FE Report
Vital health indicators in urban slums are worst for inequalities among urban citizens, patchy service delivery and lack of coordination, experts said.
Poor access to health facilities despite having doctors and infrastructures, and lack of manpower and capacity of local government institutions also make things bad.
Other reasons attributable to this poor state of health are lack of catchment population, service duplication and dysfunctional referral system, they added.
A 2018 data showed 1.1 doctors serve 10,000 people in rural areas and 18.2 doctors in urban areas for the same population.
The poor have little access to city health facilities largely dominated by the private sector, it revealed.
Considering urban population growth and abnormally high growth of slum population, experts suggested the City Corporation and Municipality Act 2009 be revised to determine the deliverers of urban healthcare.
Local government institutions are responsible for primary healthcare for urban areas and health ministry for tertiary healthcare services.
The experts came up with the observations at the third policy dialogue on 'Urban Health and Universal Health Coverage in Bangladesh'.
Health Policy Dialogue (HPD) organised the event moderated by Dhaka University's Prof Robaet Ferdous in the CIRDAP Auditorium in the capital.
The icddr,b initiated the policy dialogue in September 2017 through its 'Strengthening Health, Applying Research Evidence (SHARE)' project.
Scientist Dr Sohana Shafique of Universal Health Coverage Programme at icddr,b, and Dr Khalequzzaman of public health and informatics department at Bangabandhu Sheikh Mujib Medical
University presented a keynote.
They highlighted rapid urbanisation, health-related shocks, inequalities in urban health, healthcare seeking behaviour of urban poor and epidemiological transition in urban Bangladesh.
The keynoters said healthcare delivery facilities and quality healthcare are still not in place fully to achieve sustainable development goals.
Besides, there is absence of health-related data from private healthcare providers as the urban health sector is largely dominated by the private sector.
A huge gap is prevailing to measure the progress of universal health coverage (UHC), they cited.
It was found from various surveys that non-communicable diseases (NCDs) are rising alarmingly in the country, accounting for 59 per cent of the total deaths.
These include 17 per cent deaths for cardiovascular diseases, 11 per cent chronic respiratory problem, 10 per cent cancer, 3.0 per cent diabetes and 18 per cent other diseases.
The NCDs are high among the urban poor.
A recent study showed 40 per cent of the urban poor are overweight and obese, 22 per cent women and 15 per cent men have diabetes.
It also found that 90 per cent of the poor do not consume fruits and vegetables.
About 45 per cent of the deliveries are done by skilled birth attendants which is 19 per cent in rural areas and 15 per cent in urban slums.
Birth registration rate in urban areas is 53 per cent while it is 54 per cent in rural areas and 28 per cent in urban slums.
Urban population with improved sanitation is 54 per cent while it is only 9.0 per cent in urban slums.
Under-five mortality rate per 1,000 births is 53 in urban areas, 66 in rural areas and 95 in urban slums.
In case of child nutrition, stunting is 40 per cent in city corporation slums, 25 per cent in city corporation non-slums and 25 per cent in other urban areas.
Wasting is 12 per cent in city corporation slums, 7.0 per cent in city corporation non-slums and 11 per cent in other urban areas.
Dhaka University Prof Abdul Hamid said municipalities do not have that attention and capability to provide healthcare services.
They only coordinate with the district hospitals, he mentioned.
Mr Hamid said, "If city corporations and municipalities fail to deliver healthcare services, why should the mandate be at their hands and is not handed to health ministry?"
Besides, the social determinants of health will never be achieved if planned urbanisation does not take place, he added.
Urbanisation is one of the leading global trends of the present century that has a great impact on health.
The speakers at the event said urban slum growth rate is twice than that of the overall urbanisation.
The annual growth of urbanisation is 3.0 per cent while it is 7.0 per cent for slum settlements, they stated.
If this trend continues, experts said, its urban population will exceed rural population by 2040 and will greatly impact the urban health.
The factors influencing urban health are complex and entwined, they observed.
It involves issues like urban governance, population characteristics, natural and built environment, economic and social development, services and health emergency management, and food security.
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