6/4/2015

Factors affecting preference for education and

health services in slum areas in Bangladesh

Md. Rabiul Haque

Dept of Population Sciences (DPS)
University of Dhaka (DU)

Urban Population in Bangladesh

With a population of over 150 million, Bangladesh is one of the few

developing countries that has been experiencing rapid urbanization
process primarily due to massive migration from rural areas of
middle and lower-income societies to the urban areas.
About 1 in 4 per sons live in urban areas (Census 2001). Urban
population as a percentage of total population increased from
around 8.21% to nearly 23.3 % during 1974-2011 periods.
The urban population recorded during the 2001 Census was nearly
28.6 million and is currently (2010) estimated at 40 million (GoB,
2012)

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Rural-Urban population in Bangladesh

Urban

n
6.27

Growth of Urban Population (in Million) in Bangladesh

1981
1991
2001
%
n
%
n
%
n
%
8.21
13.23
15.18
20.87
19.63
28.61 23.10

Rural

70.12

91.79

73.89

84.82

85.44

80.27

95.25

76.90 116.49 77.70

Total

76.40

100.0

87.12

100.0

106.32

100.0

123.85

100.0 150.04 100.0

1974

2011
n
%
33.55 23.30

Bangladesh Bureau of Statistics

The growth of urban population is expected to increase over the next

few decades (UNPD 2014) mainly due to internal migration

Projected rural-urban population

theurban

Urban population will grow from its current level of 53 million

people to 79.5 million in 2028, an increase of 50% in 14 years. From
being a largely rural country now (66.5% lives in rural areas in
2014), Bangladesh will be an urban country in 2039 when the
majority of people will live in urban areas.
After migration, most of these migrants possessing low human and
financial condition generally settle in slums, the areas prone to
intense poverty and environmental vulnerability.
One quarter of the population lives in urban areas, where population
density is 200 times greater than the national figure.

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Rural-Urban Populations in Bangladesh: 1950-2050

UNPD 2014 in UHS, 2013

Urban internal migration, 2005-2011

SVRS, 2011

Urban internal migration rate, 2005-2011

2005

2006

2007

2008

2009

2010

2011

Rural to Urban

20.3

21.9

23.7

17.3

21.9

24.5

23.7

Urban to Urban

43.5

38.2

41.1

34.4

28.3

8.9

42.5

By year 2021 nearly 33% of the population of Bangladesh will be living

in urban areas. Of which, one third will be due to natural increase, and
two thirds due to internal migration from rural areas.

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% of urban population living in slums: 1990-2009

UNPD, 2012

Population Density : Slum Area and Overall City

Population Density : Slum Area and Overall City
City
Persons per acre

Dhaka
Chittagong
Khulna
Rajshahi
Sylhet
Barisal
All cities

Persons per square-km

Slum Area

City Total

Slum Area

City Total

891
1032
538
272
626
541
831

121
94
82
39
52
29
95

220246
255100
132988
67236
154741
133730
205415

29857
23299
20346
9544
12961
7152
23378

Source: CUS, MEASURE Evaluation, NIPORT, 2006

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Living space per person

The median living space per person is much smaller in slums, 48 sq feet, compared
to 120 and 110 sq feet in non-slums and other urban areas, respectively. In slums, 3
out of 4 households live in only one room. In comparison, 3 out of 10 households
live in one room in non-slum and other urban areas. The median living space per
person in slum households increased from 36 sq feet in 2006 to 48 sq feet in 2013.

Household population by age, sex, and domain, 2013

10

The population in slums is younger than in non-slums; 44% in slums are aged under
20 years compared to 40% in non-slums and other urban areas.

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Major Districts of Origin of the Slum Dwellers by

City

Districts of Origin of the Slum Dwellers

Major Districts of Origin of the Slum Dwellers by City

Dhaka
Chittagong Sylhet
Rajshahi

11

Total

Khulna

Barisal
Barisal (65%)

Barisal
(23%)

Chittagong Mymensingh Rajshahi

(20%)
(16%)
(70%)

Barisal (36%)

Faridpur
(9%)

Comilla
(19%)

Sunamganj
(14%)

Bagerhat (18%)

Comilla
(11%)
Rangpur
(10%)
Hobiganj
(10%)
59%

Faridpur (17%)

Comilla (9%) Noakhali

(15%)
Mymensingh
(7%)
Rangpur
(5%)
53%
54%

70%

70%

65%

Source: CUS, MEASURE Evaluation, NIPORT, 2006

Place of births of slum dwellers by sex and

division, 2013

12

A third of the female slum

population was born in the
same city as their current
residence.
A fifth of women currently
residing in City Corporation
slums were born in Dhaka
Division
Over a third of males in
slums were born in the
same city as their current
residence

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Prior residence of slum dwellers in Dhaka

13

Prior residence of slum dwellers in Chittagong

14

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City corporation slum, and non-slum population

by wealth quintiles, UHS 2006 and 2013
3 out of 4 slum households are in
the lowest two wealth quintiles
compared with 1 in 5 in non-slum
areas.
Almost 60% of non-slum
households are in the two richest
wealth quintiles compared with
7% in slums.
In slums, a larger proportion of
households are poorer in 2013
than in 2006.

