Key Stakeholder Message: Dr. Salman Mahmud Siddique

Dr. Salman Mahmud Siddique
Kobe University, Japan

In the dense informal settlements of Bangladesh’s metropolitan centers, Antimicrobial Resistance (AMR) threatens to dismantle decades of public health progress. In overcrowded urban slums where inadequate water, sanitation, and hygiene (WASH) infrastructure prevails, resistant bacterial pathogens spread rapidly across communities.

The AMR crisis in urban settings is driven by extreme economic vulnerability and structural governance gaps. Facing out-of-pocket healthcare expenditures exceeding 68% of total health spending, slum residents frequently bypass formal primary healthcare centers. Instead, they rely on unregulated retail drug shops that dispense over-the-counter prescription antibiotics without formal diagnosis. This unmonitored antibiotic overuse creates an ideal breeding ground for multidrug-resistant pathogens, including MRSA and multidrug-resistant tuberculosis (MDR-TB). To counter this threat, genomic surveillance must be integrated into the urban primary healthcare baseline. While traditional tracking relies on clinical symptoms, genomic sequencing decodes pathogen DNA signatures, identifying resistance mutations, tracking transmission across city blocks, and detecting environmental contamination in urban wastewater. However, as noted in the 5th Health, Population and Nutrition Sector Program (HPNSP), public laboratories face severe capacity constraints, creating critical blind spots in national disease defense.

Containing AMR requires overcoming the longstanding structural divide in Bangladesh’s health governance. While the Local Government Division (LGD) under the Ministry of Local Government, Rural Development, and Co-operatives (MoLGRD&C) holds the statutory mandate for urban health delivery under the Local Government Acts of 2009, the Ministry of Health and Family Welfare (MoHFW) governs clinical standards, regulation, and national surveillance through IEDCR and DGHS. Consequently, municipal clinics operate without standardized infection control, clinical stewardship, or direct linkage to national genomic networks. To address this urban health security crisis, I recommend five priority actions for municipal leaders, health sector policymakers, and development partners: Expand Genomic & Wastewater Surveillance: Upgrade DGHS and IEDCR reference laboratories to support routine pathogen sequencing and municipal wastewater tracking in informal settlements.

Institutionalize Antimicrobial Stewardship in Urban PHC: Embed WHO AWaRe guidelines and clinical stewardship protocols into the municipal Essential Services Package across all Ward Primary Health Care Centers. Enforce Pharmaceutical Regulation: Strengthen Directorate General of Drug Administration (DGDA) enforcement capacity to eliminate non-prescription antibiotic sales in urban retail pharmacies. Establish Co-Managed Urban Health Governance: Operationalize Urban Health Coordination Desks within City Corporations to integrate MoHFW clinical surveillance with LGD municipal service delivery. Upgrade Municipal Medical Waste Management: Enforce liquid waste treatment and infectious clinical waste segregation across urban clinics to prevent antibiotic-resistant genes from contaminating city water tables. Tackling AMR is an urgent issue of urban health equity, environmental safety, and public governance. Through coordinated multi-sectoral action, we can safeguard our urban communities against drug-resistant threats.