Even if the state administrations at the province and district tiers did not always comply with their duties in pasture management and allocation before the introduction of the new law because of a structural lack of resources such as knowledge, personnel, financial, and physical capital, they were at least legally responsible for pasture management and allocation.
Health services are organized around a three tier system at district level, with the district hospital as the referral level, the health centre at subdistrict level, and the Community Health and Planning and Services (CHPS) compounds, which deliver close-to-client services mostly at home, at community level.
Ninety-two percent of the unqualified providers (Bangladesh is divided in 64 districts, second tier for administrative purposes) have district level training and more than 96% have specific training on hypertension (22).
There are four tiers of care at the district level: general hospital, health centres at the county-level (health centre of level IV), sub county level (health centre of level III) and parish level (health centre of level II).
Prenatal care services are delivered through a three-tier perinatal care network system consisting of primary hospitals, district level WCHC (including secondary hospitals) and a city level WCHC (including tertiary hospitals).
The three-tier network of community mobilizers (community level, block level, and district level) does the main work of the SM Net.
At district level, the core of facilitators already trained by the project could be part of provincial /district /cluster level tiers.
The health system is decentralized at district and health sub-district level with no regional tier.
During selecting a rural area, we selected randomly a sub-district from the selected district (second lowest tier of regional administration).
The view has also been expressed that integration may impose western medical treatment models, pay scant attention to other sectors of health care (such as the district or secondary tier levels) and result in a failure to address and strengthen community rehabilitation [ 12, 13].
