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Access to health100%Availability of food in one year80%60%40%20%SurplusBreak-evenOccasional deficitChronic deficit0%Figure 3: Food security status during last one yearNSUP02 SUP02 NSUP05 SUP05(Rabbani et al. 2006)Findings from the impact evaluation studies also revealedsubstantial improvement in other objective indicators such aschildren’s nutritional status and use of contraceptives 34 , andimproved quantity and quality of food consumption 35 . The latterstudy based on the three days recall method found that theintake of energy significantly increased from 1750±650kcal/day to 2138±704 kcal/day in SUP households where nosuch significant change was observed in the NSUPhouseholds. Also, the percentage of energy coming fromcereals decreased from 85% to 78% in SUP households whileit remained unchanged in NSUP households. The consumptionof fish and oil improved significantly in the SUP households 36 .Self-rated healthWhen women’s self-rated health status during 2002 to 2004was compared, SUP women fared better than the NSUPwomen (Figure 4) 37 . They reported better improvements,fewer reported poorer health, and a marginal proportion ofSUP women reported good health if it was previously good.The effects of the CFPR/TUP programme remain positive andsignificant even when factors like marital status, education,age, previous health, disability, occupation, sanitaryknowledge and behaviour, family planning and location areheld constant 38 . Thus, the programme has a significant effecton women’s health.100%80%60%40%20%0%SUPWas bad, is now goodWas bad, is still badFigure 4: Self-rated health statusNSUPWas good, is still goodWas good, is now bad(Prakash & Rana 2006)Economic consequences of illnessThe increase in number of workdays lost to illness could reflecta greater ability for SUP members to take time off to recoverrather than attempt to keep working and thus prolong theirailments (Table 1). In 2002, fewer SUP members spent money,and those that did spent far less than the NSUP members.These differences vanished in 2005, showing increasedcapacity for expenditure on health for the SUP households.Health care-seeking behaviourBy increasing capacity for health expenditure and facilitatingaccess to formal public sector health care facilities (by use ofhealth card), the CFPR/TUP programme initiated changes inhealth-seeking behaviour of the ultra poor towards greater useof qualified health care providers and reduction of selftreatment/notreatment 39 . This happened, presumably,through activities in the intervention to overcome specificdemand-side barriers (e.g., informational, economic, cultural,and social barriers) for accessing health care. However,gender differences in health care-seeking and healthexpenditure disfavouring women were also noted.Importance of the health componentsThe importance of customized health support to overcomeincome-erosion is also reiterated in the impact evaluations.Authors of another study on the same group of participatingwomen explored factors underlying change and found that“health is a major factor in determining change in the TUPprogramme” 40 . They concluded that if participants cannotwork due to poor health and nutrition, they are never likely tosee significant change that is sustainable. Similar conclusionabout the importance of the health component was alsoreached by an independent mid-term review mission of theCFPR/TUP programme 41 .Sustainable livelihoodAt the end of the intervention period, over half (around 54%)of the ultra poor households participating in the interventionwere at different stages of joining the mainstreamdevelopment programme of BRAC and taking microcreditloans to continue with their income-earning enterprises(Figure 5) 42 . They also continued to receive regular EHCservices provided by the programme. The authors concluded036 ✜ Global Forum Update on Research for Health Volume 4
Access to health2002 2005 Diff.SUP NSUP Difference SUP NSUP Difference in diff(1) (2) (3=1-2) (4) (5) (6=4-5) (7=6-3)Prevalence of illness 15.21 14.17 1.04* 14.17 14.45 -0.28 -1.32*(% people sick in last 15 days)Workdays lost due to 1.28 1.47 -0.19 2.96 2.66 0.31 0.50*illness (mean)Average expenditure 76.26 148.10 -71.84** 127.47 112.64 14.83 86.67**on illness (doctors’fees+medicine)Average expenditure 25.34 52.42 -27.08 27.08 22.48 4.60 31.68*on transport for medicalattention*, ** denote significance at less than 5 and 1% level respectivelyTable 1: Factors affecting health(Rabbani et al. 2006)that with a lower borrower-member ratio and relativelysmaller sized credit taken by these “graduated” ultra poormembers, microcredit/microfinance for the poorest may takea longer time to achieve sustainability.In the CFPR/TUP model, a declining trend in the total costof intervention per ultra poor household was seen with time(from US$ 344 in 2002 to US$ 287 in 2004) which isexpected to go down further to US$ 278 in 2006 43 . Themodel was concluded as cost-effective considering theimpacts on livelihood which were found to be positive(improved income and asset base), comprehensive(economic, social and health changes) and apparentlysustainable (maintenance of asset growth after “graduation”and joining regular microcredit/microfinance programme).ConclusionsMitigation of the income-erosion effect of illness is anessential pre-requisite for alleviation of poverty, especially forthe poorest households in low-income countries likeBangladesh 44 . The findings of this study support theTUP Beneficiaries(Sulaiman et al. 2006)Borrower(49%)Non-Borrower(51%)Repaying withoutany difficulty (37%)Faced trouble inrepaying loan (12%)Applied for loan(14%)Have not applied(37%)Willing to take furthercredit (30%)Willing to take furthercredit (6%)Application onprocess (5%)Will apply (14%)Uncertain about furthercredit (5%)Uncertain about furthercredit (3%)Application rejected(9%)Uncertain aboutapplying (9%)Unwilling to take furthercredit (3%)Unwilling to take furthercredit (3%)Will not apply (14%)Figure 5: Status of beneficiary households of 2002 (baseline) in February 2005 (one year after completion of intervention cycle)Global Forum Update on Research for Health Volume 4 ✜ 037
