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Ensuring healthcare for urban poor

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05th-Nov-2018       
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Dr. Md. Shairul Mashreque and Dr. M. Abul Kashem Mozumder :
'World heath day 2010 draws attention to the health challenges that are associated with urbanization'. True slums and squatter settlement are springing up in the wake of unplanned urbanization in Bangladesh. There are score of problems faced by the vulnerable groups living in squatter settlements. They lead a sub-human life suffering manifold ailments often without treatment. The filthiest city corners in which they reside obviously in hazardous living conditions create problems of hygiene and sanitation. The villagers drifting into town out of dire necessity usually take position in urban slums. Most of them are rickshaw pullers, vendors and hawkers and basti women or young girls render service in rich and middle class families as maid domestics on temporary or part-time basis. Living below poverty level equilibrium trap this urban poor cannot aspire for modern health facilities available in metropolitan cities.
Our government has paid little attention to the basic needs of the poor, particularly in the area of health. The public hospitals are ill-equipped with shortage of drugs and other supplies Thing are that primary health care putting the last first is not only the social responsibility of the government.
Private organizations may have much to fulfill this social obligation towards the have-notes. Both government and private bodies should improve Poor's access to primary health care, child immunization, pre-natal and antenatal services, hospitalization with modern service and other improved facilities. Urban health facilities should be subsidized for the poor as the beneficiaries.
Health related policies operate in an inequitable situation. The rich and the poor are differentiated with regards to health service and facilities. The outcome of the emphasis on privatization of health services in the proposed health policy may amplify such differentiation. It is not difficult to predict a tilt in favor of money hungry private investors seeking to trade on public health. The heat of commercialization of health in open market economy under the impact of globalization will jeopardize right to health services. Of course some members of the team of experts rule out such unhealthy probabilities.  Actually redenomination of health governance calls for involvement of non-state agencies in the management of health related programs.
What we need is affordable treatment for the poor. The treatment being too expensive cannot be afforded the low income groups. . Many ailing poor patients succumbed to killer diseases in the absence of treatment. In electronic media and national dailies their relatives appeal for funds to help to defray the cost of treatment. The social cost of such policy outcome is much more than the economic cost of the government.  Many a family has turned pauper after defraying high cost of curing serious diseases.
Health insurance scheme for the low income group may well be taken for consideration. It should be made compulsory for the employees working in public and private organizations. This is for combating the serious diseases including the catastrophic ones.
Health may well be brought into public safety net including charitable clinics conducted by a dedicated cadre of doctors aided by paramedics and health workers. Each dispensary available near the residence can install a box for the collection of unused and unexpired medicine for free distribution among the poor.  
The issue of patient's empowerment is an important one. Their rights to health services have been under constant threat due to the misbehavior of some medical practitioners with 'professional deficiencies.'
Another issue is occupational health. The workers associated with hazardous jobs are at the risk of occupational diseases. Their workplace does not meet the requirements for 'health and safety protection'. These poor workers compelled to do job in an adverse environment include among others: ship breaking laborers, street children and garments workers. Mention ably occupational risk factor in ship breaking industries may result in asbestos.
Another issue of urban health is child labour.The grinding urban poverty along with situational adversities in the total absence of motherly care and affection deprive the poor working  children from basic health care and services. Effects of ruthless street situation are stated to be damaging creating a lot of psychiatrically problems.  Non-fulfillment of psychological needs that affect street children mentally is an inevitable outcomes of urban poverty mixed with mistreatment, neglect and deprivation in a situation unfriendly to the motherless vulnerable children.  This has become a issue of mental health.  The syndrome of abnormal state of child psychology is characterized by verbal aggression, physical harm, sexual assault, emotional hurt, traumatic neurosis, and many others forms of behavioral disorder.
The ignored tragedy is that there are millions of exploited children in the world rummaging in garbage for a scrap of food looking in the darkness of despair for a street corner to sleep. Many of them are forced into two types of prostitution, female prostitution and mate prostitution. The appalling neglect and exploitation to which the street children and adolescents are exposed is a glaring testimony to the fact that we live in the age of moral erosion.  Urban situation has turned into the vortex where values have completely passed into oblivion.
Now we see many sex workers, young street sex workers, injecting drug users (IDU) among street children are out to damage urban 1environment and create violence. Narcotics, inhalants, volatile like glue, gas, oil ointment, benzene, spray, liquids, opium, heroin, pathedrine, and phensydil used by them are risk factors.  Health workers are not sufficiently informed about risk factors causing spread of STD/HIV among street children.  Sexual initiation and experimentation in children carries for greater risks than before, especially in some sub-Saharan African countries with very high HIV prevalence role (World Development Report 2007: 32).
Last, far from least the poor actually deserve urban health facilities. For they are the worst victims of natural devastation that compelled them to migrate to cities. Alarmingly the deluge of climate change is increasingly the number of the destitutes in the major urban areas. They are climate refugees trekking to towns for secured living.   

(Dr. Md. Shairul Mashreque is a Professor of Public Administration, Chittagong University and Dr. M. Abul Kashem Mozumder is Professor and Chairman of Public Administration, Jahangirnagar University)

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