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We evaluated a poverty-reduction program that targeted ultra-poor women in rural Bangladesh to promote economic and social improvement through income-generating activities and strengthening socio-political awareness. We hypothesized that ultra-poor women participating in the program would have lower domestic violence and depressive symptoms and higher subjective well-being, household economic status, and food security than non-participants. A quasi-experimental design with program and comparison arms and assessments at two times (i.e., baseline and end-line) was used. Analysis of covariance with linear multilevel random-intercept models adjusted for available baseline variables was used to estimate program-comparison differences at end-line for economic status, perceived economy, food insecurity, domestic violence, depressive symptoms, and subjective well-being. We also estimated the benefits attributable to the program for subjective well-being, food insecurity, and domestic violence. Women in the program arm had greater subjective well-being with a decrease in negative affect of life by 33.5% and dissatisfaction with life by 42.5%. The women in the program arm encountered 12% or fewer incidences of domestic violence than did the women in the comparison arm. Food insecurity reduced by an average of 14% due to the program. This poverty-reduction program helped in improving women’s access to and control of resources and their social awareness, thus empowering them and promoting economic, social, and psychological well-being. Poverty-reduction programs that acknowledge and address the social complexity of extreme poverty have the potential to effectively reach the ultra-poor who otherwise are often missed by traditional microcredit programs.

Abstract City governments are well-positioned to effectively address urban health challenges in the context of rapid urbanization in Asia. They require good quality and timely evidence to inform their planning decisions. In this article, we report our analyses of degree of data-informed urban health planning from three Asian cities: Dhaka, Hanoi and Pokhara. Our theoretical framework stems from conceptualizations of evidence-informed policymaking, health planning and policy analysis, and includes: (1) key actors, (2) approaches to developing and implementing urban health plans, (3) characteristics of the data itself. We collected qualitative data between August 2017 and October 2018 using: in-depth interviews with key actors, document review and observations of planning events. Framework approach guided the data analysis. Health is one of competing priorities with multiple plans being produced within each city, using combinations of top-down, bottom-up and fragmented planning approaches. Mostly data from government information systems are used, which were perceived as good quality though often omits the urban poor and migrants. Key common influences on data use include constrained resources and limitations of current planning approaches, alongside data duplication and limited co-ordination within Dhaka’s pluralistic system, limited opportunities for data use in Hanoi and inadequate and incomplete data in Pokhara. City governments have the potential to act as a hub for multi-sectoral planning. Our results highlight the tensions this brings, with health receiving less attention than other sector priorities. A key emerging issue is that data on the most marginalized urban poor and migrants are largely unavailable. Feasible improvements to evidence-informed urban health planning include increasing availability and quality of data particularly on the urban poor, aligning different planning processes, introducing clearer mechanisms for data use, working within the current systemic opportunities and enhancing participation of local communities in urban health planning.

In 1985, the Rockefeller Foundation published Good health at low cost to discuss why some countries or regions achieve better health and social outcomes than do others at a similar level of income and to show the role of political will and socially progressive policies. 25 years on, the Good Health at Low Cost project revisited these places but looked anew at Bangladesh, Ethiopia, Kyrgyzstan, Thailand, and the Indian state of Tamil Nadu, which have all either achieved substantial improvements in health or access to services or implemented innovative health policies relative to their neighbours. A series of comparative case studies (2009–11) looked at how and why each region accomplished these changes. Attributes of success included good governance and political commitment, effective bureaucracies that preserve institutional memory and can learn from experience, and the ability to innovate and adapt to resource limitations. Furthermore, the capacity to respond to population needs and build resilience into health systems in the face of political unrest, economic crises, and natural disasters was important. Transport infrastructure, female empowerment, and education also played a part. Health systems are complex and no simple recipe exists for success. Yet in the countries and regions studied, progress has been assisted by institutional stability, with continuity of reforms despite political and economic turmoil, learning lessons from experience, seizing windows of opportunity, and ensuring sensitivity to context. These experiences show that improvements in health can still be achieved in countries with relatively few resources, though strategic investment is necessary to address new challenges such as complex chronic diseases and growing population expectations.

