Understanding decision-making and health-seeking practices of the Hijra community in accessing informal healthcare services in Bangladesh: an exploratory qualitative study

Abstract

In Bangladesh and other South Asian countries, Hijra people, mainly a community of transgender women who follow a particular cultural system, faces a multitude of barriers while trying to access their right to healthcare services. In this paper, we aimed to understand decision-making factors and health-seeking practices of Hijra community in accessing informal healthcare services, focusing on their common health problems, their perception and knowledge of health, patterns of healthcare utilization along with the challenges faced and reasons for decision making in seeking healthcare from informal facilities in Bangladesh. The exploratory qualitative study was conducted among 26 self-identified Hijra persons, and 5 key informants affiliated with the Hijra community, during the period of November to December of 2022 in different areas of Dhaka. Two qualitative guidelines were used to collect data via face-to-face in-depth and key-informant interviews. Thematic analysis was used to identify key concepts, cluster themes into patterns and conclude meaning from those patterns. Findings reveal that Hijra persons have poor knowledge and understanding about their own health, and sought healthcare services from informal health facilities more than formal health facilities, particularly from pharmacies, kobiraji, hujur, homeopathy and through self-medication. The Hijra population reported a number of reasons in opting for informal services, including better availability and accessibility, influence from peers and support network, negative attitude of formal healthcare providers, non-friendly interaction and discrimination from other patients, attendants and staff, along with long waiting times and harassment in formal health facilities. Our findings highlight the need for understanding of gender orientation, and sensitization of Hijra lifestyle for formal healthcare providers, policies for Hijra inclusivity in healthcare services.