Grim picture of health services for urban poor in Bangladesh

Manzur H Maswood  | Published: 00:29, Jan 11,2019 | Updated: 16:02, Jan 12,2019


The health services for urban poor people are largely ignored, leaving them vulnerable to different communicable diseases and non-communicable diseases. Urban health experts and health rights campaigners have shared their opinions and suggestions about health services for the urban poor with New Age.

AK Azad Khan
President of Diabetic Association of Bangladesh

The health services for urban poor people are obviously inadequate. The urban rich can buy healthcare but the poor have to struggle to get health services.
Though the local government ministry runs some health centres, those are not adequate. Even the poor people have to spend in taking services from those health centres.
The urban poor people are vulnerable to different communicable diseases and the risk factors of non-communicable diseases are present including diabetes, obesity, malnutrition and tobacco use, but there is not much awareness programme for them.
Political commitment is essential to address these issues but it is severely lacking.


Muzaherul Huq
Former regional adviser of World Health Organisation

The urban poor people are vulnerable to different communicable and non-communicable diseases because of their living standard and environment.
But health services are not dedicated to address their vulnerability.
There is a lack of preventive and rehabilitative health services for urban poor people while they cannot buy healthcare because of their poverty and illiteracy and lack of information.
The local government ministry is mandated for ensuring health services for them, but there is a lack of policy to address the preventive and rehabilitative care for the urban poor.
The health services are not accessible to and affordable by the urban poor people. The approach of health services is not public health oriented. The well-off people in urban areas have influence and capacity to buy healthcare but the poor people who live in slums or day labourers or rickshaw pullers or vendors cannot access health services.
There should be adequate health service facilities for the urban poor and the health facilities should be poor-friendly and accessible and affordable. The facilities should have a referral system.
There are a number of agencies working for urban health services including the local government ministry, health ministry and NGOs, but their activities are not well-coordinated, well-monitored and supervised.


President of Bangladesh Health Rights Movement

The main and primary problem is that the local government ministry is assigned to ensure health services in urban areas. The local government is not directly providing the services rather they contract out to NGOs, which are not monitored well.
Moreover, the urban poor have to buy healthcare from these health centres and only a small number of people get free services, which is too tough to avail.
Due to inadequate services, the urban people, who are supposed to get health services from local government ministry’s health centres, are going to health ministry-run tertiary hospitals providing primary health cares.
As a result, the tertiary health centres are facing burden for primary healthcare.
There are different tiers of health centres for rural people – community clinics in villages, union health centres at union level and upazila health complexes at upazila level, but there is no such structured health service delivery system in urban areas.
The dedicated health services for the urban poor are totally non-existent. We are advocating for long to bring the urban poor people under a frame of the health system, but this has not come to in light as yet.
The urban poor people are vulnerable to communicable diseases because of their living standard, lack of sanitation facilities, improved water and nutrition. Even, they do not get family planning services as the rural people get.
It is time to decide about the local government ministry’s capacity and their will to assign them to provide health services in urban areas. If they fail, there should be a solution to providing healthcare services for the growing urban poor population.
If we do not address the issues, Sustainable Development Goal of universal health coverage would not be achieved.


Farida Akhter
Joint convener of Shashtya Andolon

The urban poor are the most marginalised group in health service delivery system in Bangladesh.
The cities, especially Dhaka city, are the ultimate destination for people to get medical treatment, but the urban poor people’s health is overlooked.
Because, they cannot afford the health treatment cost and the city corporations’ health centres are not adequate to meet their demand.
So, the urban poor people go to pharmacies to get treatment. They buy medicines, even antibiotics or pain relieving drugs when they get injured, without any prescription.
For urban poor’s health services, it’s like the dark area under the lamp. The urban poor are working class people and they have no time to get treatment in day time. But the city corporation run health centres, which are mandated for their primary health care, have not adequate domicile services.
At one point, the urban health centres are inadequate and they do not have enough manpower to provide the floating urban poor, slum dwellers and working class urban poor, on the other hand, they are bedevilled by mismanagement in absence of monitoring.
The urban poor people have more risk factors associated with different communicable and non-communicable diseases because of their living standard, their environment they are living in, their working environment, but their health is largely overlooked.
They are falling in long-term health hazards and the urban poor women are even more ignored. They cannot go to doctors alone and go to the doctors when their diseases at the last stage.
The health ministry is assigned to look after the health of the nation, but in the cities, it is the local government ministry responsible for the health services, but the local government ministry seems indifferent or cannot feel importance of improved health services.
The local government ministry lacks policies to address the health needs of the urban poor, and as a result of that, the urban poor are left to struggle to get health services.
Over all, the government has to decide how and who will provide improved health services for the urban poor. And the health ministry has to play a leading role for ensuring healthcare to the urban poor.


