Making Health Care Affordable for the Urban Poor in Bangladesh
Project Result / Case Study | 23 February 2017
Maternity clinics run under a public–private partnership are making quality health care a reality in Dhaka’s slum communities.
Dhaka, Bangladesh – Three days after undergoing a difficult cesarean section, 21-year-old Tamanna Akter Jinat cradles her newborn in her arms at Bashbari Nagar Shayastha Kendra urban health care center in Dhaka’s sprawling Mohammadpur slum area.
The surgery would normally cost more than $300 but Tamanna is poor and received the procedure for free. “In the past, it was unthinkable to get admitted to a hospital for childbirth,” says her mother-in-law Shahina.
The Asian Development Bank (ADB)-supported Second Urban Primary Health Care Project has brought about a revolution in health services for the urban poor in Bangladesh by improving access to better health care facilities located near slum areas. A special feature of the project was the contracting of primary health care services to 12 NGOs through 24 partnerships between the NGOs and municipalities.
“In the past, it was unthinkable to get admitted to a hospital for childbirth.”
Following the success of the ADB-supported Urban Primary Health Care Project, substantial grant funding and sector expertise was mobilized from the Department for International Development of the United Kingdom, Orbis International, the Swedish International Development Cooperation Agency, and the United Nations Population Fund.
The project built reproductive and primary health care centers to provide maternal and child care to poor urban communities. Each reproductive health care center has an ambulance service and employs 32 staff, including a physician for emergency obstetric care, a pediatrician, and four medical officers. The primary health care centers have a staff of 10, including a physician.
About 80% of services are provided free or at subsidized rates.
Transforming health behavior
Physician Kazi Nurun Nabi, program director at the Al-Haj Jahurul Islam Matri Sadan maternity center, says the facility provides health care for an area with more than 200,000 people. “The proportion of women from the slums coming to the center for delivery and other health care services has doubled to more than 70% in the last few years,” he says.
The centers also provide health education. Five years ago, only 45% of mothers visiting the centers exclusively breast-fed their babies for the first 6 months, but now 70% do, higher than than the national average.
“People, mostly women, come here seeking health care services,” says physician Md. Moniruzzaman as he examines Salma Yasmin, 35, and her baby at the Bashbari center. “Nowadays, they visit the center for minor health problems too, which is a major change in their health behavior.”
Creating health awareness
Creating awareness among adolescent girls and boys about sexually transmitted diseases and family planning methods means more poor youths are avoiding disease and unwanted pregnancies. “Before coming here, I had no idea about HIV or AIDS,” says Saifuddin Ahmed, 16, a rickshaw driver in the northern Mirpur area. “Now, I know how to keep myself protected.”
Project Manager Rehana Akhter Mita of the Bashbari center says men now make up 21% of clients. “We invite male members of a mother’s family to be tested for sexually transmitted diseases and help them become motivated to change their health behavior,” she says.
The health centers have also become referral points for poor patients and send complicated cases to specialized hospitals. Physicians at the Bardhonbari center suspected 40-year-old rickshaw puller Abdul Malek had tuberculosis and referred him to a public hospital. Doctors confirmed he had the disease and sent him back to the center for treatment. “I come here often to take medicine for free or at a low cost,” Abdul says.
The success of the project has shown the importance of the partnership between government and NGOs in delivering health services effectively, especially to the urban poor. Project director Md. Abu Bakr Siddique is convinced that the successful public–private partnership project is a model that can be scaled up to benefit many more people.
The health care centers provide medical support to millions of Dhaka citizens each year, including childbirth services to more than 3,500 women like Tamanna Akter Jinat every month, says Abu Bakr. “This project is contributing to a reduction in the maternal mortality rate,” he says.
Tamanna knows that without the cesarean operation by doctors at the center, the chances of survival for her and her baby were slim. “I am so grateful that my son and I are both well,” she says.
This article was originally published in Together We Deliver, a publication highlighting successful ADB projects across Asia and the Pacific that demonstrated development impacts, best practice, and innovation.