Thesis on Slum Dwellers Health Care: Provisions, Preference and Challenges

Rapid population growth in the urban areas of Bangladesh, particularly in the major cities Dhaka and Chittagong, caused heavy influx of migrants from vast rural areas that have led to severe pressure on the existing utilities and services. Overall health conditions of these urban poor are not so good because they came in the urban areas with poor health conditions, which influenced by poverty and illiteracy. They get doubly affected because of poor living conditions with inadequate preventive health facilities and lack of sufficient curative health facilities. The slower rate of expansion of these health facilities is increasing the destitute conditions of the urban poor. Although, UNICEF, NGOs and some charitable organizations have been working on urban poor health, but they concentrated only to the preventive health. On the other hand the urban inhabitants usually receive priority in government expenditures and
policies, but even the large investments in general and specialized hospitals and clinics in the public sector, the facilities barely touch the health problems of urban poor, which lead them to seek modern health cares from private sector.

Against this backdrop, a poor community in the south part of Chittagong City was comprehensively studied. Systematic exploration was done of the existing living conditions particularly focusing on the availability of preventive health facilities and accessibility to curative health services of the slum dwellers. Opinions were taken from dwellers regarding their service uses and preference and causes for preferences. Also, the study had collected information slum people’s attitude and knowledge about health.

The results indicate that the majority of the poor people had same kind of health cares service preference during their illness. According to the present study the poor slum inhabitants are sufferer from both preventive as well as curative health facilities. Moreover existing urban basic services delivery are also inadequate and unsafe for use. The results also indicate that income and education have no impact on their health care behavior in this studied settlement. It was understood from the observation as well as from the study; most of the service delivery institutions have lower capability and lack of commitment to deliver preventive as well as curative services to the poor people. But the users of health cares choices attach highest priority on modern health facilities, especially to the curative health facilities. This study discovered that the dwellers are willing to pay for their health care. The study also identified some problems from the data about the public health facilities such as, long distance, lack of proper care and long times waiting. On the other hand modern curative health care in the private sector is expensive. Therefore, these available health cares services should place priority on accessibility for all walks of life that will make it possible to have good health for all.

The life, work and productivity of a person are all linked with health. Health in turn is dependent upon a set of basic inputs, which helps a person to optimize a quality of life. For the existence of life in this world, human beings have to struggle for the minimum requirement of these essential inputs, which is necessary for life. This basic need includes two elements; one is private consumption that is food and shelter, the other is essential service such as water, sanitation and so on. But due to the increasing poverty people is unable to meet the basic need. Though in the urban areas of all developing countries some form of public or private health services are there. But, these are not uniformly and equally distributed. People have less access to these facilities because of various socio-economic, cultural and political reasons. For example, sometimes superstitions act as a hinder to use the modern health facilities; people’s traditional belief is that baby should not be delivered in the hospital. Such beliefs work well among poor, as they are illiterate. Sometimes their income is too low; because of majority of them have one source of earning for their family. This deprives them from using proper health facilities. Poor people also go to hospital after being sick, since they have little knowledge about preventive measure. So, various factors are involved with the accessibility of health facilities.

Rapid urbanization is a common scenario in the developing countries. It has close association with poor health condition. In the last few decades, most of the third world nations have experienced with rapid growth in their urban population that is unmatched to any time in the history. Since 1950, the numbers of people living in cities have increased almost three times in developing countries and twice in developed countries. In developing countries 1.3 billion people are living in the urban centers and the total number of urban dwellers in the Third World is comparatively more than in Europe, North America and Japan (Cairncross et al., 1990, 1). These large populations in the urban area affect the urban quality of life in developing countries. A United Nations study predicted that 60 percent of the urban population in Asia would live in slum or squatter settlements by the turn of the century unless drastic reform measures were taken (State of Urbanization, 1993,). If the current situation goes on, especially urban poor people’s health condition would be unimaginable.

To maintain an overall minimum quality of life, the Third World countries are on the way to address the urban health issues in a multi-sectoral approach, especially in Asia; because of its rapid urban growth. It is also essential to improve the dweller’s required basic facilities, to maintain the over all minimum quality of life in urban areas.

It is true that within urban areas, the good health of the poor inhabitants depend upon their access to the public health facilities. But, in many cities policy bias to higher income group reinforce the poorer section remain as disadvantage group. The poor are either excluded from obtaining these services or at least can have minimal access to them. Because in many cases slums and squatter settlements are not even shown on official maps and no recognition is shown of the conditions in which poor people live. (WHO Report, 1990)

The similar picture exists in Bangladesh. Urban population increasing at a rate of 5.3 percent per year in 1980-93 according to the World Bank according to World Bank reading (EIU country profile, 1997-98). The increasing urban populations are mainly from rural poor and settling themselves among the slum and squatter settlements of principal urban center Dhaka and Chittagong. But those cities are already over burdened with high population. Local government is facing problem to meet the basic demand. Therefore, the low-income communities are the worst affected due to shortages of basic health services, even, the poor have very limited or no access to health care facilities, water, sanitation and education. This results in deteriorated environmental conditions and consequently increased difficulties in maintaining minimum standard of living and public health.