Understanding the urban healthcare landscape: is there method in the madness?
Abstract
Background Rapid urbanization in low and middle income countries like Bangladesh has been accompanied by a proliferation of healthcare services. What meets the eye is a metaphorical jungle which is difficult to navigate or... [ view full abstract ]
Background
Rapid urbanization in low and middle income countries like Bangladesh has been accompanied by a proliferation of healthcare services. What meets the eye is a metaphorical jungle which is difficult to navigate or regulate. Until recently, little was known about the configuration of the urban healthcare landscape, nor the extent to which effective coverage is achieved especially for poor and disadvantaged populations. A GIS mapping project of 7 city corporations in Bangladesh has enabled an indepth examination of the logic of the urban healthcare landscape and how it might be harnessed to improve service quality and coverage for the urban poor.
Method
A geo-referenced census of health facilities disaggregated by type of facility was superimposed on maps indicating population density and the location of poor urban settlements. Patterns were identified as regards what types of facilities are located where.
Results
27,000 health facilities in 7 city corporations were mapped of which 1% are public, 13% NGO, and 86% private. Health facilities concentrate in areas with high population density. The public sector largely operate through tertiary and specialized hospitals while NGOs, both government and international donor supported, focus on primary healthcare and outreach services. In smaller cities, greater proximity and coordination coverage of NGOs is apparent around poor settlements. Except for institutions offering emergency services, most public and NGO services have daytime hours only. Privately owned doctor’s chambers locate close to poor residents and operate in evening hours. Private clinics and diagnostic centres are clustered around affluent areas and public hospitals.
Conclusions
Private for-profit and non-profit providers complement the public sector by filling gaps in urban primary healthcare in terms of geographic coverage and hours of service. The dominance of the private sector in urban service provision merits strategic consideration in health policies, but not without vigilant stewardship by government.
Authors
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Alayne Adams
(International Center for Diarrhoeal Disease Research, Bangladesh (icddr,b))
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Rubana Islam
(International Center for Diarrhoeal Disease Research, Bangladesh (icddr,b))
Topic Area
V. Healthcare Service 5.1 Accessibility of healthcare services and its optimization 5.2 He
Session
LMIC-O-05 » LMIC Lessons Learned - The Business Community and Urban Economic Development (15:00 - Sunday, 3rd April, TBA)
Paper
Logic_of_urban_healthcare_landscape_abstract.docx
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