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Access to healthhypothesis that an intervention that included health andsocial protection measures in addition to economic resourcesand capability development typical of microcreditprogrammes, would be more likely to succeed among thevery poor 45 . However, existing evidence indicates thatproviding health services for the poorest is more expensivethan the average cost in any population due to a number ofreasons such as cost of targeting, varied service needs andacceptable quality of care to attract people for service use 46 .For scaling up of this kind of intervention, the problem offinancing has to be resolved due to large resources needed inthe initial phases. This is not the sole purview of healthsystem, but collaboration with other sectors such aseducation, agriculture, employment generation, small andmedium enterprise development, women’s affairs etc. isneeded. The health system can play a stewardship functionin guiding this collaboration. ❏Syed Masud Ahmed is Research Coordinator in the Research andEvaluation Division of BRAC in Bangladesh. He graduated fromDhaka Medical College in 1978 and did MPH from NIPSOM in1991. He received his PhD from Karolinska Institutet, Sweden, in2005. Dr Ahmed joined BRAC in June 1992 and since then hasbeen involved in studying the impact of development interventionson the health and well-being of the poor. His research interestsinclude impact evaluation of complex interventions and exploringthe mechanisms of such impact; gender and health; health equityand improving a health system’s ability to reach the poorest of thepoor and other disadvantaged populations in society.References1.GHW (Global Health Watch). Global Health Watch 2005–2006: Analternative world health report, 2005. London and New York: Zed Books.Available from: http://www.ghwatch.org (accessed 20 July 2005).2.Krishna A. Escaping poverty and becoming poor: who gains, who loses,and why? World Development, 2004, 32:121-136. Noponen H & KantorP. Crises, setbacks and chronic problems-the determinants of economicstress events among poor households in India. Journal of InternationalDevelopment, 2004, 16:529-545. Russell S. The economic burden ofillness for households in developing countries: A review of studies focusingon malaria, tuberculosis and Human Immunodeficiency virus/acquiredimmunodeficiency syndrome. American Journal of Tropical Medicine andHygiene, 2004, 71 (2 Suppl):147-155.3.“The availability of good medical care tends to vary inversely with theneed for it in the population served” (Hart JT 1971. The inverse care law.The Lancet, 1:405-412.)4.Gwatkin DR, Bhuiya A & Victora CG. Making health systems moreequitable. The Lancet, 2004, 364:1273-1280.5.WHO (World Health Organization). Dying for change: Poor people’sexperience of health and ill health, 2002, (WHO/NMH/MSD/WHA/01.3).Geneva and Washington DC: World Health Organization and World Bank.6.Bloom G et al. Health and poverty in sub-Saharan Africa, 2000. WorkingPaper No. 103. Brighton, Sussex: Institute of Development Studies,University of Sussex.7.Russell S. The economic burden of illness for households in developingcountries: A review of studies focusing on malaria, tuberculosis andHuman Immunodeficiency virus/acquired immunodeficiency syndrome.American Journal of Tropical Medicine and Hygiene, 2004, 71 (2Suppl):147-155. Xu K et al. Household catastrophic health expenditure: amulti country analysis. The Lancet, 2003, 362:111-117.8.Gwatkin DR et al. Socioeconomic differences in health, population andnutrition in Bangladesh, 2000. Washington DC: HNP/Poverty ThematicGroup, World Bank.9.Cockcroft A et al. What did the public think of the health services reformin Bangladesh? Three national community-based surveys 1999-2003.Health Research Policy and Systems, 2007, 5:1. DOI:10.1186/1478-4505-5-1. Available from: http://www.health-policysystems.com/content/5/1/1(accessed 30 March 2007).10.HEU (Health Economics Unit), MOHFW, Government of Bangladesh.Bangladesh National Health Accounts, 1999-2001, 2003. Dhaka: HEU,MOHFW, GoB.11.Cockcroft A et al. What did the public think of the health services reformin Bangladesh? Three national community-based surveys 1999-2003.Health Research Policy and Systems, 2007, 5:1. DOI:10.1186/1478-4505-5-1. Available from: http://www.health-policysystems.com/content/5/1/1(accessed 30 March 2007).12.Ensor T & Cooper H. Overcoming barriers to health service access:influencing