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Urban Health Investments in India and Bangladesh: Rationale and Cost of Essential Health Services

29 Pages Posted: 23 Mar 2019

See all articles by Daphne C. N. Wu

Daphne C. N. Wu

University of Toronto - Centre for Global Health Research

Eduardo P Banzon

Asian Development Bank

Hellen Gelband

University of Toronto - Centre for Global Health Research

Brian Chin

Asian Development Bank

Hayman Win

Asian Development Bank

Varsha Malhotra

University of Toronto - Centre for Global Health Research

David Watkins

University of Washington

Sonalini Khetrapal

Asian Development Bank

Sungsup Ra

Asian Development Bank

Dean T. Jamison

University of California, San Francisco (UCSF)

Prabhat Jha

University of Toronto - St. Michael's Hospital; University of Toronto - Centre for Global Health Research

Asian Development Bank-University of Toronto-Disease Control Priorities Group

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Abstract

Background: By 2030, the urban populations of India and Bangladesh are expected to nearly double. We describe the anticipated health needs of these urban populations, with an emphasis on equity. We propose a South Asia Urban Package (SAUP) of essential health interventions based on the Disease Control Priorities, 3rd edition (DCP3), and estimate its expected costs and mortality reductions.    

Methods: We used population data from the countries' censuses and United Nations Population Division. For causes of mortality in India, we used the Indian Million Death Study; to examine equity, we used data from the Indian National Family Health Surveys. Costs and mortality reductions expected with SAUP were estimated using the DCP3 model.    

Findings: Non-communicable disease (NCDs) rates have been rising for two decades, and communicable disease rates are declining. NCD risk factors in urban India are higher among the poorest population groups, who also have the least access to healthcare. The SAUP would cost about US$105 per capita in India and $75 in Bangladesh. Of this, 60% would be invested in prevention and treatment of NCDs and about 80% in primary care and first level hospitals. Investing in SAUP would return about $7 and $6 in welfare benefits per dollar spent in India and Bangladesh, respectively.    

Interpretation: Rapid urban population growth, high levels of NCDs, and the unfinished agenda of infectious diseases support the need for major investments in urban health. The SAUP would cost an additional $75 and $50 per capita, in India and Bangladesh, respectively, and would help India and Bangladesh substantially achieve their 2030 United Nations SDG goals.  

Funding Statement: The study was funded by the Asian Development Bank. EB, BC, HW, SK, and SR from the Asian Development Bank helped to draft the key messages and reviewed the drafts of the manuscript.

Declaration of Interests: The authors state: "No conflicts of interest to declare."

Ethics Approval Statement: Missing.

Keywords: Urban health, universal health coverage, non-communicable diseases, India, Bangladesh, South-Asia

Suggested Citation

Wu, Daphne C. N. and Banzon, Eduardo P and Gelband, Hellen and Chin, Brian and Win, Hayman and Malhotra, Varsha and Watkins, David and Khetrapal, Sonalini and Ra, Sungsup and Jamison, Dean T. and Jha, Prabhat and Group, Asian Development Bank-University of Toronto-Disease Control Priorities, Urban Health Investments in India and Bangladesh: Rationale and Cost of Essential Health Services (February 27, 2019). Available at SSRN: https://ssrn.com/abstract=3343646 or http://dx.doi.org/10.2139/ssrn.3343646

Daphne C. N. Wu

University of Toronto - Centre for Global Health Research

Toronto, Ontario M5B 1W8
Canada

Eduardo P Banzon

Asian Development Bank

6 ADB Avenue, Mandaluyong City 1550
Metro Manila
Philippines

Hellen Gelband

University of Toronto - Centre for Global Health Research

Toronto, Ontario M5B 1W8
Canada

Brian Chin

Asian Development Bank

6 ADB Avenue, Mandaluyong City 1550
Metro Manila
Philippines

Hayman Win

Asian Development Bank

6 ADB Avenue, Mandaluyong City 1550
Metro Manila
Philippines

Varsha Malhotra

University of Toronto - Centre for Global Health Research

Toronto, Ontario M5B 1W8
Canada

David Watkins

University of Washington ( email )

Seattle, WA 98195
United States

Sonalini Khetrapal

Asian Development Bank ( email )

6 ADB Avenue, Mandaluyong City 1550
Metro Manila
Philippines

Sungsup Ra

Asian Development Bank

6 ADB Avenue, Mandaluyong City 1550
Metro Manila
Philippines

Dean T. Jamison

University of California, San Francisco (UCSF) ( email )

Third Avenue and Parnassus
San Francisco, CA 94143
United States

Prabhat Jha (Contact Author)

University of Toronto - St. Michael's Hospital ( email )

Toronto
Canada

University of Toronto - Centre for Global Health Research ( email )

Toronto, Ontario M5B 1W8
Canada

No contact information is available for Asian Development Bank-University of Toronto-Disease Control Priorities Group

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