Enabling the extreme poor to access urban health care services in Bangladesh

Bangladesh’s urban population has increased rapidly over the past few decades. In 2000, 24% of the population lived in urban areas.  By 2017 this has risen to over 35%, and by 2050 it is expected to reach 56%. One of the major consequences of a rapidly growing urban population is a lack of basic services at the migrants’ destination. There is a huge amount of pressure on the public sector health system which is unable to cope with the increased demand for services.

Many private and not-for-profit providers have emerged to service the rising demand for healthcare. Whilst this helps to meet people’s health needs, it has also led to an unregulated and divided health service. Many providers operate in an overlapping and uncoordinated way with no standardisation of provision for the poorest groups.

Some external providers have issued discount cards to enable their poorest clients to receive subsidised services from their facilities. With no standard Government definition for classifying the urban poor, providers have developed their own criteria and methodologies for defining who qualifies as poor and thus who is eligible to receive subsidies. This has meant that the urban poor receive different levels of subsidised health care depending on the provider they use, often determined by their locality.

Our Urban Health System Strengthening Project (UHSSP) is working in three cities, Dinajpur, Jessore and Mymensingh, in collaboration with the urban health provider NGOs, the local government divisions and the Ward Health Coordination Committees to pilot an innovative solution to address some of the issues caused by rapid urbanisation.

The Common Health Care Entitlement Card

Across the three cities, we have brought together healthcare actors to test a common health care entitlement card (CHCEC) for the extreme poor. The card enables the urban poor  to claim free or subsidised healthcare from all participating government, private and NGO facilities – ensuing they can access services regardless of their ability to pay. The project has also helped to harmonise who counts as ‘extreme poor’, ensuring all those using the card can access the same services.  .

UHSSP uses evidence and advocacy to make sure the local government, NGO health service providers and government health facilities are all on the same page, and understand the importance of improving access to health services for the extreme poor.

Romana’s story

Romana is the 10 year old daughter of Kahinur Begum, a daily labourer who is unable to work due a chronic disease. Before the distribution of the CHCEC, Kahinur took Romana to the General Hospital in Dinajpur. Upon checking her health, the doctor referred her to the Medical College Hospital. However Kahinur did not take Romana to the hospital because he thought they would not be able to pay for the services and treatment required.

Romana’s father told the UHSSP team and Medical Officer about visiting the General Hospital and their referral to the Medical College Hospital. The Medical Officer advised him to take Romana to the Medical College Hospital again, taking his ID and CHCEC. The officer told Kahinur to meet with the medical consultant first with a member of the UHSSP team accompanying them to explain the CHCEC to the doctors and other officials. The CHCEC was welcomed by the hospital and they happily treated Romana free of charge. Romana is now being treated for a heart disease, which could have been fatal if left untreated.