I am a day labourer living in a slum and have to live from hand to mouth in Dhaka city. I was diagnosed with multiple tumors in my body in 2019 along with high blood pressure, high blood sugar, and joint pain. With my little income, I cannot afford to seek treatment from a better facility; neither public nor private. No matter how much I try to access public health care facilities, they dispel me because I am a poor man. They say I am not capable of affording the medical bills for multiple surgeries and post-operative care, treatment, and medication. Every month I get a few medicines from the outdoor doctor, and I don't even know my physiological status. The doctor and other medical assistants don't bother to talk to me about my condition, medicines, or further treatments since I am illiterate and poor. I cannot think of going to a private health care facility due to the expenses. Moreover, I am sure that they will also neglect me due to my socio-economic status.” -- Abu Momen, a 60 year old day labourer from Bosila slum in Mohammadpur, Dhaka, expressed his experience on inequality in the provision of health care services in public-private facilities in Dhaka.
Bangladesh is quickly becoming an urbanized nation with expanded urban areas across the country and the number of people living in urban areas is also increasing. Due to the poor public services and infrastructure in the urban areas of the country, there is an increase in inequality and urban poverty in these segments. Large disparities in economic, living, and health-related situations are common among urban population groups as a certain amount of determinants follow the situation.
Urban health disparities, inequalities in seeking healthcare service facilities, and the provision of effective public-private health care facilities are major concerns for the urban population's health. While adverse health consequences are a significant source of vulnerability for low-income urban households living in urban areas, it's vital to recognize that health conditions are often brought on by unfavourable living and working circumstances.
Due to the lack of affordable and easy-to-access public and private facilities for health care, the urban populations are the ones who suffer from growing health disparities. Additionally, health issues have emerged as a result of changing lifestyles, hunger, continuing social inequality, economic instability, and unstable social life.
Public health specialists have noticed that the urban population is expanding quickly in Bangladesh. And the structure and system for providing health services have been unable to adequately address their vulnerability to many health issues like communicable diseases, non-communicable diseases, malnutrition, and deficits in micronutrients; as well as substance abuse, injury, trauma, accidents, and mental health issues. According to surveys in Bangladesh, a major portion of urban residents seek treatment from the informal private sector as a result of poor public service delivery in urban regions.
Urban people's equitable access to high-quality health care and nutrition services has become a significant and urgent development concern for Bangladesh.The health care services and facilities are highly different for different groups in the urban areas of Bangladesh. Due to their socio-economic status, people living in slum areas or in lower income neighbourhoods in urban areas, are highly vulnerable to the inability of receiving health care services in the proper manner.
Hospitals and clinics may not be physically far from poor urban populations, but they remain socially and economically distant from them. In general, lower-income individuals and slum dwellers make up the majority of the population in Bangladesh's urban areas. They face greater obstacles to maintaining and enhancing their health than non-slum residents. They reside in slum regions that are heavily occupied with elements that are bad for one's health and well-being.
The health of urban slum dwellers is influenced by migration identity, the environment of slums, the unplanned living arrangements in slum areas, limited access to economic opportunities, lack of knowledge on health, sanitation, and nutrition, exclusion from urban services, inadequate resources as well as a weak position in the social hierarchy. Urban poor population groups are highly prone to experience poor health outcomes as a result of limited access to affordable quality healthcare services, and discriminative treatment from healthcare workforce, facilities, and the health care system as well.
Urban poor population segments are vulnerable to costly medical services available in private facilities. And also being unable to pay for high-quality medical care, their health issues are less prioritized according to the urban slum population. Clinical and public health research has shown instances of exploitation, unacceptable conduct, and a lack of ethics in the provision of health care to the underprivileged and illiterate urban population groups rather than economically privileged and educated urban population groups. Due to this, people of impoverished communities in urban areas may have different health outcomes, including greater risk of multi-morbidity, disability, and sudden mortality also.
More than 70% of the urban poor population seek care from the informal private sector, such as pharmacies, paramedics, quacks, and traditional healers, as the first point of care because the health care services at public facilities and formal private facilities for the urban poor are inaccessible.
Experts commented that the present health care facilities in the public health care service sector are insufficient to meet the needs of the impoverished and disadvantaged population, especially the expanding poor slum portion. It underlines the lack of coordination across the ministries in the domains of health service delivery, coverage, and referral, and it claims that these issues constitute significant obstacles to ensuring the urban poor have access to proper health care.
Promoting accessibility of urban poor people, slum dwellers in health care facilities can be accomplished through management and service reform in the health system of Bangladesh, especially focused on the urban health sector. As a result, in order to receive proper health care, it is necessary to expand health coverage for slum people, implement a health insurance program for economically disadvantaged groups in urban areas, empower urban poor populations, and provide effective and transparent health service administration in public hospitals to reach urban slum populations.
Together with government supervision on providing health care services the local, national, and international development agencies are encouraged to promote extensive urban health care services to be flexible enough for the poor slum population living in urban areas of Bangladesh.
Dr Md Shamim Haider Talukdar is the CEO of Eminence Associates for Social Development and a Consultant at UNICEF. Sarna Samanta Mallick is a Research Assistant at Eminence Associates for Social Development.