SHARE Bangladesh - Epidemiological Transition and Non-Communicable Diseases among Urban Poor in Bangladesh: A Knowledge Synthesis

Epidemiological Transition and Non-Communicable Diseases among Urban Poor in Bangladesh:  A Knowledge Synthesis

Abstract

Background: Urbanization is increasing very rapidly in Bangladesh and this rapid growth has hindered government’s capacity to regulate, plan or provide health care services in urban areas, especially to the poorest. Due to the epidemiological transition in recent decades non-communicable diseases have been increased significantly in urban areas and the burden of NCDs pose greater risk for urban poor.

Aim: The aim of the knowledge synthesis is to identify the gaps in knowledge in urban health service delivery both from the demand and supply side and generate evidence to formulate policies and strategies to increase access to health services and reduce NCDs among urban poor and provide actionable recommendations.

Methods: A knowledge synthesis was carried out based on the evidence generated in the last ten years through systematic and scoping reviews, surveys, surveillance, mapping of health service, routine information systems concerning both the demand and the supply of health services in urban areas, especially in urban slums. The World Health Organization (WHO)’s conceptual framework on health systems building blocks was used for analysis and organization of information and put together in the socio-economic context of urbanization and poverty. Furthermore the outcomes were compared to WHO’s global recommendations and key priority areas for policy advocacy were highlighted to inform key stakeholders, and create ownership for policy advice.

Results: The demand for health services for NCDs in urban poor areas is much higher than that generally perceived with obesity and hypertension affecting a large number of people. The supply side shows a highly-fragmented health system with domination of private sector in urban areas, with lack of regulatory authority in primary health care that overburden the tertiary public health care. There is also lack of clarity about roles and responsibilities in prevention and health promotion among responsible ministries involved. Prevention and control of NCDs among urban poor would require building awareness about the risk factors for NCDs with an emphasis on women and adolescents and young adults and creating and enabling environment so that they can practice healthy lifestyle. The primary healthcare should be redefined to meet the need of urban poor. Strengthening coordination between relevant ministries and investing in social determinants of health in urban settings were highlighted as key priority areas for prevention and control of NCDs in Bangladesh. Some other priority areas include establishing community-based health care services in urban poor areas and establish referral linkages to secondary and tertiary care; improving public health workforce for controlling the burden of NCDs; and engaging private sector to prevent and control NCDs in urban areas.

Conclusion: The Government of Bangladesh should strengthen health care governance and accountability to their citizens for action on NCDs in urban areas. There should be allocation of human resources and budget and strengthening of monitoring mechanisms to ensure transparency and accountability of the authority to provide services for urban poor.