SHARE Project initiates policy discussion on urban health

European Union supported SHARE (Strengthening Health, Applying Research Evidence) project of icddr,b in collaboration with Institute of Informatics and Development organized a  Policy Breakfast event on Urban Primary Health Care on 28 July, 2016 at the Red Shift Café in Dhaka- capital city of Bangladesh.  Mr. Anisul Haque, Mayor of Dhaka North City Corporation (DNCC) graced the event as the Chief Guest. Representatives from stakeholders, development partners, academicians, physicians, researchers, and sector experts shared their views on the key challenges of policy implementation on urban health care in Bangladesh. A senior research team led by Dr. ATM Iqbal Anwar, Scientist and SHARE Project Director of icddr,b participated in the policy discussion. The objective of the event was to promote evidence-informed debate on urban health and primary health care.

In the event, Dr. Alayne Adams, Senior Social Scientist of icddr,b termed urban health as having multiple challenges. The highest rate of malnutrition has been found among children living in slums, as revealed in the Bangladesh Urban Health Survey 2013 report. icddr,b has already completed  urban health mapping with seven City Corporations. It shows first caregivers are pharmacies despite the density of health service delivery centers. With a diversity of people, the demands of urban poor are diverse and with these demands of health care, increased prevalence of hypertension and diabetic diseases, ground reality of urban poor’s health needs and availability of health services need to be re-examined. The two Chief Health Officers of Dhaka City Corporation pointed out important determinants of urban health system like access to essential drugs and hygienic sanitation and that only 37% of women slum dwellers use facility delivery and requested sufficient budget allocation for them. The rapid growth rate of urbanization in Bangladesh has overwhelmed the government’s capacity to regulate and provide primary health care services in urban areas. The poorest in these areas are already victims to disparities in health care access.

Mr. Anisul Haque said that reinstating discipline in different areas of city governance including health issues was a priority of DNCC. DNCC have emphasized on cleanliness in environment which impacts the health of city dwellers. He underscored the necessity of having a master plan for shaping health care system under City Corporation. The Mayor admitted that city corporation did not have sufficient focus in health areas so far. He requested specific guidelines and recommendations from policy dialogue.

Due to rapid, unplanned urbanization, four million poor people living in slum areas and street or pavement areas in Dhaka are deprived of healthcare. The discussion was not limited to slums dwellers only. Proper urban healthcare system is also necessary for the majority of women in the readymade garments sector.Health services for low paid service holders like school teachers and reproductive health needs of the women were also addressed on priority basis in policy discussion. In this relation, discussants also shed light on social determinants of health to know accessibility of health care and needs, setting indicators to clarify ultra poor and operational definition of urban poor. Universal health coverage under health insurance for urban poor came up as another solution.

Scientist and researchers of icddr,b emphasized on evidence based planning. Several discussants emphasized on health literacy programs considering the information gap among people. Therefore health education has been considered as an indispensable element of health service. Ensuring dignity and welcoming environment for clients in health facilities, better coordination among ministries for optimal utilization of limited resources, workable strategy for mobilizing resource, effective community involvement to get their voices heard, and involvement of civil society groups in health governance

were discussed as priority intervention areas in policy breakfast event. Most positive result of the policy discussion is that it made the Mayor Mr. Anisul Haque committed about implementation of recommendations, as he affirmed in concluding speech of the event.

As part of European Union supported Strengthening Public Health Institute Programme (SPHIP), SHARE project  is working closely with government health institutes of Bangladesh to form national level think tank who will provide rigorous and robust analysis on evidence-informed policy matters and high quality policy advice to government, the private sector and the non-state sector. Organizing policy dialogues on health issues is an important plank of desired think tank to work as a pressure group as well as to influence government and other stakeholders. Dr. ATM Iqbal Anwar who is leading SHARE Project in Bangladesh said, ‘We have been waiting for this initiative since SHARE project started its journey last year. This policy dialogue won’t be a one-off event; rather we will follow up to put forward recommendations towards an enabling policy environment and  promoting  evidence-informed decision making in health policy process of Bangladesh.’ Same expectations were echoed in the views of stakeholders in the vibrant policy discussion.