SK Roy
Chairman of Bangladesh Breastfeeding Foundation

The health services for the urban poor are not at all adequate. The health centres for urban areas do not have adequate doctors and the health centres are also few.
The few health centres and inadequate manpower cannot give full coverage to the urban people.
The local government ministry, responsible for ensuring healthcare to urban people, does not even provide the services on their own rather they contract out the services to NGOs.
The funding for urban health centres is not also adequate. The poor service recipients have to bear the expenses which add to the burden on them.
The health ministry is dedicated to ensuring health services for the nation but the exception is that they are not responsible to ensure health services for the urban people, though they formulate policies and make decision about the health of the nation. Ensuring universal health coverage is not possible in this way, keeping the vast urban poor population out of health services. Surveys and studies find that the urban poor people are lagging behind as per every health indicator including nutrition, sanitation and improved water supply.
The urban poor are vulnerable to different health hazards including communicable and non-communicable diseases. And without service intensity with adequate manpower, they cannot be uplifted from the sorry state they are in now.
We see some policies to address the health issues of urban poor people, but in reality, we do not see much operation plan and programme for them. We complain about fund crisis, but well-planned formula to address the health needs of urban people would not require much money.
The health ministry and local government ministry along with the NGOs and donors have to work in a coordinated manner to come out of the sorry state of urban poor population’s health.


Mohammad Mainul Islam
Chairman, department of population sciences
Dhaka University

The urban poor population is rapidly increasing in Bangladesh and they are becoming victims of widening inequalities in health service delivery.
Health indicators for the urban poor show that they are far behind the other urban people in accessing health coverage.
Bangladesh is witnessing a huge growth in urbanisation and so the urban slum settlements are growing every year.
If the current trends continue, the number of urban population would exceed the rural population though the health services for the urban poor are not increasing, which is widening the inequalities in health services delivery.
The health service delivery system in Bangladesh have different setups, the rural areas have community clinics, union health centres, upazila hospitals and district hospitals but no such tiered health services are available in the urban areas. But the urban areas have tertiary hospitals or institutes.
The health service delivery is ensured by health ministry across the country though the local government ministry is mandated to provide health services in cities and municipal towns.
The urban poor people are vulnerable to the outbreak of diseases and there are risk factors of communicable and non-communicable diseases in the urban poor population.
More efforts, budgetary allocations and coordination among different ministries and NGOs should be focused to ensure health services for the urban poor.
The local government priorities other issues and seems to be indifferent to health issues.
The city corporations do not provide health services themselves rather they assign NGOs, which are not well-supervised.
The vulnerability of the urban poor people should be identified and polices and plans should be formulated.
For example, women and adolescents in urban slum areas are vulnerable. But do they get adequate reproductive health services?
The children are vulnerable and different studies show their health indicators are below the national average.
An integrated health service approach is needed to attain universal health coverage so that the urban poor people do not lag behind.
It needs well planning to achieve universal health coverage now. Or else, we could not achieve it by 2030.
The accessibility in health services, the quality and affordability of urban poor people should be assessed now.
The health awareness in urban slums is crucial – about the nutrition, diets, disease outbreak, about the family planning and other issues.
The health policy should be reviewed and coordination between local government ministry and health ministry should be increased to ensure health services for the urban poor.

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