Creating responsive health systems: improving the use of feedback from service users in quality assurance and human resource management in Bangladesh This project aims to improve the responsiveness of the health system in Bangladesh. This addresses an issue of high interest to the country's policymakers.   Effective interaction and engagement between the health service users and practitioners and policymakers is an important attribute of responsive health systems. Central to this concept is the opportunity for users to provide feedback on their experiences engaging with the health system, and vitally the ability of the health system to respond to users' suggestions.   This project focuses on Bangladesh, a low income Asian country where the Ministry of Health and Family Welfare (MOHFW) is implementing a program allowing service users to send feedback via SMS texts. The texts from the whole country are aggregated in a web portal, which is monitored by the MOHFW staff, who are then expected to follow up each issue with both a sender and local authorities. Service users can also provide feedback directly to health management committees at Upazila level, and through suggestion boxes in each health facility. However, it is unclear how issues received directly at the Upazila level are followed-up and by whom. .  The AIM of this project is to assist the policymakers in designing a comprehensive health systems intervention to make Bangladesh's health system more responsive. Specific project OBJECTIVES are to work closely with national and local decision-makers to: 1. Develop an in-depth understanding of the nature and contents of, and key reasons for, feedback received from health service users at Upazila level; 2. Analyse the processes of collecting and responding to service users' feedback at Upazila level, as well as the key contextual facilitators and constraints influencing these processes; 3. Assess the approach to, and processes of, service quality assurance and human resource management, focusing specifically on the use of feedback from service users at Upazila level;  4. Using results of objectives 1-3, develop a comprehensive health systems intervention to improve the use of feedback from service users in quality assurance and human resource management processes at Upazila level.  This 18-months project will analyse the national-level user feedback data and collect more detailed qualitative information in one district in Bangladesh. Within the district, we will focus on two Upazila Health Complexes (UHC) which, being the first level referral services from the primary health care, are the backbone of the health system.  We will implement a multi-method health systems research using realist evaluation. Qualitative and quantitative data will be collected using combinations of:  1) in-depth interviews with purposefully-identified service users and gender and age-specific focus groups with communities to explore their knowledge of and use of feedback systems;  2) in-depth interviews to explore views of purposefully-selected service providers and managers at the UHC about the user feedback systems;  3) analysis of country-level secondary data on user feedback from the government web portal, to understand types of issues, their location and gender and age of users who initiated issues;  4) non-participant observation of: feedback environment in the district, health management committee meetings and UHC routine quality assurance and staff management practices;  5) review of key documents (e.g. feedback to users and actions taken, meeting minutes, quality assurance guidelines, staff performance appraisal and supervision records).   Throughout the project, we will work closely with decision-makers, to facilitate the shared understanding, adoption of results into policy and practice and achieving its highest impact. Project results will be communicated widely through policy briefs, presentations at management meetings, development of newsletters and press-releases, to ensure their uptake in policy and practice in Bangladesh and wider. The Global Challenges Research Fund (GCRF) supports cutting-edge research to address challenges faced by developing countries. The fund addresses the UN sustainable development goals. It aims to maximise the impact of research and innovation to improve lives and opportunity in the developing world.