Dhaka Statement: 'Pushing' and 'Pooling' for Urban Health

Through the Dhaka Statement, the participants of the International Conference on Urban Health 2015 recognised urban health as a priority in sustainable development. The forum also raised the necessity of including urban health in the sustainable development goals, targets and indicators for the post 2015 development agenda, Third International Conference on Financing for Development, The United Nations Climate Change Conference, Habitat III and 2016 Conference on Housing and Sustainable Urban Development.

Cities as Drivers of Development

The Statement also acknowledged the role of cities/urban areas in national development as they provide the following opportunities:

  • Potential to improve lives through economic support
  • Planned environment (housing, land use and transport) can result in healthy choices of food, exercise and social engagement
  • Advancement of education, child growth and human empowerment

Gearing Up Governance

The Statement reiterates on strong and effective governance to promote urban health – clarifying roles and responsibilities of local bodies as well as building up strong public health infrastructure to work in partnership with other sectors, preventing and mitigating potential risks and benefits to the health of policies, programmes and investments across sectors.

Call for Action

The Statement has urged for the following actions to mainstream urban health into sustainable development agenda:

  • Recognising critical importance of the health of urban dwellers to achieving Sustainable Development Goals
  • Mainstreaming consideration of the unique opportunities and challenges or urban environments across the SDGs
  • Recognising need for evidence based and cost effective interventions to achieve health targets outlined in SDG, Goal 3: Ensure healthy lives and promote well-being for all at all ages
  • Committing to meet the needs of SDG Goal 11 – Make cities and human settlements inclusive, safe, resilient and sustainable
  • Developing national health policy that integrates planning for rural and urban areas
  • Including urban health targets and indicators to implement SDGs at national level that reflect progress towards urban health and health equity
  • Advancing health of people in cities including resource mobilisation for capacity building, applied research and strengthening governance for urban health
  • Seeking suggestions for experts to define, understand and address major challenges of urban development into the intergovernmental process leading up to UN Conference on Housing and Sustainable Urban Development (Habitat –III) taking place in October 2016 in Equador
  • Acknowledging role of health as both input and outcome of development in the New Urban Agenda emerging from Habitat III

This way, the International Conference on Urban Health brought about the Dhaka Statement not only in order to 'push' the initiative for incorporating urban health components in the sustainable development agenda but also 'pooling' the commitment and resources from the global development community to bring the UH agendas into practice.

Urban Health Policy Development: The Nepal Experience

Health Research and Social Development Forum (HERD) during presented its analysis of policy development process in Nepal in a breakout session on Day 4 of the International Conference on Urban Health. The session was chaired by Anthony Kolb, Urban Health Advisor for USAID.

The presentation highlighted three major issues drawn from the study which used qualitative retrospective policy analysis:

  • Actors – individuals with an interest in urban health needed to be influential positions with power and knowledge to influence others
  • Context – issue felt important at this point of time needed to be tackled given the confluence of interest from governmental, non-governmental and international organisations
  • Issue – clear evidence of health and service provision of urban poor and potential solutions required

Sudeeepa Khanal (on the left), Senior Research Officer at HERD during her presentation 

Q&A Session

Mr. Hom Nath Subedi, Programme Manager at HERD and a Health Systems Expert with over three decades of experience coordinating different national health programmes responds to various pertinent queries raised during the floor discussion.

Q – In this draft policy, is it addressed only for the government urban health facilities or also includes those run by the private/ non-government sectors?

A – There is no mentioning specifically of the private/non-government health facilities and the policy talks of developing the strategy and then making it more specific from there onward as action points for different ministries to take the initiative forward in terms of defining roles and responsibilities of various bodies; allocating budgets and outlining the activities.

Q – With regards to handling urban health issues by the urban centres, are there any local government bodies (say municipalities) that are independent enough to deal with urban health problems on their own or with minimum central support?

A – Very few municipalities such as those in Kathmandu valley are independent enough in terms of resources to implement urban health programmes. Other municipalities require central support through the ministry and the regional offices. In that regard, the health ministry should come up with a distinct approach of categorising urban areas based on their resource bearing capacities and design tailored interventions to meet the specific urban health needs. I don’t think there is budgetary constraint. I think it is more about proper planning and realisation about the problem.

Q – Sometimes, in sectors like health and education, it is difficult to come up with a consensus as the policies and programmes and very much donor driven and based on different interests, there are different methods of standardisation. How did you manage to cope with this trend?

A – It would be unfair if we do not acknowledge the contribution made by the donor agencies supporting the urban health policy development. Though they didn’t have the direct involvement, their moral support and moral pressure to the government and facilitators like us was enormous for the urban health policy to come to this stage. Funding is not an issue to conduct some workshops but their contribution of sensitising the issue was strategically important for us.

Rajesh Kumar Mishra from FHI 360 during the Q&A session

Q – Doesn’t it become very difficult to come up with one-size-fits-all policy to come up with the same policy for Kathmandu as well as other urban areas?

A – Yes, it is difficult but we are finding ways to overcome such problems. One innovative initiative that we have started is Performance Based Management System where health officials and health facilities are ranked and supportive facilities are prioritised on the basis of their performance. This has led encouragement for better health system functionality where regional and local level planning and implementation are also prioritised.

Q – There seems to be problem here in Bangladesh about roles and responsibilities of different ministries and ministries escaping from certain responsibilities claiming that they don’t fall under their scope of work. Do you have any specific examples/success stories of better way of handling these responsibilities?

A - I think that a costed strategy should be developed so that the ministries are more answerable to their actions. The costed strategy will help in outlining specific roles and responsibilities and therefore result in swift follow up on the actions.

The 'Organic' Process

Anthony Kolb as a chair of the session congratulated HERD team for facilitating the urban health policy development process so 'organically' as compared to India or Bangladesh where it was mostly donor driven. 

Supporting Anthony's views, Dr. Helen Elsey Lecturer at University of Leeds, UK remarked, “Another dimension of HERD’s role in the urban health policy development has been stimulating some actions by facilitating the Joint Annual Review meeting of health sector in Nepal. This perhaps indicates that UH policy in Nepal much more organic and less donor driven. There is therefore some distinct difference in Nepal’s urban health policy development than in other countries.”

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