15

HS, 2013

Education and health situation in urban slums

16

Education is a vital requirement for combating poverty,

empowering women, protecting children from hazardous and
exploitative labor and sexual exploitation, promoting human
rights, protecting the environment, and influencing population
growth.
Mainly, poverty among the slum dwellers stanches inadequate
access to education and reproductive health services.
Lack of awareness and insufficient support for schooling
resulted in very low level of literacy among the slum dwellers

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Overall Educational situation in urban areas

Overall Educational situation in urban areas
Indicators
Municipality City corporation
Pre-school attendance rate
25.0
27.3
Primary school net intake
73.6
78.1
rate
Net attendance rate in
84.2
84.3
primary school
Net attendance rate in
54.1
53.4
secondary school

Slum
13.0
51.4
65.1
18.4
MICS, 2009

The overall educational situation in urban slums is not considerably satisfactory

17

Educational attainment of slum population by

survey year: Female

18

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Educational attainment of slum population by

survey year: Male

19

Slum population: Access to safe drinking water

Proportion of sources of drinking water in slum areas
Source of drinking water

UHS 2006

UHS 2013

Piped inside/outside dwelling

60.0

59.3

Tube-well inside/outside dwelling

39.5

39.7

Pond/river/stream/rainwater/other

0.5

1.0
UHS 2006, 2013

20

No visible change observed between two time period

10

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Slum population: Access to improved sanitation

21

Slum population: principal method of garbage disposal

Almost half of slum
households dispose of
garbage in an open space.
Collection of garbage
from home or disposed in
bin
outside
home
increased in slums from
38.7% to 47.9%

22

11

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Total fertility rate

23

Trends in teenage pregnancy

24

12

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Contraceptive use among currently married

women age 15-49

25

Trend in utilization of ANC by type of provider

26

13

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Trend in use of health facility for delivery

27

Facility delivery is highest

among women living in
non-slums (65%) and
lowest in slums (37%).
Home delivery is the most
common among women in
slums and other urban
areas while private
facility is the most
commonly used place of
delivery by women in nonslums.

Delivery by medically trained provider by place

of delivery

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14

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Medically trained birth attendants

Use of medically trained providers has
increased.
Delivery by medically trained providers
in slums doubled between 2006 and
2013.
Yet differences exist between slums
and non-slums, births among non-slum
women is 1.8 times more likely to be
assisted by a medically trained
provider compared to births among
slum women.

29

PNC for women and newborn from a

medically trained provider by 2days of delivery

30

15

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Trend in childhood mortality rate in City

Corporation slums

31

Care seeking for childhood ARI from trained

facilities/persons

32

16

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Trend in nutritional status of under-five children

33

Contraceptive prevalence rate (CPR)

HPNSDP aims to reach a CPR of 72% by
2016. Couples in slums are closest to
this level with a CPR of 69.6% in 2013.
Over the last 7 years, CPR increased by
12% points in slums compared with 2%
points in non-slums.

34

17

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Total Fertility Rate

HPNSDP aims to reach TFR of 2.0
by 2016 has already been reached.
The difference in TFR between
slum and non-slum has narrowed
from 0.6 birth in 2006 to 0.3 birth
in 2013

35

Number of ANC 4+ visits

HPNSDP targets to achieve
coverage of ANC 4+ visits of 50%
by 2016. This target has been
surpassed in non-slums only (58%)
but 29% only in slum areas.
ANC 4+ is 2 times higher in nonslums
compared to women in slums.
The absolute difference in seeking
ANC 4+ between slums and nonslums is 29% points.

36

18

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Use of medically trained provider at delivery

37

HPNSDP aims to achieve skilled

birth attendance rate of 50% by
2016.
This target has been surpassed in
non-slum and other urban areas
but in slum areas.
Non-slum women are 1.8 times
more likely to be assisted by a
medically
trained
provider
compared to births among slum
women. Absolute difference is 31
percentage points

Trend in stunting of under five children

HPNSDP targets to reduce
prevalence of stunting among
young children to 38% by 2016.
This target has been achieved in
non-slum (33%) and other urban
areas (37%).
In slums, stunting is still as high
as 50% in 2013.

38

19

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PNC for newborns, UHS 2006 and 2013

39

HPNSDP aims to achieve

50% PNC for newborns by
2016 from a medically
trained provider. In 2013,
both non-slums (49%) and
other urban areas (45%)
are close to reaching this
target.
Slums are lagging behind in
approaching this PNC level
with a rate of 27% in 2013.

Availability of health services within 1 km

40

20

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Employment, Women, 2013

Women in slums are more likely to work full time than women in non-slum and
other urban domains. 1 in 3 women in slums was in employment compared with 1 in
41
6 in non-slum areas

Reasons to migration of slum dwellers

42

21

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Key Challenges

Rapid growing urban population: The rapid growth of urbanization

has adverse socio-economic and environmental consequences,
especially in slum areas. We need to turn these human resources
from burden to asset. Urban slum populations are the integral but
underprivileged parts of urban population, without which the
development will not sustain. Thus, preference of education and
health services for these urban slum populations are inevitable.