Page 3 and 4: Editorial Advisory Board:Luis Gabri
Page 5 and 6: Contents096 Child immunization: acc
Page 7 and 8: IntroductionResearch contributions
Page 9 and 10: IntroductionType IType IIType IIIPr
Page 11 and 12: Introductionmaking), takes account
Page 13: Access to healthStrengthening healt
Page 16 and 17: Access to healthTraining more healt
Page 18 and 19: Access to healthimperative for acti
Page 20 and 21: Access to healthReferences1.Further
Page 22 and 23: Access to healthDeterminantsAvailab
Page 24 and 25: Access to healthThe authors are inv
Page 26 and 27: Access to healthCombining health an
Page 30 and 31: Access to healthhypothesis that an
Page 32 and 33: Access to healthMandatory clinical
Page 34 and 35: Access to healthWhile there are som
Page 36 and 37: Access to healthItemDefinition/Expl
Page 38 and 39: Access to healthReferences continue
Page 40 and 41: Access to healthintegrating individ
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Page 46 and 47: Access to healthMaking human rights
Page 48 and 49: Access to healthResources outsideth
Page 50 and 51: Access to healthReferences1.McCoy D
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Page 54 and 55: Access to healthDiscrimination as a
Page 56 and 57: Access to health“Two months ago I
Page 60 and 61: Access to healthsocio-cultural and
Page 62 and 63: Access to healthIntergovernmental P
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Page 68 and 69: InnovationTowards the development o
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Page 72 and 73: Innovation60% of enterprises5040302
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InnovationFinancing of vaccine R&D-
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InnovationFinancing Ultimate Interm
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Innovationsome of this risk might b
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InnovationChild immunization:accele
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Innovationare revealing previously
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InnovationDeveloping countries % De
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Innovationcapacities. It is indeed
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InnovationSome plausible causes of
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Innovationwhere he was a programme
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Research resourcesResearch impact o
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Research resourcesBiotechnologists6
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Research resources1,61001,41,219080
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Research resourcesReferences1.The R
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Research resources✜ A group of nu
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Research resourcesReferences1.Inter
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Research resourcesThe threat of pan
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Research resourcesChanging environm
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Research resourcesPartnerships offe
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Research resourcesWe encourage othe
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Research resources181614No. of PPPs
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Research resources12010080604020Pro
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Research resourcesCapacity strength
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Research resourcestreatment is prov
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Research resourcesSmall scale busin
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Research resourcesthis process in a
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Research resourcesways. For instanc
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Decision-making148 Delivering evide
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Decision-makingChallenges in employ
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Decision-makingUsing evidence forpo
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Decision-makingdesire to publish. T
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Decision-makingsystems development.
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Decision-makingTowards evidence-inf
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Decision-making✜ develop a critic
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Decision-makingwas prior to 2001, a
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Decision-makingGlobal and regional
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Decision-makingHigh-incomeChildrenE
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Decision-makingLow- and middle-inco
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Decision-makingLow- and middle-inco
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Decision-makingthan a quarter of th
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Decision-makingThe potentials of in
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Decision-makingGenerally, any resea
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Decision-makingReferences1.Hawes H.
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