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The Institute for Global Health and Development

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    Assessment of socioeconomic and health vulnerability among urban slum dwellers in Bangladesh: a cross-sectional study
    (BioMed Central, 2024-10-24) Hasan, Md Zahid; Rabbani, Md Golam; Ahmed, Mohammad Wahid; Mehdi, Gazi Golam; Tisha, Khadija Islam; Reidpath, Daniel; Hanifi, Syed Manzoor Ahmed; Mahmood, Shehrin Shaila
    Background: Bangladesh is rapidly urbanizing and approximately half of its urban population resides in deprived slums with limited access to basic needs. However, there is a dearth of information on vulnerability levels among slum dwellers. We aimed to assess the level of vulnerability within and between slums via various socioeconomic and health indicators. Methods: A cross-sectional survey of 810 randomly selected households was conducted in two purposively selected slums, Korail and Shyampur, in Dhaka from November to December 2021. Data was collected on various indicators, including demographics, education, employment, access to utility, and healthcare services. Principal component factor analysis was employed to identify the key indicators to construct the socioeconomic and health vulnerability index for the urban slums of Bangladesh (SEHVI-BD). Kaiser-Meyer-Olkin, Bartlett’s test, and Cronbach’s alpha coefficient test were used to assess indicators’ suitability. The selected indicators were used to generate an index on a scale of 100, with a higher index value indicating a higher level of vulnerability. The estimated scores were used to categorize the vulnerability status into three levels: mild, moderate, and severe vulnerability. The Mann-Whitney-U test and Kruskal-Wallis test were applied between the generated index and other socioeconomic variables to validate the relationship. Results: A total of 27 socioeconomic and health indicators were identified that explained 60% of the variance. The indicators were then grouped into six domains on the basis of their relevance. The prevalence of severe vulnerability in the Korail slum was approximately 9% and moderate vulnerability was 30% whereas these values were approximately 58% and 37%, respectively, in the Shyampur slum. The difference in the vulnerability level between the two slums was also evident across the domains. Households in the poorest wealth quintile, with lower education levels of household heads, and having irregular income experienced higher levels of vulnerability. Conclusions: The SEHVI-BD offers a critical tool for policymakers to identify and address vulnerabilities, facilitating more targeted public health interventions in urban Bangladesh and similar low-income settings. This study further emphasizes the importance of integrating comprehensive vulnerability assessments into public health policies to reduce inequalities and improve well-being, especially for the urban marginalized slum population.
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    Interrogating resilience in health systems development.
    (OUP, 2017-09-23) van de Pas, Remco; Ashour, Majdi; Kapilashrami, Anuj; Fustukian, Suzanne
    The Fourth Global Symposium on Health Systems Research was themed around 'Resilient and responsive health systems for a changing world.' This commentary is the outcome of a panel discussion at the symposium in which the resilience discourse and its use in health systems development was critically interrogated. The 2014-15 Ebola outbreak in West-Africa added momentum for the wider adoption of resilient health systems as a crucial element to prepare for and effectively respond to crisis. The growing salience of resilience in development and health systems debates can be attributed in part to development actors and philanthropies such as the Rockefeller Foundation. Three concerns regarding the application of resilience to health systems development are discussed: (1) the resilience narrative overrules certain democratic procedures and priority setting in public health agendas by 'claiming' an exceptional policy space; (2) resilience compels accepting and maintaining the status quo and excludes alternative imaginations of just and equitable health systems including the socio-political struggles required to attain those; and (3) an empirical case study from Gaza makes the case that resilience and vulnerability are symbiotic with each other rather than providing a solution for developing a strong health system. In conclusion, if the normative aim of health policies is to build sustainable, universally accessible, health systems then resilience is not the answer. The current threats that health systems face demand us to imagine beyond and explore possibilities for global solidarity and justice in health. [Abstract copyright: The Author 2017; all rights reserved. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.]