Urban healthcare situation for the poor in the country needs immediate attention, and policy-planning before it becomes too late, to avoid a catastrophic consequence in the public health sector, said experts, and officials representing the government of Bangladesh.
They made the observation during a multi-stakeholder consultation event on “Urban Primary Healthcare” by Power and Participation Research Centre (PPRC) in the capital on Tuesday.
PPRC Chairman Dr Hossain Zillur Rahman said the urban health care needed to be addressed in a comprehensive way if the country wants to achieve UN sponsored Sustainable Development Goals (SDG) by the year 2030.
A study published in 2018 by the United Nations’ Population Division estimates that by 2030, a large number of population is expected to migrate to urban areas from the rural communities – recent population migration trends suggests that direction.
As a consequence, other cities, townships, and urban centers will experience a significant boom in mass mobilization, and population concentration.
The all important port city of Chittagong is expected to grow into the country's next megacity with a population size between 5-10 million people by 2030.
By the year 2030, Dhaka’s population figure is likely to double from the existing number.
Referring a UN data on urban population, Dr Hossain Zillur Rahman said the ratio of urban poor went up from 14.4% to 21.1% between 2000 to 2016. The ratio of extreme poor reached a staggering 16.1% from 11.7% during the same period.
He reckons at the same time that the number of population has increased a lot.
The PPRC chairman said it has been evident that rural health care management was able to achieve more success in different criteria of the health index compared to what the urban poor is receiving, in terms of quality of health services.
There is a lack of coordinated health care management for urban people, and the poor are suffering most, he emphasized.
To put it more precisely about the sorry state of the urban health care, he said the urban people are receiving their services from pharmacies, NGO led hospitals, community clinics, public, private hospitals, and even from the village quakes – typically fraudulent or ignorant pretender of medical skill.
There is no proper referral services in the management, he added.
Former Joint Director of health care project Md Shahjahan said 40% urban poor are residing in the cities, 29% at divisional towns, and 29% urban people are currently living at the municipalities.
Unsettling situation of the existing urban health care situation may be depicted by delving into a scenario – eg; Dhaka city has only 17 government-run dispensaries to provide health care services, all are functioning poorly.
Mamunur Rahman of Dhaka North City Corporation (DNCC) said if the DNCC authority wants to run a health care centre for 50,000 people, then DNCC would need 80 such centers.
Abdul Baten, president of the Municipal Association of Bangladesh, also the mayor of Bera upazila of Pabna said the municipalities in the country are very keen to help community hospitals but the hospitals lack proper workforce.
He also cited the lack of motivated political leadership, to help restore quality of urban health care for the poor, as one of the reasons behind the prevailing situation.
Abdul Hamid Majumder, project director of Urban Primary Health Care project said it is not possible for a project to render all kinds of medical services to the urban people. It may be required to establish a national urban healthcare commission for this purpose.
ASM Mahbubul Alam, former LGD director said although it has been said that the community clinics in urban areas have succeeded a lot. But our experiences said that although having good perspective, the project could not attain its goal properly.
Director General of Directorate General of Health Services (DGHS), Dr Abul Kalam Azad said the government authorities lack administrative vision in setting their priorities in their action-plan list.
He said, we need to ensure health coverage for every citizen. At present the healthcare system badly need an overhauling. If we could implement community clinics with strong political will, significant improvement could be achieved in the urban health care management.
Besides, the GP system in Bangladesh would have been a useful mechanism to ensure health care for the urban poor, he added.
Professor Dr Abdul Aziz, MP who is also the member of Parliamentary Standing Committee on Ministry of health and family welfare(MoHFW) and Ministry of Women and Childrens’ Affair (MoWCA) said there is an impasse over who would take the responsibility to render the services.
“The dilemma needs to end to ensure better health care service for the urban poor immediately before it gets too late.”
