete steps, roles, and responsibilities, and a timeline for introducing domestically financed contracting of TB services. The Government of Bangladesh is anticipated to begin contracting TB services in 2024 in select districts under the fifth Health, Population, and Nutrition Sector Program (HPNSP). The Bangladesh experience has lessons for implementers embarking on similar reform efforts in other countries. The SEP has been instrumental in guiding the implementation of TB contracting and has helped shift the position and perceptions of stakeholders to a better understanding of the benefits of, and rationale for, health services contracting in the evolving economic context of Bangladesh.