BMI View : Urbanisation is undoubtedly a major mega-trend in emerging markets, with hundreds of millions of people moving from the countryside to towns and cities in search of economic opportunities. Overall, the growth of cities will mean tremendous opportunities for the healthcare industry (including companies focussed on the construction of healthcare infrastructure and the provision of healthcare services). The big risk, of course, is that governments will fail to manage the process successfully, causing cities to effectively become vast slums, inhibiting patient accessibility to adequate healthcare services.
Bangladesh has experienced rapid population growth in the last two decades:
Between 2002 and 2012, the country's population grew by 13.48%, rising by 18.1mn people, from 134.3mn people to 152.4mn people.
Between 1992 and 2012, the country's population grew by 38.29%, rising by 42.2mn people, from 110.2mn people to 134.3mn people.
The 2011 national census stated that just under a third of the population live in rapidly expanding cities and towns, with the urban population increasing about 6% a year as millions of people leave rural areas in search of work. Dhaka, the capital of Bangladesh, is a fast growing megacity. The population rose from 2.2mn in 1975, to 12.3mn in 2000 and 15.4mn in 2012. Dhaka is the densest urban area in the world, estimated at 44,000 people per km 2. Meanwhile, the city of Chittagong in Bangladesh is the fourth densest urban area in the world, following Mumbai and Surat in India.
Bangladesh's low income urban population suffers from the worst health status in the country. The urban primary health care (PHC) system is severely underdeveloped and cannot provide basic preventive, promotional and curative services. This is worrying as population growth in urban Bangladesh is primarily concentrated among those on low incomes.
Strained Urban Healthcare Services
In comparison to the rural PHC infrastructure, the urban PHC system has been given little attention by the government and has received little support from external aid agencies. While many rural districts now have an accessible community outreach healthcare system in place, in Dhaka the vast majority of healthcare services are still based in hospitals. Dhaka's largest hospital is operating at 50% staff capacity and trying to accommodate 3,000 patients in a facility with just 800 beds.
Urban Patients Have Poor Access To Adequate Healthcare Services
As a result of low affordability levels and a fear of hidden charges, rural migrants are reluctant to access hospital or clinic-based services. In 2008, the mortality rate for children under five in Bangladesh's urban slums was 91 per 1,000 live births, compared with 77 per 1,000 live births in rural areas. In 2011, children from the poorest families were four times more likely to be malnourished than children from the wealthiest families. A 2007 study found that among the urban poor, 70% of women gave birth at home accompanied by untrained traditional birth attendants, exposing them to higher risks of complications.