Aalo Clinics: Evaluating a new model for urban primary healthcare in Bangladesh
As cities grow, so do the challenges of ensuring equitable access to quality healthcare. In Bangladesh, rapid urbanisation has left many low-income communities underserved, particularly those living in informal settlements. Women, children, adolescents and other vulnerable groups often face significant barriers to essential health services.
To help address these gaps, UNICEF, with financial support from Sida and in partnership with national and local government institutions, established six Model Urban Primary Health Care Clinics in Greater Dhaka, known as Aalo Clinics. hera was commissioned to conduct the final evaluation of the clinics, assessing not only how well the model had performed, but also whether it could be sustained and expanded.
Designed as an integrated, community-linked and digitally enabled model of primary healthcare, the clinics aimed to provide free, accessible and high-quality primary healthcare services while generating lessons for the future of urban health in Bangladesh.
Looking beyond service delivery
The evaluation examined the Aalo Clinic model from multiple perspectives, exploring its relevance, coherence, effectiveness, efficiency, emerging effects, sustainability and potential for replication and scale-up.
This included assessing the full range of services and systems that underpin the model, from maternal and child healthcare and nutrition services to non-communicable disease management, community outreach, digital health systems, referral pathways and mechanisms for community accountability.
The ultimate objective was to generate robust evidence to inform future decisions about institutionalising and financing urban primary healthcare services in Bangladesh. .
Combining quantitative and qualitative evidence
hera adopted a mixed-methods approach to build a comprehensive picture of how the clinics were functioning and the value they were delivering.
The team developed a Theory of Change-informed evaluation framework, reviewed programme documentation, assessing all six clinic facilities and analysing routine service data alongside financial and cost information.
Primary data collection captured the perspectives of both service users and providers. The evaluation included:
Exit interviews with 242 clinic users.
A household survey involving 504 women who had given birth within the previous 12 months in the clinics' catchment areas.
28 key informant interviews with representatives from UNICEF, government, city corporations, implementing partners and clinic management.
Group interviews with general practitioners working within the clinics.
18 focus group discussions with Community Health and Nutrition Workers, pregnant and lactating women, other adult women and men, and community leaders.
Bringing together these different sources of evidence enabled the team to assess not only service performance, but also access, quality of care, equity, gender responsiveness, community engagement and continuity of care.
What did the evaluation find?
By October 2025, the six clinics had recorded approximately 1.9 million consultations and more than 760,000 laboratory investigations. The evaluation found that free services, extended opening hours and community outreach helped make care accessible to low-income populations, including those living in urban informal settlements, while users generally reported positive experiences of care. At the same time, it identified challenges that would need to be addressed to support sustainability and wider scale-up, including high staff workloads and periodic shortages of medicines and diagnostic supplies.
Informing the future of urban health
Alongside the performance evaluation, hera conducted an economic and value-for-money analysis, including cost-effectiveness modelling, to examine the resources required to deliver the model and the health benefits generated relative to cost. The evaluation was conducted in line with UNICEF evaluation standards.
The evaluation provides an important evidence base for policymakers and development partners considering how integrated urban primary healthcare models can be strengthened, institutionalised and used to inform future approaches to reaching underserved urban populations.
As countries continue to grapple with the health impacts of rapid urbanisation, evaluations like this play a vital role in ensuring that future investments are informed by rigorous evidence, practical experience and the voices of the communities they are designed to serve.
If your organisation is looking to conduct programme evaluations, strengthen monitoring and learning processes, or generate evidence to guide future investments, the hera team would welcome the opportunity to collaborate. Contact us at hera@hera.eu.