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

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.