Neglect, underfunding cripple urban healthcare

Urban health -- particularly for low-income communities -- remains one of the most neglected, least prioritised, and underfunded areas of Bangladesh's healthcare system, said speakers at a conference yesterday.

They pointed to major gaps in the country's urban healthcare system, especially in primary care, noting that services for more than 70 million city residents are not as well-structured as those available in rural areas.

Speakers highlighted the need for ward-based General Practitioner (GP) units to ensure primary care, disease prevention, and basic treatment services.

The discussion took place at the Bangladesh Urban Youth Conference 2025, themed "Youth Voice for Sustainable Sexual and Reproductive Health Rights (SRHR)", organised by Ipas Bangladesh at the Krishibid Institution Bangladesh in the capital's Farmgate.

The event was supported by the Government of Canada through the Health Bridge Foundation.

At the conference, youth volunteers presented the "Dhaka Declaration 2025", calling for transformative changes in urban healthcare.

They urged the development of a comprehensive strategy to make health services inclusive for all urban citizens.

The declaration recommended establishing primary healthcare in every neighbourhood, provided only by registered medical professionals under a regulatory framework and overseen by a dedicated authority to ensure quality.

Key proposals include establishing primary healthcare centres in every ward to provide awareness, prevention, and treatment services, alongside 100 to 150-bed hospitals in each city corporation zone.

It also recommended establishing Zonal Health Offices, modelled on the Civil Surgeon's Office, to oversee hospitals, clinics, pharmacies, GP chambers, diagnostic centres, family planning, vaccination, and other public health initiatives. These offices would include field workers, service providers, public health specialists, and other staff.

The declaration also called for an effective referral system linking primary healthcare centres to secondary and tertiary facilities for timely treatment of complicated cases.

It stressed the need to guarantee women's and adolescents' access to SRHR services and counter stigma, misconceptions, and superstitions through awareness campaigns.

Other recommendations included reactivating government and non-government reproductive health call centres, establishing adolescent and women-friendly healthcare centres in educational institutions, and involving youth in awareness initiatives.

Financial measures proposed included more allocation in the national health budget for urban healthcare, lowering the price of essential medicines, introducing health insurance schemes for the ultra-poor, and providing subsidised diagnostic services for marginalised communities.

The declaration also demanded a more accountable health administration with strict monitoring to prevent exploitation by middlemen in hospitals and health centres.

Speaking as chief guest, Prof Md Sayedur Rahman, special assistant to the chief advisor, stressed the role of youth and volunteers in driving healthcare reform.

He emphasised that lasting change comes not from short-term incentives but from civic responsibility and collective action, urging the youth to extend their activism beyond their own rights to include the well-being of the elderly.

On urban health specifically, he admitted to structural gaps compared to rural healthcare. "The rural health structure is very well-organised… But in cities, where more than seventy million people live, the structure for primary healthcare is not as systematic as in rural areas."

He noted the government's plan to introduce ward-based GP units in cities to provide a structured entry point for urban primary healthcare, in line with the Dhaka Declaration's recommendations.

Dr Rahman also emphasised equity and safety, highlighting the critical role of women doctors in both rural and urban settings, and called for ensuring their protection and dignity alongside patients'.

Ipas Bangladesh Country Director Dr Syed Rubayet said, "Sexual and reproductive health services and rights are highly stigmatised and a neglected issue. We all probably know that sexual and reproductive health is a fundamental right, but there has been widespread indifference towards it."

He admitted that past and current efforts remain inadequate and stressed the urgent need for stronger action.

Edward Cabrera, first secretary (development-health) at the High Commission of Canada in Bangladesh, said the skills and advocacy learned by youth volunteers will shape the leaders of tomorrow.

He called on health professionals, government bodies, and development partners to keep supporting volunteer-led models to strengthen SRHR across the country.