Bangladesh's Urban Slums

Previous studies of health seeking behavior among Dhaka’s urban slum population; suggest that the use of ‘traditional’ medicine has decreased as the use of biomedical services has increased; and that pharmacies are the principal healthcare provider for the majority of the population. However, as such studies are largely quantitative, little in-depth information is available; to shed light on how and why such health seeking choices are making.

Kamrangirchar and Hazaribagh are the largest slum areas in Dhaka, Bangladesh. In 2013, Médecins Sans Frontières initiated an urban healthcare program; in these areas providing services for factory workers and responding to the sexual and reproductive health needs of young women. Little in-depth information is available on perceptions of health and health seeking behavior in this population. We aimed to provide a better understanding of community perceptions toward health; and health care in order to inform program strategies.

But in-depth interviews were conducting with women (n = 13); factory workers (n = 14); and key informants (n = 13). Participants were select using purpose maximum variation sampling and voluntarily consent to take part. Topic guides steer participant-led interviews, which were audio-record; but translated and transcribed from Bangla into English. By comparing cases, we identified emerging themes; patterns and relationships in the data. NVivo11© was using to sort and code the data.

Fragmented health system

Emerging themes indicated that in Kamrangirchar and Hazaribagh; health is as an asset necessary for work and for survival. But residents navigate a highly fragmented health system looking for ‘quick fixes’ to avoid time off work; with the local pharmacy deemed ‘good enough’ for ‘common’ health issues. However, health care seeking for ‘serious’ conditions is characterizing uncertainty, confusion, and unsatisfactory results.

However decisions are make communally and shape collective perceptions of quality care. But people with limited socio-economic capital have few options for care. ‘Quality care‘; perceived as comprehensive care ‘under one roof,’ including predictive biomedical diagnostics and effective medication, delivered through a trusting relationship with the care provider.

Health seeking behavior of slum dwellers of Kamrangirchar and Hazaribagh; is based on competing priorities, where quick and effective care is key, focused on the ability to work and generate income. But this takes place in a fragmented healthcare system characterized by mistrust of providers; and where navigation is informed by word-of-mouth experiences of peers.

Effective treatment and referral

But improving health in this context demands a comprehensive and integrated approach to health care delivery; with an emphasis on rapid diagnosis, effective treatment and referral, and improved trust in care providers. But health education must be developed in collaboration with the community to identify knowledge gaps; support decision-making, and be channeled through existing networks. Further research should consider the effectiveness of interventions aiming to improve the practice of pharmacists.

Residents of Kamrangirchar and Hazaribagh see their health as a necessary asset to maintaining an income, and the ability to work is a key driver for staying healthy. At the same time, staying healthy with very limited resources, demanding working hours, and in poor living and working conditions is difficult.