Investing in Urban Health: Evidence from three Asian countries

Failure to promote urban health, particularly essential primary care services, is a key barrier to achieving universal health coverage. Political commitment and strategies for improving health in urban areas, however, often... [ view full abstract ]

Failure to promote urban health, particularly essential primary care services, is a key barrier to achieving universal health coverage. Political commitment and strategies for improving health in urban areas, however, often lack evidence about how to design, implement and monitor large scale interventions. Urban health in low and middle income countries has tended to be eclipsed by larger rural development health programs.
The Asian Development Bank (ADB) has extensive experience in supporting development projects in urban areas, including urban health and related sectors (water and sanitation, clean energy and infrastructure). This working paper summarizes the evidence from the implementation of three urban health interventions, namely the Bangladesh Urban Primary Health Care Services Delivery Project, the Mongolia Health Sector Development Projects, and in India, the National Urban Health Mission. All three urban health interventions focus on supporting quality primary services, in addition to strengthening the health system, including governance, health information systems, and capacity building. The modality of service provision ranges from entirely public sector, to partnerships with both not-for-profit and for-profit providers.
This multi-country evidence suggests that Mongolia, Bangladesh and India are all making progress towards universal health coverage by providing affordable services to the poor and vulnerable populations (slum dwellers and nomads). All three health system interventions share common challenges in providing adequate and appropriate health services for their urban population, particularly weak referral systems, dominance of an unregulated private sector and fragmented inter-ministerial collaboration. Based on these findings, a framework is presented to support the planning and the development of urban health systems across three aspects: Governance, Service Delivery, and Financing. Strong urban health systems will have an integrated and flexible basis across the public and private sectors to meet the dynamic health care needs of the population they are designed to serve.