More and more rural people are moving to urban areas day by day. Most are coming to urban areas to maintain the financial stability of their family. This trend follows the continued development of an urban-centric economy in Bangladesh. About 30% of Bangladesh’s total population lives in the cities at present, and by 2040, it is likely to increase to 50%.
Even though they are coming to urban areas for a better life, closer observation reveals that they mostly dwell in unhealthy slums. Many moved to the cities leaving their education incomplete, mostly relying on their physical ability as their biggest capital to invest in economic activities. But they live with serious risk as they try to adapt to an unhygienic environment amid lack of health awareness.
Is it possible to make the economy sustainable, while leaving such a large portion of the working class at health risk? It is important to ensure that the urban poor -- working men and women, and other members of their families, such as children and adolescents -- live healthily in order to keep the economy stable.
The question remains, how can the health security of this population be ensured? General and medical college hospitals, expensive private clinics, and doctors' private chambers are crammed and overcrowded in the cities, although for poor families, accessing medical care under private management seems like a luxury. But any negligence to primary healthcare only complicates the severity of their disease and also poses major health risks in the future. In almost every case, the cost of treatment will increase simultaneously with the severity of disease.
The Bangladesh government is trying its best to implement the concept of primary healthcare established by the World Health Organization's 1978 Alma Ata Declaration. The universally recognized concept of primary healthcare refers to accessible child and maternal healthcare, improved nutrition, family planning, adolescent healthcare facilities, preventive vaccinations, treatment of minor injuries and common illnesses, communicable disease control, and epidemic prevention measures.
The availability of primary healthcare at the rural level is one of the many areas in which Bangladesh has made unprecedented progress since its independence. However, the urban poor’s healthcare remained neglected for a long time.
The incumbent government, during its previous regime in 1998, took the issue seriously and launched the Urban Primary Healthcare Project. The project, which was commissioned under the direct supervision of the local government department with the support of the Asian Development Bank and other development partners, expanded in the form of the Urban Primary Healthcare Services Delivery Project (UPHCSDP) without any pause after completing its second phase in 2012.
The second phase of UPHCSDP is currently underway. Within it, 45 maternity hospitals, 167 city health centres, and 334 satellite clinics in around 11 city corporations and 18 municipal areas are operational in order to provide local city dwellers, especially those impoverished, with low-cost but advanced primary healthcare and diseases prevention services. More than 2,00,000 (till March, 2024) Red Cards have been distributed among the extreme poor families. According to surveys, the project at present has brought more than 1.7 crore urban people of the country under its coverage.
For those wondering where the urban poor residents can access primary healthcare, the answer is: The rainbow-marked health centres under UPHCSDP -- which are ready to serve with the motto “Access to Health Service for All.” Patients can receive medical consultancy from MBBS doctors at only Tk50. In case of normal delivery, the charge is Tk1,000-1,200 while a C-Section costs Tk10,000-12,000. Family planning services and kits can be availed for free. The Red Card holders will receive all kinds of treatment without having to spend a single penny.
As the health services are available at the doorsteps, both the time and money of the people will be saved. Accessing services from the health centres certainly will benefit the service seekers. Now the spontaneous participation of the people is needed to make the project viable.
The project is financed by the loan which will be repaid from public exchequer. Therefore, to meet the objectives of the project -- which is to increase the quality of healthcare for the urban poor, women, and children, and to improve the quality of efficient, quality, and sustainable primary healthcare -- the beneficiary group must feel ownership of the health centres. It should be considered that if the health centres can create a social demand, resources needed to improve the quality will be generated socially. In this case, involvement of the public representatives is crucial.
It is to be noted that a Ward Urban Health Coordination Committee has been formed under the leadership of public representatives in each of the project areas. The committees will formulate and implement policies to make the health centre sustainable and identify and solve the challenges in the services. The public representatives and conscious citizens are well aware that they can garner social support if they help establish fundamental rights like healthcare in the society. They are welcome to come forward.
The government cherishes a long-term goal of building a healthy nation with proper healthcare services. Because, only a healthy nation can keep their economic and social development sustainable.
Abul Foyez Md Alauddin Khan is Additional Secretary, Project Director, UPHCSDP-II.