Seasonal hunger induced by agricultural seasonality is often a characteristic feature of rural poverty. The evidence of seasonal distress in many agrarian societies can be found in the narratives of economic historians. With agricultural diversification made possible through technological breakthroughs in many parts of the developing world, the severity of seasonal stress and adversities has been reduced considerably, if not altogether eliminated. In certain agricultural settings, however, the seasonality of poverty and hunger, along with the associated seasonal shortfalls in income and consumption, is still a policy quagmire. The problem gets more complicated when agricultural seasonality is locked into a cycle of endemic poverty, seasonal hunger, and risk of further impoverishment. Poverty and seasonality may also reinforce each other through various other forces that create and sustain both. The thrust of policy needs to be to break this interlocking cycle of poverty and seasonality. The book has nine chapters. Chapter two looks at the key conceptual issues and presents a global perspective on the challenge of addressing seasonal hunger. Chapter three brings Bangladesh's reality to the fore regarding seasonal poverty and food insecurity and the vulnerability of the northwest region. Chapter four analyzes the vulnerability of households to seasonal hunger, their coping strategies, and the extent to which income seasonality affects seasonal poverty and food deprivation. Chapter five reports some findings for both the Rangpur region and the country as a whole regarding the effects of policies and programs on poverty and food deprivation. The findings reported in the next three chapters are mainly related to the Rangpur region only. Chapter six examines the issue of seasonal migration in the context of mitigating seasonal deprivation. In chapter seven, the impact of the social safety-net programs is tested, whereas the effectiveness of microfinance is assessed in chapter eight. The concluding chapter, chapter nine, looks at the policy implications while also pointing to some emerging challenges.

We discuss various anti-poverty policies which involve direct transfer policies for the poor, focusing on their different dimensions—namely the size and time sequence of the transfers, whether it is cash or in kind, any conditionality involved, whether they are means-tested. We argue that their pros and cons depend on what is the underlying aspect of poverty that the policy is aiming to address, namely what is the cause of it, what is the time horizon, what is the social objective, and what, if any, limitations on state capacity might be present. We illustrate the issues involved by discussing two transfer policies in detail, a rural asset transfer programme in Bangladesh and a hypothetical universal income support programme in India—and highlight the dual nature of such policies as both redistributive and potentially productive investments. We conclude by discussing the potential complementarities between different types of anti-poverty policies.

In Bangladesh, the health risks of unplanned urbanization are disproportionately shouldered by the urban poor. At the same time, affordable formal primary care services are scarce, and what exists is almost exclusively provided by non-government organizations (NGOs) working on a project basis. So where do the poor go for health care? A health facility mapping of six urban slum settlements in Dhaka was undertaken to explore the configuration of healthcare services proximate to where the poor reside. Three methods were employed: (1) Social mapping and listing of all Health Service Delivery Points (HSDPs); (2) Creation of a geospatial map including Global Positioning System (GPS) co-ordinates of all HSPDs in the six study areas and (3) Implementation of a facility survey of all HSDPs within six study areas. Descriptive statistics are used to examine the number, type and concentration of service provider types, as well as indicators of their accessibility in terms of location and hours of service. A total of 1041 HSDPs were mapped, of which 80 % are privately operated and the rest by NGOs and the public sector. Phamacies and non-formal or traditional doctors make up 75 % of the private sector while consultation chambers account for 20 %. Most NGO and Urban Primary Health Care Project (UPHCP) static clinics are open 5–6 days/week, but close by 4–5 pm in the afternoon. Evening services are almost exclusively offered by private HSDPs; however, only 37 % of private sector health staff possess some kind of formal medical qualification. This spatial analysis of health service supply in poor urban settlements emphasizes the importance of taking the informal private sector into account in efforts to increase effective coverage of quality services. Features of informal private sector service provision that have facilitated market penetration may be relevant in designing formal services that better meet the needs of the urban poor.

This paper presents a pen picture about the changes of livelihood patterns to the char people, mostly living under poverty in Bangladesh. The study was conducted on the three Northern Districts such as Nilphamari, Lalmonirhat and Pabna in Bangladesh, where the Char Resources Mobilization project was provided by an international non-government organization—Concern Worldwide Bangladesh. The study used mixed method approach where quantitative data were collected from 378 households (126 from each District) using structured interview schedule. A number of qualitative data collection methods such as focus group discussion, participant observation, community mapping, case study, and key informants interview guidelines were used to collect data about the conditions of the Char people in terms of understanding its connection with their livelihoods and socio-economic consequences. This study compares the changes with influential factors with a baseline survey conducted in 2007. Findings showed that there were a number of areas such as education, income, family assets and properties, annual household income, employment, savings, improving market chain, food intake and food security, presence of governmental and non-governmental organizations’ services and awareness about disaster and vulnerability and coping strategies were found positive. The study also observed some negative changes on assets base and livelihood options. The paper argues that the findings on these changes will help to formulate policy on poverty alleviation for the government and non-government authorities who implement the similar type of programmes.

