Abstract
This study reflected the author's one-decade professional journey in Bangladesh when he worked on the urban local body. Nevertheless, the author's sensuality with high empathy is that alleviating the urban primary health issues requires a governing department—Urban Health Unit. The urban local body is always under capacity to provide health services in terms of sustainability. In this sense, development agencies like ADB, DFID, and UNFPA anticipated the projects and accelerated the primary health care services under urban local bodies' capacities to downsize health pressure in secondary and tertiary health levels. As a result, assertive public participation and time-befitting policy implications were shaky to do so. For this drive, this study dives into ethnographic methods—participant observation and in-depth interviews with project personnel and public representatives in five urban local bodies of Bangladesh to write this chapter for policy recommendations, ab initio, on urban health issues to establish an Urban Health Unit to achieve SDG 3.
TopIntroduction
In Bangladesh, we have 341 municipalities and 12 city corporations (www.lgd.gov.bd) have a full-fledged health department with a workforce and budget to provide logistics; all these institutions have a little alternative in Bangladesh to prevent the catastrophic disaster of primary health care in urban areas of Bangladesh, even this continent (Siraz et al.,2020).
In the current local government act of the country (LGD Act, 2009), these bodies are supposed to play a significant role in implementing primary health care services, clean water, urban waste management, faecal management, population control, and immunisation programs for 31.5% of urban residents. What is happening at all? To avoid a devastating situation, GoB, with the collaboration of development agencies; for example, in 1996, launched the Urban Primary Health Care Project (UPHCP) under the leadership of the Asian Development Bank with the financial and technical support of UNFPA, Swedish SIDA, DFID, and Orbis International to strengthen the urban health sector of the local government bodies like City corporation and Municipalities. The project takes the opportunity of the Local Government Act 1977; now it is 2009 (amended). After many setbacks, the scheme is still being implemented in selected municipalities and all city corporations, but instead of strengthening the health department, it has gradually weakened itself regarding budget, logistics support, and human resources. That is a different story and context, but the author still explores it as a strategically important part of Bangladesh's health policy interventions aligned with Health Policy 2011. Because ” The government health system is weak, with inadequate attention given to the delivery of basic health care to slum-dwellers. For the past 15 years [it’s a legacy of British rule], the Local Government Division has been responsible for providing primary health care services to poor urban populations, but it has been unable to meet their needs and demands adequately” (Afsana & Wahid, 2013).
Key Terms in this Chapter
Reflected Ethnography: Typically, this chapter is based on personal experiences with ULB in Bangladesh and shared for mitigating the future pandemic for efficient resource management when we have enough to make a decision. For that reason, the author e mphasized personal reflections rather than academic text citations whilst working on those issues.
Local Government Division: It’s a division of the Government of Bangladesh, per se, the rules of business to work smoothly to the outreach part of the country. All urban local bodies are under the LGD of the concerned ministry.
Urban Health Unit: This unit has been proposed in this chapter to look after the Urban Health Systems for effective services.