Establishing Health and Demographic Surveillance System in urban slums: Recent experience from Bangladesh

Urban population in Bangladesh is growing rapidly. Currently 30% of 160 million of the country’s population are living in urban areas. Bangladesh will face a huge challenge to ensure health of the urban poor with one-third... [ view full abstract ]

Urban population in Bangladesh is growing rapidly. Currently 30% of 160 million of the country’s population are living in urban areas. Bangladesh will face a huge challenge to ensure health of the urban poor with one-third of more than half of 200 million in 2050 living in slums. This is unique for the sheer size of the future slum population in Bangladesh. Availability of reliable data is a pre-requisite for effective programmes for the slum dwellers. Keeping this in mind icddr,b has recently started a Health and Demographic Surveillance Systems (HDSS) in three slums in and around Dhaka city among a population of 30,000. This paper presents the learnings in starting the HDSS.

Steps to start a HDSS involve identification of the geographic area, census of the population, numbering the households and regular visits to the households to update birth, death, migration and collect other information of interest.

Dispersed settlements of slums with varied sizes and stability was a challenge in choosing the slums. One of the slums included in the census might disappear soon and was substituted. Listing of the households with an indication of locations was another challenge given the disorderliness of the dwellings and having multiple households in very compact compounds. An attempt to have GIS codes for the households was abandoned for the settlement was so compact that household/compound GIS coordinates would not separate one compound from the other. It was revealed during the pretesting that recording of migration especially within surveillance slums would be a challenge. Absence of adult members during daytime for interview was another challenge.

Despite the challenges it was possible to establish the HDSS in the slums. Special data collection efforts will be needed to be made to collect data and many innovations will be required to maintain the surveillance.