BANGLADESH

The health minister has suggested putting urban primary healthcare under the health department insisting that local government division, which oversees the service, could not ensure care for poor slum dwellers.

"Keep health under the health department… We've the expertise that they [local government division] don't," AFM Ruhal Haque said in a discussion on Tuesday.

He does not feel the local government ministry would 'disagree' with his idea.

The minister solicited suggestions to solve the issue, at the discussion in the capital on the draft National Urban Health Strategy 2011, first of its kind in Bangladesh.

But experts opposed the minister's idea saying local government bodies have a long history of giving primary healthcare within their jurisdiction and the 2009 local government ordinance also mandated that.

"Don't put all axes in one basket," health analyst Dr Muhammad Abdus Sabur told and that: "They (health ministry) cannot do their own task. How they will carry out responsibilities of others?"

"Better share the risks," he quipped and suggested coordination between the two ministries for the sake of public health.

To justify his idea, the health minister said: "When diarrhoea breaks out, nobody asks local government bodies. I can assure their (diarrhoea patients') treatment, but if you ask me to supply water, I cannot do it."

"Same way if you ask local government to manage diarrhoea, they would not be able."

Ruhal said there are many divisions and if they do the same work, problems would be created.

"I asked you to solve it," he told the participants comprising government officials of the two ministries, former secretaries, health experts, demographers and local government representatives.

Former health secretary and adviser to the caretaker government Dhiraj Kumar Nath told bdnews24.com that there was a need for a body that would coordinate between the two ministries (health and local government) in carrying out common responsibilities.

"By government rules, city corporations and municipalities see healthcare like family planning, reproductive health services and emergency care within their areas. You cannot ignore that," he said.

"But they (local government) should make their presence visible to the people," he said.

The government is formulating the urban health strategy as demographers predict equal number of urban and rural population within the next 20 years in the country with increasing trend of internal migration to make a living.

The Bangladesh Urban Health Survey 2008 and Bangladesh Demographic and Health Survey 2007, however, showed growing disparity between the health conditions of the urban poor and the rich.

Infant mortality rate in urban slums is 63 per 1000 births while it is only 29 in non-slum areas. Nearly 80 percent deliveries are assisted by unskilled attendants in slums.

Child malnutrition is 55 percent in slums while it is 40 percent in non-slum areas.

"The strategy aims to see urban people, particularly the poor, healthier, happier and economically productive," said Dr AMM Shawkat Ali, an urban health expert of Asian Development Bank while presenting the key points of the draft strategy.

For universal healthcare coverage, the draft keeps provision for giving free health cards to the poor.

Local government division's secretary Abu Alam Md Shahid Khan hoped they would be able to place the strategy before cabinet by December.