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Reaching the poorest of the poor with health services: the case of BRAC’s CFPR/TUP programme in Bangladesh Image

Promoting Inclusive Markets and Financial Systems

Reaching the poorest of the poor with health services: the case of BRAC’s CFPR/TUP programme in Bangladesh

Reaching the poorest of the poor with health services: the case of BRAC’s CFPR/TUP programme in Bangladesh

Summary

More than three decades of grassroots experience led BRAC (an indigenous Bangladeshi NGO) to the realization that regular microcredit-based intervention is not enough to effectively reach the most vulnerable section among the poor, i.e., the ultra-poor. A targeted grants-based intervention (integrating income-generating asset grants, subsistence allowance, skill training, pro-poor advocacy, and health inputs) was designed by BRAC for them under the name of “Challenging the frontiers of poverty reduction/targeting ultra-poor, targeting social constraints (CFPR/TUP)”. Once the grant phase is over, it is expected that they will attain the foundation for sustainable livelihoods and participate and benefit from mainstream microcredit programmes. The asset’s long term impact is enhanced by the health component of the programme which by reducing incomeerosion effect of morbidity acts as a safety net and allows their productive engagement in livelihood activities. Findings from an impact evaluation study revealed substantial improvement in self-rated health and other objective indicators such as children’s nutritional status, use of contraceptives, health-seeking behaviour and capacity of health expenditure. Engaging elite support for success of ultra-poor related programmes, consumer information on locally available health services to improve accessibility, health cards for facilitated access to govt. health facilities, community mobilisation of fund for meeting costly morbidities and in-patient care are some of the tools that emerged for scaling up and replicating the model in wider environment. Thus, a combination of components that includes both health and livelihood protection measures in an intervention was found to be more effective in meeting the health-related needs of the very poor.

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