The street children of Dhaka, Bangladesh are amongst the toughest and most resilient; they ride out the elements, floods and pollution; eat things that would prove toxic to an average stomach; as well as face abuse from mastans and molesters on a regular basis.
In their volatile world they have learnt to adopt and survive what the privileged will not stand to handle for even a day. And yet there is only so much a child in such an environment can bear - studies show that about a third of street dwellers are afflicted by disease, most of which are preventable and curable (Islam et al, 1997; Ghani, 2001).
Infectious diseases like tuberculosis, polio and diarrhea are most common amongst the street children as well as acute respiratory infections like fever, breathing difficulties and chest infections (Podymow et al, nd; NIPORT, 2009).
Bangladesh is known to have countless NGOs working to help the poor and needy, however shockingly, upon research, there is in fact no healthcare service that specifically target this marginalised group, with the exception of one international NGO, Marie Stopes Clinic Society, that has 7 mobile clinics scattered around Dhaka.
Statistically the better-off benefit from healthcare services even when specific services are intended for the poor (Ashford et al, 2006).
It is curious as to why that is the case; how millions are spent on aid and human resources to only result to leftover vaccines and provisions to trickle down months after to the target group.
A study conducted in Dhaka looked specifically at the health needs and care-seeking behaviours of street dwellers to determine what obstacles arise in the delivery of aid and services. The snapshot cross-sectional study, with a sample of over 387 participants, discovered that many of the street dwellers lacked knowledge of locations of where vaccines are provided (Uddin et al, 2009) and, as such, an average of 41% of participants do not seek healthcare services during their sickness. Of those who do, however, all consult drug sellers at their nearest pharmacies to 'treat' their illnesses. The male participants feel that treatment is not necessary for most of their sicknesses whilst others intentionally shy away from services due to lack of money.
Tragically, the study continues on to state, healthcare services, whether government led or of the private sector, are only accessible if paid for. This poses as the biggest barrier for the most destitute group of children in Bangladesh.
Other studies have stated further factors like basic education, in order to recognise and read signs that mention aid and services as well as to understand the need and the nature of treatments; accessibility of facilities in street dweller hot spots (Ashford et al, 2006) and the inconsistency of follow-up treatments.
There is a clear and urgent need of healthcare services and provisions that are exclusively aimed at and reachable to the street children.
In Bangladesh, there are no formal providers for providing small-scale services to street-dwellers except the mobile clinics of the MSCS at night. There is no strategic approach to include street-dwellers in the urban health care structure. The city corporations, government and NGO health service providers do not have any specific policy or strategy for providing health care services that are accessible to this population.
- (Uddin et al, 2009).
Around 500,000 of Bangladesh's children live on the streets; a figure that has had the misfortune of being born into poverty; but this must not, cannot, prevent mobility in their socioeconomic standing. Out of all the social, economic and public health issues that a street child had to face, the eradication of preventable and treatable illnesses proves to be amongst the most inexpensive (Uddin et al, 2008).
Reducing morbidity rates, coupled with provisions of basic education, will give these deprived children a fighting chance at grasping opportunities and raising themselves out of poverty. It is compulsory upon policymakers and programme managers to invest more on the future of their children; to invest more on the future of their nations imminent decision makers.
- Ashford LS, Gwatkin DR, Yazbeck AS, 2006. Designing Health & Population Programs to Reach the Poor. World Bank. Population Reference Bureau. Washington. [Last accessed 17 August 2011]
- Ghani A. 2001. A report on participatory needs assessment of street dwellers in selected areas of Dhaka city. Marie Stopes Clinics Society, Bangladesh, Dhaka (unpublished document).
- Islam N, Huda N, Narayan FB (eds). 1997. Addressing the urban poverty agenda in Bangladesh: critical issues and the 1995 survey findings. Dhaka: University Press Ltd.
- National Institute of Population Research and Training (NIPORT), 2009. Bangladesh Demographic and Health Survey 2007. Dhaka, Bangladesh and Calverton, Maryland, USA: National Institute of Population Research and Training, Mitra and Associates, and Macro International.
- Podymow T, Turnbull J, Islam MA, Ahmed M, nd. Health and Social Conditions in the Dhaka Slums [online]. [Last accessed 17 August 2011]
- Uddin Md J, Koehlmoos TL, Ashraf A, Khan AI, Saha NC, Hossain M, 2008. Health needs and health-care-seeking behaviour of street-dwellers in Dhaka, Bangladesh. ICDDR,B. Dhaka. [Last accessed 17 August 2011]
- Uddin Md J, Koehlmoos TL, Ashraf A, Khan AI, Saha NC, Hossain M, 2009. Health needs and health-care-seeking behaviour of street-dwellers in Dhaka, Bangladesh. Health Policy and Planning;24:385-394