Ahmed, S. M., et al. (2006).

"Targeted intervention for the ultra poor in rural Bangladesh: Does it make any difference
in their health-seeking behaviour?" Soc Sci Med 63(11): 2899-2911.
It is now well recognised that regular microcredit intervention is not enough to effectively reach the ultra
poor in rural Bangladesh, in fact it actively excludes them for structural reasons. A grants-based integrated
intervention was developed (with health inputs to mitigate the income-erosion effect of illness) to examine
whether such a targeted intervention could change the health-seeking behaviour of the ultra-poor towards
greater use of health services and "formal allopathic" providers during illness, besides improving their
poverty status and capacity for health expenditure. The study was carried out in three northern districts of
Bangladesh with high density of ultra poor households, using a pre-test/post-test control group design. A
pre-intervention baseline (2189 interventions and 2134 controls) survey was undertaken in 2002 followed by
an intervention (of 18 months duration) and a post-intervention follow-up survey of the same households in
2004. Structured interviews were conducted to elicit information on health-seeking behaviour of household
members. Findings reveal an overall change in health-seeking behaviour in the study population, but the
intervention reduced self-care by 7 percentage units and increased formal allopathic care by 9 percentage
units. The intervention increased the proportion of non-deficit households by 43 percentage units, as well as
the capacity to spend more than Tk. 25 for treatment of illness during the reference period by 11 percentage
units. Higher health expenditure and time (pre- to -post-intervention period) was associated with increased
use of health care from formal allopathic providers. However, gender differences in health-seeking and
health-expenditure disfavouring women were also noted. The programmatic implications of these findings
are discussed in the context of improving the ability of health systems to reach the ultra poor.

Amin, R., et al. (2001). "Integration of an Essential Services Package (ESP) in child and reproductive health and family
planning with a micro-credit program for poor women: Experience from a pilot project in rural Bangladesh." World
Development 29(9): 1611-1621.

Bhuiya, M. M. M. (2016). Impact of microfinance on health, education and income of rural households: evidence from
Bangladesh. Queensland, Australia, University of Southern Queensland. Doctoral dissertation: 188.

Fottrell, E., et al. (2013). "The effect of increased coverage of participatory women's groups on neonatal mortality in
Bangladesh: A cluster randomized trial." JAMA Pediatr 167(9): 816-825.
IMPORTANCE: Community-based interventions can reduce neonatal mortality when health systems are
weak. Population coverage of target groups may be an important determinant of their effect on behavior
and mortality. A women's group trial at coverage of 1 group per 1414 population in rural Bangladesh
showed no effect on neonatal mortality, despite a similar intervention having a significant effect on neonatal
and maternal death in comparable settings. OBJECTIVE: To assess the effect of a participatory women's
group intervention with higher population coverage on neonatal mortality in Bangladesh. DESIGN: A cluster
randomized controlled trial in 9 intervention and 9 control clusters. SETTING: Rural Bangladesh.
PARTICIPANTS: Women permanently residing in 18 unions in 3 districts and accounting for 19 301 births
during the final 24 months of the intervention. INTERVENTIONS: Women's groups at a coverage of 1 per 309
population that proceed through a participatory learning and action cycle in which they prioritize issues that
affected maternal and neonatal health and design and implement strategies to address these issues. MAIN
OUTCOMES AND MEASURES: Neonatal mortality rate. RESULTS: Analysis included 19 301 births during the
final 24 months of the intervention. More than one-third of newly pregnant women joined the groups. The
neonatal mortality rate was significantly lower in the intervention arm (21.3 neonatal deaths per 1000 live
births vs 30.1 per 1000 in control areas), a reduction in neonatal mortality of 38% (risk ratio, 0.62 [95% CI,
0.43-0.89]) when adjusted for socioeconomic factors. The cost-effectiveness was US $220 to $393 per year of
life lost averted. Cause-specific mortality rates suggest reduced deaths due to infections and those
associated with prematurity/low birth weight. Improvements were seen in hygienic home delivery practices,
newborn thermal care, and breastfeeding practices. CONCLUSIONS AND RELEVANCE: Women's group
community mobilization, delivered at adequate population coverage, is a highly cost-effective approach to
improve newborn survival and health behavior indicators in rural Bangladesh. TRIAL REGISTRATION:
isrctn.org Identifier: ISRCTN01805825.

