Strong, Effective and Functioning Collaboration among Stakeholders: An Opportunity for Healthy Urban Governance in Bangladesh

Bangladesh is experiencing a significant demographic change due to rapid urbanization, industrialization and escalating migration from rural to urban areas. Presently, about 27% of people live in urban areas, and this... [ view full abstract ]

Bangladesh is experiencing a significant demographic change due to rapid urbanization, industrialization and escalating migration from rural to urban areas. Presently, about 27% of people live in urban areas, and this proportion is expected to reach 50% by 2040.1 This situation requires particular attention to urban population health, especially for poor slum dwellers.

Objectives of this study were
- To explore policy platforms and existing government coordination mechanisms which guide and support basic health services for urban population
- To identify gaps and opportunities for strengthening coordination mechanisms among urban health actors

Methods:
- Review of existing policy documents
- Semi-structured interviews with government and non-government key informants
- Round table discussion to obtain stakeholders’ collective viewpoints
- Data analysis was performed thematically followed by summarizing contents.

Through literature review, a number of multi-sectoral policies have identified which address urban health as a priority concern. Along with a government approved Urban Health Strategy, two ministries exclusively work for urban health in Bangladesh. The Ministry of Local Government, Rural Development and Cooperatives (MoLGRDC) is solely responsible for providing urban primary health care; on the other hand, the Ministry of Health and Family Welfare is responsible for providing secondary and tertiary level health care. NGOs, donors and charitable organizations are also present here to provide health services to urban population.

Although urban health is a prime concern in relevant health guidelines, the responsibilities of different actors are not well defined. A little is cited about inter-ministerial coordination, sectoral-involvement and monitoring issues. These circumstances have created ambiguities among stakeholders’ roles and gaps in coordination mechanisms.

Key informants recommended that a structured policy-strategy is needed to address urban health coordination gaps. Developing a separate Urban Health Unit under MoLGRDC can be a better approach for a well functioning urban health system in Bangladesh.