Rainbow-marked health centres brighten lives of urban poor

The urban areas of Bangladesh are now highlighted by accelerated economic activities and GDP growth. As the trend of urban-centric economy continues, migration of rural people to urban areas is eventually growing. Statistics show that about 30 per cent of Bangladesh’s total population lives in the cities at present. By 2040, the rate is likely to increase to 50 per cent.

Most of the migrated people in the cities are from marginalised rural communities. They are shifting to the metropolises with a hope of improving their financial status and social security. A closer observation can reveal that they are dwelling in unhealthy slums although the cities are developing. And many of them in poor health are trying to keep the economy rolling without any bump.

Common sense suggests that these poor people have migrated to the cities leaving their education incomplete and their physical ability is their biggest capital to invest in economic activities. But they are at serious health risk as they try to adapt to an unhygienic environment amid lack of health awareness. Is this possible to make the economy sustainable, leaving such a large portion of the working class at health risk? Obviously, national productivity will be severely affected if the working class, the instrument of production, remains weak.

Therefore, it is important to ensure that the urban poor – working men and women and other members of their families such as children and adolescents – live healthy in order to keep the economy stable. The question is, how can the health security of this population be ensured? Overcrowded general and medical college hospitals, expensive private clinics and doctors’ private chambers are crammed in the cities. But for poor families, accessing medical care under private management seems like a luxury. Do they actually get cured with over-the-counter medicines from their neighbouring drug stores? Maybe they feel relieved for a while, but any negligence to primary healthcare not only complicates the severity of their disease but also poses major health risks in the future. Everyone will agree that the cost of treatment increases simultaneously with the severity of disease.

In this context, it is necessary to mention that the Bangladesh government is trying its best to implement the concept of primary healthcare that was established by the World Health Organization’s 1978 Alma Ata Declaration. The universally recognised concept of primary healthcare refers to accessible child and maternal healthcare, improved nutrition, family planning, adolescent healthcare facilities, preventive vaccinations, treatment of minor injuries and common illnesses, communicable disease control, and epidemic prevention measures.

The availability of primary healthcare at the rural level is one of the many areas in which Bangladesh has made unprecedented progress since its independence. However, the urban poor’s healthcare remained neglected for a long time.

The incumbent government, during its previous regime in 1998, took the issue seriously and launched the Urban Primary Healthcare Project. The project, which was commissioned under the direct supervision of the Local Government Department with the support of the Asian Development Bank and other development partners, expanded in the form of the Urban Primary Healthcare Services Delivery Project (UPHCSDP) without any pause after completing its second phase in 2012.

Currently, the second phase of UPHCSDP is being implemented. Under the project, 38 maternity hospitals, 150 city health centres and 300 satellite clinics in around 11 city corporations and 13 municipal areas are being operated in order to provide the local city dwellers, especially poor people, mothers and children, with low-cost but advanced primary healthcare and diseases prevention services. More than 2 lakh (till March, 2022) Red Cards have been distributed among the extreme poor families. According to surveys, the project at present has brought more than 1.70 crore urban people of the country under its coverage.

If anyone enquires about where the poor people living in the cities can access primary healthcare amid the dominance of expensive medical facilities, the answer is: the rainbow-marked health centres under UPHCSDP are ready to serve with the motto “Access to Health Service for All”. Patients can receive medical consultancy from MBBS doctors at only Tk50. In case of normal delivery, the charge is Tk. 1,000 - 1,200 while a C-Section costs Tk 10,000 – 12,000. Family planning services and kits can be availed at free of cost. Nonetheless, the Red Card holders will receive all kinds of treatment without spending a single penny.

As the health services are available at the doorsteps, both the time and money of the people will be saved. Accessing services from the health centres certainly will benefit the service seekers. Now the spontaneous participation of the people is needed to make the project viable.

The project is financed by the loan which will be repaid from public exchequer. Therefore, to meet the objectives of the project: to increase the quality of healthcare for the urban poor, women and children and to improve the quality of efficient, quality and sustainable primary healthcare, the beneficiary group must feel ownership of the health centres. It should be considered that if the health centres can create a social demand, resources needed to improve the quality will be generated socially. In this case, involvement of the public representatives is crucial.

It is to be noted that a Ward Urban Health Coordination Committee has been formed under the leadership of public representatives in each of the project areas. The committees will formulate and implement policies to make the health centre sustainable and identify and solve the challenges in the services. The public representatives and conscious citizens are well aware that they can garner social support if they help establish fundamental rights like healthcare in the society. They are welcome to come forward.

The government cherishes a long-term goal of building a healthy nation with proper healthcare services. Only a healthy nation can keep their economic and social development sustainable.

The writer is an Additional Secretary and Project Director, UPHCSDP-II.