Healthcare in urban slums: do we care?

Although the best service providers from public, private and NGO sectors are active in Dhaka city, most of the slum dwellers have a very limited access to modern facilities due to financial inabilities, lack of information and awareness about how to utilise the services.
Like most other common public services, healthcare facilities are not readily available in the slums, especially those situated on public land. A few NGOs and some private services provide the primary and maternal healthcare supports in the slums. But the patients with acute and chronic illnesses are facing major challenges to access healthcare. Moreover, they suffer from frequent diseases due to their unhygienic living conditions and low level of knowledge.
As NGO services are mainly available during the office hours, more than 45% of patients are visiting local pharmacies, quacks and traditional healers. For the extreme situations of acute and chronic illnesses, they go to the public hospitals. Most often they are too late for many serious cases.
Many slum dwellers have also shared their negative experiences about the services of public hospitals. They faced different kinds of social stigma such as ignorance and rough dealings from the service providers and demanding illegal fees from the lower class employees or local agents especially to get admission at the hospitals.
Besides the direct cash expenditures, they face indirect loss due to the sickness of any individual such loss of working days, salary cut and losing jobs with some other serious consequences.
Primary healthcare and awareness rising activities should be incorporated with significant health interventions covering the acute and chronic illnesses of the slum dwellers for protecting their right to access healthcare. Specialist doctors can visit at the local static clinics at the slums at least 2 days per week. Specialised private hospitals can be encouraged to provide some free or subsidised services. Besides the formal referral systems, organisational follow up supports are needed for ensuring the proper services from the public hospitals.
Voucher system can be effective for covering medicine, diagnostics and other relevant expenditure. The local government authority (such as ward commissioners) can issue special health card to receive a totally free or subsidised health supports from public or specialised private hospitals. Micro health insurances for the poor and extreme poor people may be one of the best options to improve health situation.

Tofail Md Alamgir Azad, PhD is a Project Director and Md Abdul Baten is a Research Co-ordinator of the Dushtha Shasthya Kendra.