ReviewBMJ global health2019
Rethinking health systems in the context of urbanisation: challenges from four rapidly urbanising low-income and middle-income countries.
Review in BMJ global health, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 60 papers, 6 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
60 citing papers in PubMed, 6 syntheses or guidelines pooled it.
- A Systematic Review of Community-based Interventions to Promote Physical Activity or Reduce Sedentary Behavior among Adults in Low- and Middle-Income Countries.Current obesity reports · 2026Pooled it
- Choice of primary healthcare providers among population in urban areas of low- and middle-income countries: a systematic review of literature.BMC primary care · 2026Pooled it
- Primary health care networks and impacts in low- and middle-income countries: a systematic review.Health policy and planning · 2026Pooled it
- Pooled it
- Implementation of the Community-based Health Planning and Services (CHPS) in rural and urban Ghana: a history and systematic review of what works, for whom and why.Frontiers in public health · 2023Pooled it
- Housing-related challenges during COVID-19 pandemic among urban poor in low- and middle-income countries: A systematic review and gap analysis.Frontiers in public health · 2022Pooled it
- Exploring the roles of informal healthcare providers in urban settings to improve access and quality of care for the urban poor: experience from Bangladesh, Ghana, Nepal, and Nigeria.Health policy and planning · 2026Article
- Health Status in Informal Urban Settlements of Barishal, Bangladesh: Social Determinants, Environmental Risks, and Treatment-Seeking Behavior as Structural Drivers.Health science reports · 2026Article
- Hybrid Governance: Negotiating justice for health services in informal urban settlements in Dhaka, Bangladesh.Health policy and planning · 2026Article
- Intersectional inequalities in healthcare utilisation in informal settlements in Freetown, Sierra Leone: a multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA).International journal for equity in health · 2026Article
- Unlocking the potential of community pharmacies to address hypertension in South Asia: the COPE-BP programme.Journal of global health · 2026Article
- How prepared are urban primary care facilities to manage hypertension and type 2 diabetes in Dhaka, Bangladesh? A cross-sectional descriptive study of government urban dispensaries and NGO clinics.BMC primary care · 2026Article
- Intersectional experiences of non-communicable diseases and health seeking strategies in informal settlements in Freetown, Sierra Leone.PLOS global public health · 2026Article
- Fragmentation in health system financing: a major challenge for improving effectiveness, efficiency, equity and choice within health systems.BMJ public health · 2026Review
- Magnitude, trends, transitions, and drivers of the double burden of malnutrition among adolescent girls in urban slums, Kenya: findings from a longitudinal study (2017-2019).BMC public health · 2025Article
- Inefficiencies identified in healthcare professional-to-patient handover practices for atrial fibrillation: a mixed-methods study in Brazil, China and Sri Lanka.BMJ global health · 2025Article
- Challenges and inequities of healthcare in meeting the growing needs of urban children in sub-Saharan Africa.BMJ paediatrics open · 2025Article
- Influence of a pilot urban primary healthcare model on the use of medically trained healthcare providers among the low-income slum populations in Bangladesh: findings from an implementation research study.International journal for equity in health · 2025Article
- Disparities and inequalities of lower respiratory infections in Iran, 1990-2021: the role of socioeconomic and demographic factors.BMC infectious diseases · 2025Article
- Programmes for pathology: improving health outcomes for low- and middle-income countries in the artificial intelligence paradigm.International health · 2025Article
Corrections and comments
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Authors and funding
15 authors.
Funding
Abstract
The world is now predominantly urban; rapid and uncontrolled urbanisation continues across low-income and middle-income countries (LMICs). Health systems are struggling to respond to the challenges that urbanisation brings. While better-off urbanites can reap the benefits from the 'urban advantage', the poorest, particularly slum dwellers and the homeless, frequently experience worse health outcomes than their rural counterparts. In this position paper, we analyse the challenges urbanisation presents to health systems by drawing on examples from four LMICs: Nigeria, Ghana, Nepal and Bangladesh. Key challenges include: responding to the rising tide of non-communicable diseases and to the wider determinants of health, strengthening urban health governance to enable multisectoral responses, provision of accessible, quality primary healthcare and prevention from a plurality of providers. We consider how these challenges necessitate a rethink of our conceptualisation of health systems. We propose an urban health systems model that focuses on: multisectoral approaches that look beyond the health sector to act on the determinants of health; accountability to, and engagement with, urban residents through participatory decision making; and responses that recognise the plurality of health service providers. Within this model, we explicitly recognise the role of data and evidence to act as glue holding together this complex system and allowing incremental progress in equitable improvement in the health of urban populations.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.