Hadi, A. (2001). "Promoting health knowledge through micro-credit programmes: experience of BRAC in Bangladesh."
Health Promotion International 13(3): 219-227.

Hadi, A. (2002). "Integrating prevention of acute respiratory infections with micro-credit programme: experience of
BRAC, Bangladesh." Public Health 116(4): 238-244.
The contribution of acute respiratory infection control project within the framework of micro-credit-based
development intervention in promoting maternal knowledge of ARIs in children was assessed. Data came
from a cross-sectional survey of 2814 mothers of under 5-y-old children residing in 200 randomly selected
villages in five districts in Bangladesh. Findings revealed that the ARI control project had significant positive
effects in raising knowledge of clinical signs and preventive measures. When ARI control project activities
were integrated with the credit-based development initiative, maternal knowledge improved even further.
The study concludes that the micro-credit programme can be a catalytic agent in raising health knowledge
among poor women in developing countries.

Hamid, S. A., et al. (2011). "Evaluating the Health Effects of Micro Health Insurance Placement: Evidence from
Bangladesh." World Development 39(3): 399-411.

Quayyum, Z., et al. (2013). "Can community level interventions have an impact on equity and utilization of maternal
health care– Evidence from rural Bangladesh. ." International Journal for Equity in Health 12(22): 1-13.

Roy, S. K., et al. (2008). "Impact of pilot project of Rural Maintenance Programme (RMP) on destitute women: CARE,
Bangladesh." Food and Nutrition Bulletin 29(1): 67-75.

Tseng, Y. H. and M. A. Khan (2015). "Where do the poorest go to seek outpatient care in Bangladesh: hospitals run by
government or microfinance institutions?" PLoS One 10(3): e0121733.
INTRODUCTION: Health programs implemented by microfinance institutions (MFIs) aim to benefit the poor,
but whether these services reach the poorest remains uncertain. This study intended to investigate the
socioeconomic distribution of patients in hospitals operated by microfinance institutions (i.e. MFI hospitals)
in Bangladesh and compare the differences with public hospitals to determine if the programs were
consistent with their pro-poor mandate. METHODS: In this cross-sectional study, we used the convenience
sampling method to conduct an interviewer-assisted questionnaire survey among 347 female outpatients,
with 170 in public hospitals and 177 in MFI hospitals. Independent variables were patient characteristics
categorized into predisposing factors (age, education, marital status, family size), enabling factors
(microcredit membership, household income) and need factors (self-rated health, perceived needs for care).
We employed Generalized Estimating Equations (GEE) to evaluate how these factors contributed to MFI
hospital use. RESULTS: Use of MFI hospitals was associated with microcredit membership over 5 years
(OR=2.9, p<.01), moderately poor household (OR=4.09, p<.001), non-poor household (OR=7.34, p<.01) and
need for preventive care (OR=3.4, p<.01), compared with public hospitals. Combining membership and
income, we found microcredit members had a higher tendency towards utilization but membership effect
pertained to the non- and moderately-poor. Compared with the group who were non-members and the
poorest, microcredit members who were non-poor had the highest likelihood (OR=7.46, p<.001) to visit MFI
hospitals, followed by members with moderate income (OR=6.91, p<.001) and then non-members in non-
poor households (OR=4.48, p<.01). Those who were members but the poorest had a negative association
(OR=0.42), though not significant. Despite a higher utilization of preventive services in MFI hospitals,
expenditure there was significantly higher. CONCLUSION: Inequity was more pronounced in MFI hospitals
than public ones. MFI hospitals appeared to miss their target population. We suggest that MFIs reorganize
health programs toward primary health care to make care equitable and universally accessible. This study
holds practical implications for governments, development agencies and microfinance practitioners working
at the grassroots level.