Scaling-Up Access to Prehospital Care in Dhaka, Bangladesh

BRAC background: BRAC, formerly known as Bangladesh Rural Advancement Committee, is an international development organization based in Dhaka, Bangladesh. It is the largest non-governmental development organization in the world, and is often called the “minigovernment” of Bangladesh. BRAC is also one of the largest public health providers in Bangladesh, working specifically with maternal health and general health care access in slums in Dhaka.

Policy Problem Statement: BRAC is committed to improving the health of the population in Dhaka’s urban slums. However, BRAC has not yet responded to the increasing number of deaths from road and construction accidents that largely affects the population in urban slums, or informal settlements. Increasing access to basic prehospital care is imperative to stopping the rising mortality rates. Recently, there have been efforts in creating basic prehospital systems to alleviate this issue. However, these startups face a multitude of barriers in scaling-up and increasing access to their prehospital care systems. Currently, prehospital care is limited to a few districts in Dhaka, and unavailable the majority of the city’s population. Expanding the area of these prehospital care systems requires resources, supportive policies, and a stable emergency system. Dhaka currently lacks these supportive policies, and actually impedes the spread of prehospital systems through their policies regarding the treatment of urban slums.

One such policy is the non-recognition of urban slums by the North Dhaka Corporation, and the South Dhaka Corporation, the two governing bodies of Dhaka. The slum areas are not considered to be geographically part of the city. Therefore, there have been little city planning efforts for these informal settlements. Police, and fire departments are not developed near slums, and there have been little resources allocated to have these areas patrolled. The safety of first responders cannot be guaranteed when responding to incidents within slums. In addition, due to the lack of city planning, and mapping, there are no road numbers or signs. First responders cannot easily navigate the roads in these areas, and access patients. Therefore, under the current governmental policy, access to prehospital systems is far more strained in informal settlements.

As a major healthcare provider in Dhaka, and an influential NGO, BRAC is in a unique position to help provide access to prehospital care as an proponent to removing the non recognition policy, and liaison between first responders and the inhabitants of urban slums.