EU support to Promoting Sustainable Health and nutrition Opportunities for Marginalized urban extreme poor Population (PROSHOMON) in Bangladesh
Due to high rural-urban migration, pockets of poverty have been developing in cities, with an increasing number of citizens having inadequate access to water and sanitation services, as well as to health care, including nutrition and family planning. The strategy used has been to identify and select households with precarious conditions, prioritizing women, children and disabled people.
The objective is to improve the health and nutrition status of the extreme poor by increasing accessibility, coverage and comprehensiveness, and sustainability of existing primary health and nutrition services in urban Bangladesh.
The scheme is directed to contribute to several SDGs, including in relation to health (SDG3), food security and nutrition (SDG2), but also addressing poverty (SDG1) and inequalities (SDG10).
93% of health providers interviewed think that PROSHOMON is responding to poor people’ needs. Among the beneficiaries interviewed, 75% think that the care received was very good and 25% that it was good. All stakeholders were unanimous that the voucher is the best model to solve the health problems of the urban poor and agreed that the model should be adopted by the Government of Bangladesh. The monitoring system shows a significant increase of SMART card holders’ contacts with Primary Health Centres, from 410 in June 2019 to 4,251 in March 2020.
The use of Primary Health Centres by the extreme poor population of urban slums has increased considerably since free health care has been available and since the SMART Cards has been incorporated. Satisfaction among users and staff of public and private Primary Health Centres is very high.
In terms of success factors, given the good performance of this strategy, information available suggests that the Government of Bangladesh is considering extending the SMART Card based voucher scheme to other levels of the system and to other areas of the country. As to constraints, while overall user satisfaction is very high – all 32 users interviewed stated that their problem had been solved and that they would seek Primary Health Centres services again – the number of services included in the package is too low and should be increased, according to the assessment of the users interviewed.
This strategy is replicable in other countries where poor people have difficulties accessing primary health care, nutrition and family planning. One innovative practice is the implementation of a SMART Card based voucher scheme for extreme poor and disadvantaged persons facilitates their access to a free package of essential quality primary health, nutrition and population services. On a monthly basis, based on the table of prices negotiated with the facility and on the information available in the computerized database of the admission service, PROSHOMON pays the amounts owed to the Primary Health Centres. There is a good complaint system in place for beneficiaries and an anti-fraud system for the billing of services. The aim of the Intervention is to reduce economic, geographic and cultural barriers to facilitate access to quality primary health care. This seems to be corroborated by the significant increase in attendance at Primary Health Centres by the end beneficiaries of the Intervention.
The scheme is particularly indicated to support resilience to the COVID-19 impact, because of its direct relation with access to health services, and the priority given to the extreme poor and disadvantaged persons, which are those more hardly hit by the socioeconomic consequences of the pandemic.
SDGS & Targets
Deliverables & Timeline
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