Md. Wazed Ali, a Field Research Manager at icddr,b draws attention to the high risk of zero-dose and under-immunisation among the urban floating population in Bangladesh. This calls for targeted interventions. Wazed Ali suggests several strategies to improve immunisation coverage among the children of the urban floating population. 

“Whenever we conduct a survey or vaccination programme, we often hear from health workers that it is a real challenge to identify and reach out to the children of urban street dwellers”, notes Wazed Ali.  The children roam around the city with their parents, moving from place to place, without a permanent shelter of their own.  

“There are thousands of people living in the streets, at the bus and train terminals, and in other public places. They lack access to basic amenities and the security of a home, rendering them deprived and vulnerable.” Most rely on daily wage labour for their livelihoods, engaging in various types of work such as carrying luggage, unloading trucks, street vending, and domestic work. Due to their unstable living conditions, they are often unable to access health and education services.  In general, street dwellers in urban areas are more vulnerable and poorer than slum dwellers. While  95% of slum children received the polio vaccine, there is no official mention of vaccination coverage for street children, for polio or any other routine vaccines like BCG and Pentavalent [1]. 

Not much data is available on the numbers and living conditions of street dwellers. The most recent census on slum areas and floating populations in Bangladesh was held in 2014. According to that census, the floating population consisted of around 16,500 people, mostly men and some 4000 women and some children [1]. Almost half of the said population was living in Dhaka city; some 7000 people in total had been found at around 100 public locations. Many street dwellers are illiterate, with only one out of six capable of reading and writing. Marriage rates are high, with four out of five individuals being married [2]. 

Urban street dwellers face various hurdles to accessing essential services like healthcare as they lack a fixed place to live. Consequently, they lag behind in crucial health indicators like immunisation, antenatal care, and skilled attendance at birth [3]. Detailing the barriers faced in accessing immunisation services, Mr. Ali refers to the fear of humiliation and vaccination payment issues, loss of vaccination cards, fear of side effects, lack of time, and lack of knowledge about vaccines and their effects [3]. “Additionally, the floating population’s transient nature and unhealthy living conditions make it difficult for health workers to track and vaccinate their children, especially when they are sick.”. 

To address these challenges, Wazed Ali suggests several ways forward. Firstly, strengthening counselling services for all clients, particularly for slum dwellers, to ensure mothers understand the importance of immunisation and the timing of doses. Second, developing strategies to adjust and minimise waiting times for parents and prevent queue-jumping by those with more financial resources. Third, implementing measures to assist and motivate the urban poor in better managing their immunisation cards. 

Stakeholders at all levels need to contribute and collaborate to improve healthcare access for the urban floating population, including the policymakers, underlines Wazed Ali. “The policymakers should consider implementing a provision for immediate-birth BCG vaccination in every hospital. Such an initiative would greatly enhance the immunisation program and effectively decrease the prevalence of zero-dose and under-immunised  individuals.” The policymakers can pave the way, but only with the support of service providers and communities. All parties need to work together. “We can tackle this situation only collectively, and ensure that the floating population receive routine vaccines.”  

References:

1. Census of Slum Areas and Floating Population 2014 (May 2015), Bangladesh Bureau of Statistics, Statistics Division, Ministry of Planning, Government of the People’s Republic of Bangladesh, ISBN: 978‐984‐33‐9608‐2, [cited 2023 July 9]; Available from: https://dataspace.princeton.edu/handle/88435/dsp01wm117r42q 
2. Parliamentarians Can Make The Difference: Pavement Dwellers’ Right To Survive (2013), All-Party Parliamentary Group (APPG) on Extreme Poverty and Urban Pavement Dwellers, Bangladesh Parliament, [Internet]. 2016 [cited 2023 July 9]; Available from: https://admin.concern.net/sites/default/files/media/migrated/parliamentary_group_report_on_pavement_dwellers.pdf  
3. Urban Street Dwellers, Evidence to Policy Series Brief No. 4 (2011). icddr,b. [cited 2023 July 10]. Available from: http://rpcc.dghs.gov.bd/pdf/urban_street_dwellers_4may2011.pdf