The challengesThe extreme poor suffer a disproportionate burden of disease. They find it more difficult to access health care and when they do it is more likely to be of inadequate quality. 15% of shiree beneficiaries suffer chronic illness at enrollment and 85% of children under five are stunted, wasted, anaemic or underweight.There is an inter-generational cycle whereby poor, undernourished mothers give birth to low weight babies, who in turn grow up physically stunted and underweight. The first 1000 days (from conception to 2 years) are generally thought to be the critical period or the “window of opportunity” for both cognitive and physical development.An individual who is stunted in this period of time is unlikely to recover lost growth later in childhood. Cognitive and mental development is also impaired and anaemic children usually have lowered intelligence, poor memory retention and reduced ability to concentrate. The extreme poor are much more vulnerable to being caught in this vicious cycle and to remain chronically poor.All programmes that focus on the extreme poor, including the BRAC – Challenging the Frontiers of Poverty Reduction Programme (CFPR), the Chars Livelihood Programme and shiree inevitably recognize that addressing health and nutrition needs is a key precondition for sustainable graduation from extreme poverty. Unless the poor can access affordable, quality health care they are always likely to be pushed back further into poverty, both due to the impact of direct health care costs (pharmaceuticals, doctors or hospital fees) and the loss of income for both the sick and for carers.Furthermore Shiree research has shown that the health seeking behavior of the extreme poor is often blighted by a lack of awareness of the cause or correct treatment of health problems, an inability to access professional services and a continued reliance on quack doctors or ritual beliefs.
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QUICK FACTSAt enrollment – 15% of Shiree beneficiaries are chronically ill whilst 85% of children under five are stunted, wasted, anaemic or underweight. Only 10% of pregnant women from the lowest wealth quintile give birth at a health facility compared to 60% of women in the highest quintile (2011 Bangladesh Demographic Health Survey – BDHS). Only 25% of respondents from the lowest wealth quartile sought care from a health provider when infants displayed symptoms of ARIs (Acute Respiratory Infections) – compared to 58% from the highest (2011 BDHS). About 30% of the rural population is in chronic poverty and experiences low consumption, hunger and under-nutrition. Over 9% of the population is physically challenged, according to the 2010 Household Income Expenditure Survey (HIES). However, less than 0.5% of the development budget has been allocated for them in the last 3 fiscal years. Extremely poor communities have a isproportionately high number of disabled people. According to a survey carried out in the flood-prone north-east districts of Bangladesh, two-thirds of households short of food often have to buy food on credit or borrow from other families; more than 90% sometimes reduce the size of their meals, and close to 60% sometimes skip a meal altogether. Data on child malnutrition shows that the region is substantially worse off than Bangladesh as a whole: 55% of children under five years old are underweight, compared with a national average of 41%. OTHER CHALLENGES |
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Expert view One expert submitted his recommendation for action: “Budget allocations for health and nutritional support in both rural and urban areas needs to be increased immediately by the Government of Bangladesh. Also, voucher systems for medical support should be introduced for the extreme poor people in both rural and urban areas in order to improve their health conditions.”Another expert on extreme poverty in the CHT submitted his recommendations for action: “Access to health services is very low in the Chittagong Hill Tracts due to remote areas and a shortage of doctors/health workers compared to other plain land districts. As a result, it would be effective to set up para-based community health clinics in the CHT for proper health services and to store necessary medicines. In the CHT most of children are born without the help of qualified midwifes, especially in remote villages. It would be good to train local midwives in each para as well as village doctors who can be available to treat people when needed.”
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Case studiesChronic illness, quacks, kabiraj, lack of hospitals, misdiagnosed fever Sharmin was a fifteen year old girl doing exceptionally well in school. She had made it to the top of her class, class nine, at Agarghata Higher Secondary School, even though her parents could not afford any private tuition for her. (They could barely afford to feed her twice a day!) Sharmin’s mother, Aleya, grows vegetables on khasland she received from Uttaran-shiree and her father is a day labourer. In 2011, the floods washed away Sharmin’s family vegetable garden and home.During the flood, Sharmin contracted a fever. Her temperature rose so high that she became delirious. With no money to consult a doctor, Aleya took Sharmin to a local quack at Agarghata. The quack prescribed medication worth 8,000 taka which failed to help. Her condition further deteriorated. A month later, when Sharmin was still suffering, Aleya took her to a kabiraj (a person who performs religious rites supposedly to heal diseases).The kabiraj performed an exorcism on her (to free the patient from evil spirits) and gave her water and oil purified by religious chants. Aleya paid the kabiraj 500 taka. The exorcism made Sharmin mentally unstable and depressed. She tried to commit suicide by jumping into the Kabodak River but she was rescued by her family and neighbours.In August, Aleya took Sharmin to another quack who once again performed an exorcism for 500 taka. Sharmin’s parents then started treating her according to the quack’s prescription of syrups, costing 1,760 taka. Sharmin’s illness started to show new symptoms. She now has continuously trembling hands and legs and she cannot stand due to this. She cannot do anything alone.It was only some months ago that she used to go to school regularly and dreamt of building a dignified life. She now blindly stares out into space. ‘If my hands and legs were steady, I would have returned to school,’ she says tearfully. In Bangladesh, where health care costs are constantly on the rise and where government services do not reach the poorest, people turn to local quacks and kabirajs. Millions of people suffer from illnesses which could have been easily treated. Instead they find themselves chronically ill and even less able to earn a living.Note: The names of individuals have been changed to protect their identity
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Some examples of what is already being done
The above are only a few examples. There is loads of good work already taking place. If you would like to add further examples or a link to a relevant website, please contribute through the form below. |
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More examples of current good practicesAdd your text
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What should be done to address this challenge?The following are recommendations shiree has received online and through various consultations with NGOs, private sector actors, government officials, international donors and other civil society activists interested in making a difference and bringing change to Bangladesh.
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Your recommendation |