5 Minutes of Inspiration: How does closing the poverty gap save lives?

5 Minutes of Inspiration: How does closing the poverty gap save lives?


CARE Bangladesh has figured out how to improve health care for everyone — with the biggest benefits going to the poor. By Emily Janoch

“The group not only helped me have a timely pregnancy. I also believe they saved my life,” Shagorika said. She’s one of more than 80,000 women who benefitted from CARE Bangladesh’s Community Support Systems (CmSS) — a community health referral and solidarity group that helps women in rural areas access much needed health care. The systems help everyone, but the biggest gains consistently go to the poorest 20 percent of the community — helping to close the poverty gap.

The Improving Maternal and Infant Health program in Bangladesh worked using the CmSS model from 2014-2017 with $572,333 from the Australian NGO Cooperation Program. It reached 135,000 people, including 80,803 women. The model has been around since 1999, but the IMIHB project refined it to focus more on social issues, and saw big results.

What did we accomplish?

  • Communities get more healthcare: Women were 3.5 times more likely to get prenatal care.  Health centers increased the number of patients they served by nearly 10 times.
  • Women are having safer births: Nearly four times more pregnant women and their families participated in birth planning sessions. More births also took place in health care facilities, rising from 52 percent to 65 percent. In 2017, 63 percent of births in Gazipur were attended by a skilled birth attendant, compared with 54 percent at the project’s beginning in 2014.
  • The poverty gap is closing: The poorest 20 percent of the population see the biggest benefits, and are 35 percent more likely to improve their access to health care than wealthier people.
  • Women are making more healthcare decisions: 52 percent of women participated in decision-making about their own and their children’s health, compared to only 29 percent at the start of the project. The number of women using contraception has also increased from 65 percent to 85 percent. They’re also 80 percent more likely to be saving to pay for emergency care.
  • The quality of services has improved: Community clinics are open for longer hours and provide more services. Doctors are 2.3 times more likely to be involved in birth planning with families. The community can also have a say in improving services by rating their experiences at the community clinics and suggesting solutions to overcome any shortcomings.
  • Women are talking about other social issues: The positive experience of working together on activities related to maternal health has motivated the Community Support Groups to discuss other issues such as child marriage and violence against women.
By delivering health care to the poorest people in Bangladesh, we can improve the health of all.

How did we get there?

  • Teaching skills: Frontline workers (Health Assistants, Family Welfare Assistants and Community Health Care Providers) were trained in counselling, birth planning, screening of disability and nutrition.
  • Building awareness: CARE worked to raise awareness and improve access to sexual, reproductive and maternal health services in the community through: events to mark Safe Motherhood Day, World Health Day, Community Clinic Day and World Breast Feeding Week; support groups; and activities such as mothers’ gatherings, street dramas, learning visits and community dialogues.
  • Working in partnership: CARE worked through Community Clinics established by the Government of Bangladesh as part of their healthcare delivery system. Effective monitoring and supervision systems were set up to ensure quality of care in Community Clinics and successful running of community groups.
  • Linking communities and health care providers: Through the Community Support System (CmSS), 215 community members have been trained in how to identify and register pregnant women in the community, and refer emergency patients to the most appropriate health provider. This has led to a 34 percent increase in referrals from community clinics to higher facilities. In addition, the project helped establish a ‘referral corner’ at the major health complex in Gazipur. This has improved the referral process from community health centers to the health complex.
  • Help strengthen health centers: The project used the community scorecards to get communities and health providers to improve services. They also helped clinics setup fundraising systems so they can offer subsidized visits for the poorest families.

Want to learn more?

Check out the final evaluation.

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