The culture of health regulation and its implications on maternal and reproductive health in South Asia

Abstract

When it comes to regulation of the health sector, the traditional focus has been a standard setting, as in the shape and form of ensuring minimum levels of quality and safety. This approach is often termed as "social, " but it neglects to consider the cultural commitment to ensuring quality, safety, and equity in health services. Our aim in this chapter is to highlight the role of culture and traditions which influence regulatory practices of the state. For South Asia, a region greatly dominated by informal social control, studying this area is critical to understanding the sociocultural obstacles to optimal health regulation and policy. We discuss in detail the types of regulatory practices and the diverse challenges to effectiveness in context to the health sectors of South Asia. Many cultural and traditional customs of the region sustain regressive and inefficient regulatory policies, including the dual practice of practitioners and commercialization of providers. Secondary data has been used from the Demographic Health Surveys to analyze the shortfalls of maternal health in South Asia, in order to highlight the role of state and society in improving protective regulatory policies for women's health. We believe that if the regulation of the existing maternal and reproductive health services in South Asia is improved, it will help to improve the regulatory challenge for gender equity across the health sector. Thus, we suggest a 20-point agenda to improve regulation in a way that would reduce maternal and child mortality risks. We conclude finally about the utility of co-regulation in a decentralized manner but with the state at the apex for management of a regulatory system to other actors in co-governance. The decentralized approach of engaging with non-state sectors, using information exchange systems and standard setting can provide a useful way of thinking through regulatory reforms and implementing them purposefully.