the demand side. Health Policy and Planning, 2004,19(2):69-79.13.World Bank. Private sector assessment for Health, Nutrition andPopulation (HNP) in Bangladesh, 2003. Report No. 27005-BD. WorldBank. Available from: http://siteresources.worldbank.org/INTBANGLADESH/Data%20and%20Reference/20206318/Bangladesh_PSA_for_HNP-Full%20report.pdf (accessed 7 June 2005).Cockcroft A et al. What did the public think of the health services reformin Bangladesh? Three national community-based surveys 1999-2003.Health Research Policy and Systems, 2007, 5:1. DOI:10.1186/1478-4505-5-1. Available from: http://www.health-policysystems.com/content/5/1/1(accessed 30 March 2007).14.Sen B. Drivers of escape and descent: changing household fortunes inrural Bangladesh. World Development, 2003, 31:513-534. Kabir MA etal. Sickness among urban poor: A barrier to livelihood security. Journal ofInternational Development, 2000, 12:707-722.15.Green C. Summary of DFID workshop: Meeting the health related needsof the very poor, 2005. London: DFID Health Systems Resource Centre.16.BRAC (Building Resources Across Communities) is an indigenous NGOworking for alleviation of poverty and empowerment of the poor, especiallywomen (http://www.brac.net).17.The upper poverty line corresponds to the consumption of 2112 kcal perperson per day and the proportion of population between the two povertylines are termed as “moderate poor” (Sen B. Poverty in Bangladesh: Areview, 2000. Available from: http://www.sdnpbd.org/sdi/international_day /poverty/2000/povertyinbd-bids.htm (accessed 22October 2004)).18.Matin I & Halder SR. Combining methodologies for better targeting ofthe extreme poor: lessons from BRAC’s CFPR/TUP programme, 2004.CFPR/TUP Working Paper Series No.2. Dhaka and Ottawa: BRAC andAga Khan Foundation Canada.19.A household labelled as “ultra-poor”, has the following characteristics inany combination: 1) household’s land-holding
Access to healthReferences continuedProgramme, BRAC).22.Halder SR & Mosley P. Working with the ultra poor: learning from BRACexperiences. Journal of International Development, 2004, 16:387-406.23.BRAC. Challenging the frontiers of poverty reduction: targeting theultra-poor, targeting social constraints (CFPR/TUP), 2001. Dhaka: BRAC.24.Sub-district, an administrative unit covering about 250 000 populations.25.Matin I & Halder SR. Combining methodologies for better targeting ofthe extreme poor: lessons from BRAC’s CFPR/TUP programme, 2004.CFPR/TUP Working Paper Series No.2. Dhaka and Ottawa: BRAC andAga Khan Foundation Canada.26.BRAC. Challenging the frontiers of poverty reduction: targeting theultra-poor, targeting social constraints (CFPR/TUP), 2001. Dhaka: BRAC.27.BRAC. Challenging the frontiers of poverty reduction: targeting theultra-poor, targeting social constraints (CFPR/TUP), 2001. Dhaka: BRAC.28.BRAC. Challenging the frontiers of poverty reduction: targeting theultra-poor, targeting social constraints (CFPR/TUP), 2001. Dhaka: BRAC.29.Rabbani M, Prakash VA & Sulaiman M. Impact assessment of CFPR/TUP:a descriptive analysis based on 2002–2005 panel data, 2006.CFPR/TUP Working Paper Series No.12. Dhaka and Ottawa: BRAC andAga Khan Foundation, Canada. Available from:http://www.bracresearch.org/working_papers_details.php?scat=28&v=0&tid=355 (accessed 10 April 2006).30.Mid-Term Review. Mid-Term Review of BRAC CFPR Specially TargetedUltra Poor Programme: Mission Report/Final Report, 2005. Unpublished.31.Rabbani M, Prakash VA & Sulaiman M. Impact assessment of CFPR/TUP:a descriptive analysis based on 2002-2005 panel data, 2006. CFPR/TUPWorking Paper Series No.12. Dhaka and Ottawa: BRAC and Aga KhanFoundation, Canada. Available from:http://www.bracresearch.org/working_papers_details.php?scat=28&v=0&tid=355 (accessed 10 April 2006).32.Rabbani M, Prakash VA & Sulaiman M. Impact assessment of CFPR/TUP:a descriptive analysis based on 2002–2005 panel data, 2006.CFPR/TUP Working Paper Series No.12. Dhaka and Ottawa: BRAC andAga Khan Foundation, Canada. Available from:http://www.bracresearch.org/working_papers_details.php?scat=28&v=0&tid=355 (accessed 10 April 2006).33.Ahmed SM & Rana AKMM. Customized development interventions forthe ultra poor: Preliminary change assessments of health and healthseekingbehaviour (CFPR/TUP 2002 to 2004), 2005. CFPR/TUPWorking Paper Series No.7. Dhaka and Ottawa: BRAC and Aga KhanFoundation, Canada. Available from:http://www.bracresearch.org/workingpapers/ health_change.pdf (accessed17 