| Issue/Objective |
Bangladesh's global health narrative centers on rural progress, yet Dhaka is now home to an estimated 4 million slum residents whose health needs are systematically invisible in national surveys, absent from urban health plans, and unreached by both government and NGO programmes. The Bangladesh Demographic and Health Survey excludes most informal settlements by design. Urban poverty is presumed to confer better access: an assumption that is factually wrong and quietly lethal. This study mapped the health burden, service access, and structural exclusion of households in eight informal settlements of Dhaka, generating the evidence base needed to make the invisible visible and hold the urban health system accountable. |
| Methodology/Approach |
A cross-sectional survey was conducted across 386 households in eight informal settlements of Dhaka City Corporation between September 2023 and March 2024, using stratified purposive sampling across settlement types. The survey captured household demographics, socioeconomic status, WASH conditions, non-communicable and communicable disease burden, maternal and child health indicators, health facility registration and utilization, out-of-pocket expenditure, and inclusion in formal health planning mechanisms. Mental distress was measured using the SRQ-20. Settlement-level exclusion from national surveys and city health plans was verified against published BDHS methodology and DCC planning documents. |
| Results |
Of 386 households, 77.7% were not registered with any health facility. Only 17.6% had been included in the last Bangladesh Demographic and Health Survey, and just 12.2% appeared in Dhaka City Corporation health planning documents. Child under-5 stunting was 42.2%, nearly double the national urban average of 22%. Chronic respiratory disease prevalence was 24.4%, compared to a national estimate of 14%. Probable common mental disorder (SRQ-20 ≥8) was found in 46.4% of respondents which is 2.6 times the national prevalence. More than half (57.5%) had skipped a healthcare episode in the past year due to cost. Of 41.7% who had migrated to Dhaka due to climate disasters or riverbank erosion, none had been identified in any climate-health vulnerability planning framework. |
| Discussion/Conclusion |
Dhaka's informal settlement residents are not hard-to-reach; they are easy to ignore. The health burden documented here is not the result of urban prosperity; it is the result of structured invisibility. |
| Presenters and Affiliations |
Afsana Shammi BRAC |
