Over the past 45 years, Bangladesh’s health and nutrition policies and programs have focused largely on rural health services and outcomes. Consequently, equitable access to quality health and nutrition services—particularly for the urban poor—has emerged as a major, pressing development issue.
To address the gap in knowledge on urban health and nutrition, the report Health and Nutrition in Urban Bangladesh examines the determinants of health and nutrition outcomes in Bangladesh’s largest cities and the structure and performance of urban health sector governance, and offers options to improve health and other services to urban residents.
- Urbanization is occurring at a rapid pace in Bangladesh, with the urban population expanding by 35 percent between 2001 and 2011, at an annualized growth rate of 3 percent. In 2011, 23 percent of the national population resided in urban areas. By 2050, more than half of the country’s population is expected to reside in urban areas.
- In 2014, the government counted 14,000 slum settlements. These settlements share characteristics such as high population densities, large share of migrants from rural areas, inferior public water and sanitation services, and poor-quality housing, which creates greater health challenges for their residents.
- Health and nutrition policies and program have largely focused on providing health services to rural areas. As a result, the urban poor have not enjoyed sufficient access to quality health and nutrition services.
- Knowledge about urban health remains sparse.
- Failure to improve urban health could undermine the health gains that Bangladesh has achieved, as the country continues to urbanize.
Challenges and options
Governance and regulation
- Challenges: The urban health system lacks effective coordination among ministries. Many regulations are weak and outdated, and their enforcement is patchy. The monitoring and evaluation of health providers is fragmented and incomplete.
- Options: Strengthen local-level involvement by allowing urban governments to be responsible for their health services, with support from relevant central ministries, and aligning donor support with the central government’s urban health strategy. Improve regulations by revising regulations on licensing and registration. Ensure rigorous quality control of health services and better monitoring and evaluation of health providers.
- Challenges: Urban governments do not have separate budget allocations for health services and public health initiatives, and have limited capacity to raise their own finances. These governments also do not have updated, standardized systems to determine who qualifies as poor and who should qualify for exemptions from user fees.
- Options: Align financing with responsibilities for urban health. Ensure that central ministries allocate adequate funds to urban governments for health services. Update and standardize identification of the poor, user fees, and exceptions from fees.
Effective and equitable services
- Challenges: The urban health system puts inadequate emphasis on equitable access to quality care, continuity of care, patient-centeredness, and patient rights. The system also lacks a culture of accountability. Services for noncommunicable diseases are not widely available.
- Options: Restructure the urban health system to address noncommunicable diseases, reach underserved groups, and make services more accessible to the working population by extending operating hours. Expedite the development of a functioning referral system. Partner with private health providers.
Overarching policy framework
- Challenges: The government needs to develop a sound urban health policy, which reflects changes on the ground including rural-urban migration and shifts in urban health and demographic profiles. This policy should also recognize slum settlements and the special needs of their residents.
- Options: Develop an urban health policy within the broader context of urbanization and urban policy, with a focus on the needs of slum residents. Give attention in the policy to non-health factors – such as environmental conditions and services, household economic status, and education – that affect health outcomes.