June 2007).34.Ahmed SM & Rana AKMM. Customized development interventions forthe ultra poor: Preliminary change assessments of health and healthseekingbehaviour (CFPR/TUP 2002 to 2004), 2005. CFPR/TUPWorking Paper Series No.7. Dhaka and Ottawa: BRAC and Aga KhanFoundation, Canada. Available from:http://www.bracresearch.org/workingpapers/health_change.pdf (accessed17 June 2007).35.Hassen F. Change in food and nutrition consumption among the ultrapoor: Is the CFPR/TUP programme making a difference?, 2006.CFPR/TUP Working Paper Series No.11. Dhaka and Ottawa: BRAC andAga Khan Foundation, Canada.36.Hassen F. Change in food and nutrition consumption among the ultrapoor: Is the CFPR/TUP programme is making a difference?, 2006.CFPR/TUP Working Paper Series No.11. Dhaka and Ottawa: BRAC andAga Khan Foundation, Canada.37.Prakash VA & Rana AKMM. Self-perceived health of ultra poor women:The effect of an inclusive development intervention, 2006. CFPR/TUPWorking Paper Series No.10. Dhaka and Ottawa: BRAC and Aga KhanFoundation, Canada. Available from:http://www.bracresearch.org/working_papers_details.php?scat=28&v=0&tid=336S (accessed 10 April 2006).38.Ahmed SM et al. Targeted intervention for the ultra poor in ruralBangladesh: does it make any difference in their health-seekingbehaviour? Social Science & Medicine, 2006, 63:2899-2911.39.Ahmed SM et al. Targeted intervention for the ultra poor in ruralBangladesh: does it make any difference in their health-seekingbehaviour? Social Science & Medicine, 2006, 63:2899-2911.40.Matin I & Walker S. Exploring changes in the lives of the ultra poor: anexploratory study on CFPR/TUP members, 2004. CFPR/TUP WorkingPaper Series No.2. Dhaka and Ottawa: BRAC and Aga Khan FoundationCanada.41.Mid-Term Review 2005. Mid-Term Review of BRAC CFPR SpeciallyTargeted Ultra Poor Programme: Mission Report/Final Report.Unpublished.42.Sulaiman M et al. Microfinance engagements of the “graduated” TUPmembers, 2006. CFPR/TUP Working Paper Series No.9. Dhaka andOttawa: BRAC and Aga Khan Foundation Canada. Available from:http://www.BRACresearch.org/ working_papers_details.php?scat=28&v=0 &tid=334 (accessed 10 April 2006).43.Mid-Term Review 2005. Mid-Term Review of BRAC CFPR SpeciallyTargeted Ultra Poor Programme: Mission Report/Final Report.Unpublished.44.Meesen B et al. Latrogenic poverty [editorial]. Tropical Medicine andInternational Health, 2003, 8:581-584.45.Green C. Summary of DFID workshop: Meeting the health related needsof the very poor, 2005. London: DFID Health Systems Resource Centre.46.Waddington C. The marginal costs of health services for the poorest.Meeting the health-related needs of the very poor, 2005. DFID WorkshopPaper No. 4. Available from: http://www.eldis.org/fulltext/verypoor/4_waddington.pdf (accessed 15 September 2005).Global Forum Update on Research for Health Volume 4 ✜ 039
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 28 and 29: Access to health100%Availability of
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
Page 42 and 43: Access to healthA social determinan
Page 44 and 45: Access to healthemployment conditio
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
Page 52 and 53: Access to healthand financial burde
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
Page 64 and 65: Access to healthand conference stat
Page 68 and 69: InnovationTowards the development o
Page 70 and 71: InnovationMajor classificationMajor
Page 72 and 73: Innovation60% of enterprises5040302
Page 74 and 75: InnovationUsing the power ofintelle
Page 76 and 77: Innovationbe adapted - and harnesse
Page 78 and 79: InnovationFinancing of vaccine R&D-
Page 80 and 81:
InnovationFinancing Ultimate Interm
Page 82 and 83:
Innovationsome of this risk might b
Page 84 and 85:
InnovationChild immunization:accele
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Innovationare revealing previously
Page 88 and 89:
InnovationDeveloping countries % De
Page 90 and 91:
Innovationcapacities. It is indeed
Page 92 and 93:
InnovationSome plausible causes of
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Innovationwhere he was a programme
Page 96 and 97:
Research resourcesResearch impact o
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Research resourcesBiotechnologists6
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Research resources1,61001,41,219080
Page 102 and 103:
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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