The 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 recognise 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 behaviour 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.
What should be done to address this challenge?
Shiree is currently consulting with stakeholders and recognized experts in this field in order to develop a consolidated list of priority recommendations that can form the core prescriptive element of the Manifesto for the Extreme Poor – with the aim of these being presented to all of those with potential access to power and resources. The consultation deadline is fixed for September 30, 2012, after which the Manifesto will be drafted.
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