Improving access to urban primary health care services in Bangladesh: Need for improved coordination and harmonization in policies

Bangladesh’s urban population is expected to overtake the rural population by 2040, and a significant part of the increase will be in poorer, informal settlements known as slums. The Ministry of Health’s current primary... [ view full abstract ]

Bangladesh’s urban population is expected to overtake the rural population by 2040, and a significant part of the increase will be in poorer, informal settlements known as slums. The Ministry of Health’s current primary health care service (PHC) provision largely excludes the urban poor, with the Ministry of Local Government actually overseeing service delivery through contracted NGOs.

Secondary data analysis was conducted on urban health status from Bangladesh Urban Health Surveys conducted in 2006 and 2013. A literature review of policy documents on urban health service delivery was also conducted.

Expansion of city areas and a rapidly rising urban population pose new challenges for effective PHC service delivery. During 2015-2029, the urban population in Bangladesh is expected to grow from 54 to 81 million, and Dhaka to become the world’s 6th largest city with 27 million people. Cities are currently characterized by large inequalities in socioeconomic and health-related conditions. Slum populations are markedly poorer and less educated; and substantially fewer women living in slums receive ANC from medically trained providers, give birth in a health facility, and optimally feed their children, compared to their urban counterparts. Despite improved access by NGOs in recent years, urban people, including the slum population, are increasingly using the private sector for health services. Existing programs and policies on MCH services are not addressing the gaps in PHC coverage and basic health services have yet to be managed efficiently either in the public or NGO sector.

The post-2015 development agenda focuses on achieving Universal Health Coverage (UHC) by 2030, which is unlikely to be achieved without addressing the gaps in PHC coverage in urban areas. Building effective liaison among the different organizations of the Bangladesh government, NGOs, and private entities is crucial to support PHC service delivery in the urban context and eventually achieve UHC.