Rethinking health systems in the context of urbanisation: challenges from four rapidly urbanising low-income and middle-income countries
The world is now predominantly urban; rapid and uncontrolled urbanisation continues across low-income and middle-income countries (LMICs). Health systems are struggling to respond to the challenges that urbanisation brings. While better-off urbanites can reap the benefits from the ‘urban advantage’,...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2019-06-01
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| Series: | BMJ Global Health |
| Online Access: | https://gh.bmj.com/content/4/3/e001501.full |
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| author | Helen Elsey Tim Ensor Tolib Mirzoev Sushil Baral Rumana Huque Irene Agyepong Bassey Ebenso Zahidul Quayyem Chandani Kharel Riffat Ara Shawon Obinna Onwujekwe Benjamin Uzochukwu Justice Nonvignon Genevieve Cecilia Aryeetey Sumit Kane |
| author_facet | Helen Elsey Tim Ensor Tolib Mirzoev Sushil Baral Rumana Huque Irene Agyepong Bassey Ebenso Zahidul Quayyem Chandani Kharel Riffat Ara Shawon Obinna Onwujekwe Benjamin Uzochukwu Justice Nonvignon Genevieve Cecilia Aryeetey Sumit Kane |
| author_sort | Helen Elsey |
| collection | DOAJ |
| description | The world is now predominantly urban; rapid and uncontrolled urbanisation continues across low-income and middle-income countries (LMICs). Health systems are struggling to respond to the challenges that urbanisation brings. While better-off urbanites can reap the benefits from the ‘urban advantage’, the poorest, particularly slum dwellers and the homeless, frequently experience worse health outcomes than their rural counterparts. In this position paper, we analyse the challenges urbanisation presents to health systems by drawing on examples from four LMICs: Nigeria, Ghana, Nepal and Bangladesh. Key challenges include: responding to the rising tide of non-communicable diseases and to the wider determinants of health, strengthening urban health governance to enable multisectoral responses, provision of accessible, quality primary healthcare and prevention from a plurality of providers. We consider how these challenges necessitate a rethink of our conceptualisation of health systems. We propose an urban health systems model that focuses on: multisectoral approaches that look beyond the health sector to act on the determinants of health; accountability to, and engagement with, urban residents through participatory decision making; and responses that recognise the plurality of health service providers. Within this model, we explicitly recognise the role of data and evidence to act as glue holding together this complex system and allowing incremental progress in equitable improvement in the health of urban populations. |
| format | Article |
| id | doaj-art-2fd07395adbf44b591700a9295e5a816 |
| institution | Kabale University |
| issn | 2059-7908 |
| language | English |
| publishDate | 2019-06-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Global Health |
| spelling | doaj-art-2fd07395adbf44b591700a9295e5a8162024-12-15T12:45:09ZengBMJ Publishing GroupBMJ Global Health2059-79082019-06-014310.1136/bmjgh-2019-001501Rethinking health systems in the context of urbanisation: challenges from four rapidly urbanising low-income and middle-income countriesHelen Elsey0Tim Ensor1Tolib Mirzoev2Sushil Baral3Rumana Huque4Irene Agyepong5Bassey Ebenso6Zahidul Quayyem7Chandani Kharel8Riffat Ara Shawon9Obinna Onwujekwe10Benjamin Uzochukwu11Justice Nonvignon12Genevieve Cecilia Aryeetey13Sumit Kane14Health Sciences, University of York, York, UKNuffield Centre for International Health and Development, University of Leeds, Leeds, West Yorkshire, UK2 Global Health and Development, London School of Hygiene & Tropical Medicine, London, UKHERD International, Kathmandu, NepalResearch and development, ARK Foundation, Dhaka, Bangladesh5 Ghana Health Service, Research and Development Division, Dodowa Research Centre, Accra, GhanaNuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds Faculty of Medicine and Health, Leeds, UKCentre of Excellence for Urban Equity and Health, BRAC University James P Grant School of Public Health, Dhaka, Dhaka District, BangladeshResearch, HERDInternational, Kathmandu, NepalEpidemiology, University of Washington, Seattle, Washington, USADepartment of Pharmacology and Therapeutics, University of Nigeria Faculty of Medical Sciences, Nsukka, Enugu, NigeriaHealth Policy Research Group, University of Nigeria Faculty of Medical Sciences, Nsukka, Enugu, NigeriaSchool of Public Health, University of Ghana, Legon, GhanaSchool of Public Health, University of Ghana, Legon, Greater Accra, GhanaNossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, AustraliaThe world is now predominantly urban; rapid and uncontrolled urbanisation continues across low-income and middle-income countries (LMICs). Health systems are struggling to respond to the challenges that urbanisation brings. While better-off urbanites can reap the benefits from the ‘urban advantage’, the poorest, particularly slum dwellers and the homeless, frequently experience worse health outcomes than their rural counterparts. In this position paper, we analyse the challenges urbanisation presents to health systems by drawing on examples from four LMICs: Nigeria, Ghana, Nepal and Bangladesh. Key challenges include: responding to the rising tide of non-communicable diseases and to the wider determinants of health, strengthening urban health governance to enable multisectoral responses, provision of accessible, quality primary healthcare and prevention from a plurality of providers. We consider how these challenges necessitate a rethink of our conceptualisation of health systems. We propose an urban health systems model that focuses on: multisectoral approaches that look beyond the health sector to act on the determinants of health; accountability to, and engagement with, urban residents through participatory decision making; and responses that recognise the plurality of health service providers. Within this model, we explicitly recognise the role of data and evidence to act as glue holding together this complex system and allowing incremental progress in equitable improvement in the health of urban populations.https://gh.bmj.com/content/4/3/e001501.full |
| spellingShingle | Helen Elsey Tim Ensor Tolib Mirzoev Sushil Baral Rumana Huque Irene Agyepong Bassey Ebenso Zahidul Quayyem Chandani Kharel Riffat Ara Shawon Obinna Onwujekwe Benjamin Uzochukwu Justice Nonvignon Genevieve Cecilia Aryeetey Sumit Kane Rethinking health systems in the context of urbanisation: challenges from four rapidly urbanising low-income and middle-income countries BMJ Global Health |
| title | Rethinking health systems in the context of urbanisation: challenges from four rapidly urbanising low-income and middle-income countries |
| title_full | Rethinking health systems in the context of urbanisation: challenges from four rapidly urbanising low-income and middle-income countries |
| title_fullStr | Rethinking health systems in the context of urbanisation: challenges from four rapidly urbanising low-income and middle-income countries |
| title_full_unstemmed | Rethinking health systems in the context of urbanisation: challenges from four rapidly urbanising low-income and middle-income countries |
| title_short | Rethinking health systems in the context of urbanisation: challenges from four rapidly urbanising low-income and middle-income countries |
| title_sort | rethinking health systems in the context of urbanisation challenges from four rapidly urbanising low income and middle income countries |
| url | https://gh.bmj.com/content/4/3/e001501.full |
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