In-depth: Aid in an urbanizing world

BANGLADESH: Urbanization strains health care

Korail slum home to 40,000 in Dhaka
DHAKA, 5 October 2012 (IRIN) - The capital of Bangladesh, Dhaka, has one of the world’s highest population growth rates but its public health facilities are ill-equipped to accommodate the tens of thousands pouring into the mega-city annually.

“Dhaka’s population is increasing abnormally, but health facilities are not increasing in line with that,” said Shamim Hayder Talukder, chief executive officer of a local NGO working on urban health, Eminence.

In 2003 the UN projected Dhaka would, alongside Lagos in Nigeria, have one of the world’s fastest growing populations from 2005-2015. 

Official estimates put Dhaka’s population at almost 13 million, but unofficial figures put it closer to 15 million. Up to 400,000 people migrate annually to Dhaka, which has witnessed a four-fold increase in its population in the last 25 years.

Nationwide there is one doctor for every 3,200 residents and one hospital bed for every 1,738 people, according to 2011 government data. While the physician figure meets international standards for providing basic care set by the World Health Organization (one physician per 10,000 residents), patients report negligent - at times inhumane - treatment from public health workers.

One night at 2am when Saiful Islam’s father fell ill in Dhaka’s Mirpur neighbourhood with diarrhoea, he rushed him to a government hospital where health workers sent him home with medication. When symptoms worsened, Islam returned to the hospital only to be referred to a specialized heart disease hospital where they were again referred elsewhere. Once at the Dhaka Medical College Hospital, his father, along with other patients, lay on the floor due to the lack of patient beds, at which point Islam decided to find a private hospital.

“At the private hospital he felt better within just one hour,” said 30-year-old Islam. “At government hospitals, harassment and doctors’ negligence just make the patients’ condition even worse, while the private hospitals are expensive.”

His father’s hospital bill was US$600, in a country where the average annual income is $770.

“People who have money are getting health [care] while those who do not have money are not getting it,” said Rashid Mahbub, president of local NGO Health Rights Movement Bangladesh. [ http://hrmbd.org/index.html]

Experts warn the situation is likely to worsen as more people seek work in Dhaka, which is ranked the world’s least “liveable city” by the UK-based Economist Intelligence Unit. Health care was one of five factors analysed in its 2012 global liveability survey, in addition to stability, culture and environment, education and infrastructure. 

Slum-dwellers

Most of Dhaka’s 3.4 million people who live in slums do not have access to health care, said Kaosar Afsana, director of health programming for the global NGO headquartered in Dhaka, BRAC (formerly known as Bangladesh Rural Advancement Committee). She said slum-dwellers can access maternal and child healthcare services through NGOs, but that primary care is largely non-existent.

The UN Children’s Fund estimates 93 percent of Dhaka’s slum areas do not have public health clinics. The under-five mortality rate in slums (95 per 1,000 live births) is almost double the urban rate (53 per 1,000 live births) and 50 percent higher than the rural estimate.

Some 30-45 percent of slum-dwellers are ill at any given time and almost 60 percent of children are malnourished.

Escaping census counts are street-dwellers, who researchers say have even more precarious access to health care. “There is no health service delivery mechanism targeting this marginalized group of people,” said Jasim Uddin, a scientist at the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B).

Based on a 2008 organization study, 72 percent of female and 48 percent of male street-dwellers surveyed were sick; half of the females and one third of the males did not seek care. The street-dwellers who did seek care were denied treatment for lack of cash or faced long waits, according to the report.

“Everyone should have accessibility to primary and emergency health care,” said Mahbub, who faulted the government for not having a plan to expand and improve health services to accommodate the growing population.

Humayun Kabir, secretary of the Ministry of Health and Family Welfare, told IRIN the government offers “some programmes” in the slums and is planning to increase public hospital capacity, including adding 600 beds at Dhaka Medical College Hospital and opening new hospitals “soon”.

"We are working with the [Dhaka] city corporation authority so that city dwellers get proper primary health care,” said Kabir, who denied public health workers systematically neglect patients. "There might be some sporadic incidents but patients get health care… at the government hospitals.”

mw/pt/cb