43

Key Challenges--

Hidden contribution to GDP by urban slum population: The growth of

modernized industries and export oriented services attracted the
rural people to migrate into urban cities. Rapid improvement in
RMG sector triggered the establishment of such factories in urban
areas. A majority of the workers of these industries live in the
urban slums contributing to national development. But, poor
livelihood, infrastructural shortcomings, poor governance of urban
slums could not manage to make this contribution sustainable.

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Key Challenges--

Poverty induced labor force participation: The push and pull factors
of rural to urban migration results in establishment of slum
settlements. The slum dwellers participation in labor force makes
them a crucial partner of urban development. Around 75% of male
slum dwellers from DMA are participating in income generating
activities while around 34% of women from that area do the same
(UHS 2006). This higher proportion of male participation was
consistent across the different city corporations.

45

Key challenges--Higher drop-out rate in slum areas:

The education situation in slum
area are not convincing due to
higher drop-out rate. It
indicates the necessity of
adequate
and
proper
intervention of education in
slum areas which will eventually
contribute to the overall human
development of the nation.

46

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Key Challenges--

Vulnerable health situation in slum areas: The health situation in slum areas is
not convincing in terms of service utilization and hazardous for the dwellers.
The over populated, dense and squalid environment of the slum areas breed
both communicable and non-communicable diseases. Moreover, the RH: FP-MCH
services to women are not available. Maternity hospitals and female wards
especially for urban poor women are inadequate in the urban areas. The poor
particularly find access to the service difficult. Private medical facilities have
improved in large cities, but these are only for the well to do. Even though
several GO, NGO and INGO initiatives are implemented to improve the heath
situation in slum areas; the sustainable development is still far reached.

47

Barriers for poor education and health

48

Poverty induced labor force Lack of permanent job and security

participation at early age
High rate of mobility
Poor living and environmental Unrecognized slums
condition in slum settlements
Uncertain daily wages
Wealth status
Traditional practices
Migration status
Low social capital
Mothers education
Lack of recognition of their
Frail access to basic services
contribution in development
Threats of extortion and exploitation

24

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HPNSDP (2011-2016) identified priority

intervention for urban health services include:

49

Developing an urban health strategy with time bound action plan in collaboration
with MOLGRDC. The focal person for urban health in MOHFW will take the
initiative for formulating the strategy in consultation with relevant stakeholders.
Commissioning a study to determine how the two Ministries can jointly assess, map,
coordinate, plan and work together to provide quality HPN services for the
urban population.
Establishing a permanent institutional arrangement and governance mechanism
incorporating relevant ministries, agencies and institutions with responsibility
to urban health.
Expanding/upgrading urban dispensaries for effective and quality PHC services
(including reproductive health, nutrition and health education services).

HPNSDP (2011-2016) identified priority intervention

for urban health services include --Defining an adequate referral system between the various urban dispensaries
and the second and third level hospitals, and exploring feasibility of
introducing General Physician (GP) system
Developing and utilizing urban HIS for effective management of urban health care
Building capacity of the various service providers under MOHFW and MOLGRDC
Determining the role and accountability of different NGOs and the private sector
in the delivery of urban health. Formalizing relationships through PPPs and
through diversification of health service delivery strategies

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National Urban Sector policy 2011

recommendations
Urban poverty and slum improvement

The need for improvement of slums

Resettlement of slum dwellers
Ensuring tenure security
Special zones for the urban poor
Access to infrastructure services
Supporting informal sector activities

Urban Heath and Education

51

Ensure implementation of universal free and compulsory education at primary

level and free secondary education for girls
Promote hierarchical structure of educational institutions

National Urban Sector policy 2011

recommendations--

52

Make provision for specific educational zones/ areas for secondary and
tertiary education in urban plans
Dedicated arrangement for primary, non-formal and vocational education with
special programs for women
Provision of free primary healthcare for the underserved population with
emphasis to the special health needs of women and children
Designate zones/areas for clinics, hospitals and health sector related
infrastructure at appropriate locations by hierarchy of services and ban
establishment of large units of such services within residential areas
Organize advocacy for urban social services approach for healthy urban
development
Organize awareness and advocacy programs for education expansion

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Conclusion and recommendations

53

Recognize the importance of addressing the right of the people from urban slums.
Creating awareness regarding the necessity of education and appropriate behaviors
of reproductive health, family planning and child health in slum areas through
intervention
Strengthening and expanding existing interventions regarding education and health
services in slum areas
Establishing effective linkage between slum community and health facilities for
referral in case of reproductive health related complications
Establishing housing for poor and slum improvement in order to eradicate the risk of
eviction of slum dwellers without proper rehabilitation or relocation.
Provision of free selected health care services for women and children.
Patronizing urban research in order to focus on planned urbanization.

ThankYou

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Authors
Mohammad Bellal Hossain
Md Rabiul Haque
Md Kamrul Islam
Assist
Mohammad Sazzad Hossain

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