Important steps have been taken at international summits to set up goals and targets to improve the wellbeing of children worldwide. Now the world also has more and better data to monitor progress. This paper presents a new approach to monitoring progress in child poverty reduction based on the Alkire and Foster adjusted headcount ratio and an array of complementary techniques. A theoretical discussion is accompanied by an assessment of child poverty reduction in Bangladesh based on four rounds of the demographic household survey (1997–2007). Emphasis is given to dimensional monotonicity and decomposability as desirable properties of multidimensional poverty measures. Complementary techniques for analysing changes over time are also illustrated, including the Shapley decomposition of changes in overall poverty, as well as a range of robustness tests and statistical significance tests. The results from Bangladesh illustrate the value added of these new tools and the information they provide for policy. The analysis reveals two paths to multidimensional poverty reduction by either decreasing the incidence of poverty or its intensity, and exposes an uneven distribution of national gains across geographical divisions. The methodology allows an integrated analysis of overall changes yet simultaneously examines progress in each region and in each dimension, retaining the positive features of dashboard approaches. The empirical evidence highlights the need to move beyond the headcount ratio towards new measures of child poverty that reflect the intensity of poverty and multiple deprivations that affect poor children at the same time.

Abstract We assessed the technical content of sugar, salt and trans-fats policies in six countries in relation to the World Health Organization ‘Best Buys’ guidelines for the prevention and control of non-communicable diseases (NCDs). National research teams identified policies and strategies related to promoting healthy diets and restricting unhealthy consumption, including national legislation, development plans and strategies and health sector-related policies and plans. We identified relevant text in relation to the issuing agency, overarching aims, goals, targets and timeframes, specific policy measures and actions, accountability systems, budgets, responsiveness to inequitable vulnerabilities across population groups (including gender) and human rights. We captured findings in a ‘policy cube’ incorporating three dimensions: policy comprehensiveness, political salience and effectiveness of means of implementation, and equity/rights. We compared diet-related NCD policies to human immunodeficiency virus policies in relation to rights, gender and health equity. All six countries have made high-level commitments to address NCDs, but dietary NCDs policies vary and tend to be underdeveloped in terms of the specificity of targets and means of achieving them. There is patchwork reference to internationally recognized, evidence-informed technical interventions and a tendency to focus on interventions that will encounter least resistance, e.g. behaviour change communication in contrast to addressing food reformulation, taxation, subsidies and promotion/marketing. Policies are frequently at the lower end of the authoritativeness spectrum and have few identified budgetary commitments or clear accountability mechanisms. Of concern is the limited recognition of equity and rights-based approaches. Healthy diet policies in these countries do not match the severity of the NCDs burden nor are they designed in such a way that government action will focus on the most critical dietary drivers and population groups at risk. We propose a series of recommendations to expand policy cubes in each of the countries by re-orienting diet-related policies so as to ensure healthy diets for all.

In Bangladesh, rapid advancements in coverage of many health interventions have coincided with impressive reductions in fertility and rates of maternal, infant, and childhood mortality. These advances, which have taken place despite such challenges as widespread poverty, political instability, and frequent natural disasters, warrant careful analysis of Bangladesh's approach to health-service delivery in the past four decades. With reference to success stories, we explore strategies in health-service delivery that have maximised reach and improved health outcomes. We identify three distinctive features that have enabled Bangladesh to improve health-service coverage and health outcomes: (1) experimentation with, and widespread application of, large-scale community-based approaches, especially investment in community health workers using a doorstep delivery approach; (2) experimentation with informal and contractual partnership arrangements that capitalise on the ability of non-governmental organisations to generate community trust, reach the most deprived populations, and address service gaps; and (3) rapid adoption of context-specific innovative technologies and policies that identify country-specific systems and mechanisms. Continued development of innovative, community-based strategies of health-service delivery, and adaptation of new technologies, are needed to address neglected and emerging health challenges, such as increasing access to skilled birth attendance, improvement of coverage of antenatal care and of nutritional status, the effects of climate change, and chronic disease. Past experience should guide future efforts to address rising public health concerns for Bangladesh and other underdeveloped countries.