Intended for healthcare professionals

Analysis Health in South Asia

Advancing universal health coverage in South Asian cities: a framework

BMJ 2018; 363 doi: (Published 29 November 2018) Cite this as: BMJ 2018;363:k4905
  1. Alayne M Adams, associate professor1 2,
  2. Devaki Nambiar, researcher3 4,
  3. Sameen Siddiqi, department chair4 ,
  4. Bushra Binte Alam, senior health specialist5,
  5. Srinath Reddy, professor6
  1. 1Georgetown University, Washington, DC, USA
  2. 2BRAC James P Grant School of Public Health, Dhaka, Bangladesh
  3. 3The George Institute for Global Health, Delhi, India
  4. 4University of New South Wales, Sydney, Australia
  5. 5Aga Khan University, Karachi, Pakistan
  6. 6The World Bank Group, Dhaka, Bangladesh
  7. 7Public Health Foundation of India, Gurugram, National Capital Region, India
  1. Correspondence to: A Adams alayne.adams{at}

Alayne Adams and colleagues propose a framework that emphasises actions on urban health governance and the social determinants of health to achieve universal health coverage in South Asian cities

Universal health coverage means that every person everywhere should have affordable access to good quality essential health services. The governments of South Asian countries have embraced the goal of universal health coverage, which is the centrepiece of commitments to deliver the third health related sustainable development goal (SDG). Universal health coverage is linked to other SDGs related to poverty (SDG 1), education (SDG 4), gender (SDG 5), equality (SDG 10), and partnerships (SDG 17).1 Its association with SDG 11 focused on sustainable cities and communities, is comparatively overlooked.

An impediment to achieving universal health coverage is rapid urbanisation. A powerful engine of social and economic growth in the region, urbanisation also brings uneven development and hampers efforts to protect the health and access to healthcare of the urban poor and disadvantaged in South Asian cities. The complexities of scale, rapidity of change, and the diversity of urban dwellers upend typical approaches to financial protection and overwhelm the capacity of urban health systems.

A review of grey and published literature strongly indicates that these urban complexities and the growing health disparities they produce require an urban sensitive approach to universal health coverage. We suggest a simple framework that identifies three areas of priority intervention that are necessary to achieving universal health coverage and greater health equity in South Asian cities (fig 1). We describe the realities of each of these areas and suggest priority actions based on this framework.

Fig 1

An urban sensitive universal health coverage framework, UHC, urban health coverage

Health disparities in South Asian cities

South Asia’s urban population is projected to grow to 250 million by 2030.2 The agglomeration of people, innovation, and industry …

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