Wameq A Raza

Healthcare seeking behaviour among self-help group households in Rural Bihar and Uttar Pradesh, India

BackgroundIn recent years, supported by non-governmental organizations (NGOs), a number of community-based health insurance (CBHI) schemes have been operating in rural India. Such schemes design their benefit packages according to local priorities. This paper examines healthcare seeking behaviour among self-help group households with a view to understanding the implications for the benefit packages offered by such schemes.MethodsWe use cross-sectional data collected from two of India’s poorest states and estimate an alternative-specific conditional logit model to examine healthcare seeking behaviour.ResultsWe find that the majority of respondents do access some form of care and that there is overwhelming use of private providers. Non-degree allopathic providers (NDAP) also called rural medical practitioners are the most popular providers. In the case of acute illnesses, proximity plays an important role in determining provider choice. For chronic illnesses, cost of care influences provider choice.ConclusionGiven the importance of proximity in determining provider choice, benefit packages offered by CBHI schemes should consider coverage of transportation costs and reimbursement of foregone earnings.

Impact of Community-based Health Insurance on Access and Financial Protection: Evidence from Three Randomized Control Trials in Rural India

Since the 1990s, community-based health insurance (CBHI) schemes have been proposed to reduce the financial consequences of illness and enhance access to healthcare in developing countries. Convincing evidence on the ability of such schemes to meet their objectives is scarce. This paper uses randomized control trials conducted in rural Uttar Pradesh and Bihar (India) to evaluate the effects of three CBHI schemes on healthcare utilization and expenditure. We find that the schemes have no effect on these outcomes. The results suggest that CBHI schemes of the type examined in this paper are unlikely to have a substantial impact on access and financial protection in developing countries. Copyright

Can ultra-poverty be sustainably improved? Evidence from BRAC in Bangladesh

With more than one-fifth of Bangladeshs population living in extreme poverty, surmounting it still remains a substantial predicament for development practitioners. To combat this issue, BRAC initiated the multifaceted Challenging the Frontiers of Poverty Reduction programme with a grant-based approach, reinforcing its efficacy with background services such as health and social development. Using propensity score matching, this paper analyses a three-round panel dataset (2002–2005–2008) to evaluate the impacts of the programme. We find that Challenging the Frontiers of Poverty Reduction is successfully able to increase the per-capita income, the productive asset bases and the overall food security of its participants in the long run.

Impact and spill-over effects of an asset transfer program on child undernutrition: Evidence from a randomized control trial in Bangladesh

Targeting the Ultra-poor (TUP) is an integrated programme that combines the transfer of income-generating assets and multifaceted training on entrepreneurship, health-nutrition, and social awareness over a two-year period to graduate ultra-poor with mainstream poverty. While positive socioeconomic effects and spill-over effects are well-documented, this is the first paper to evaluate the effects of the programme on nutritional outcomes of under-5 children using data from a randomized control trial over a four-year period. We find notable improvements in nutritional outcomes of children in participating households. TUP is further seen to improve food-security, sanitation and duration of exclusive-breastfeeding. Nutrition status of children living in poor non-participant households are also positively affected though no effects were found on children from non-poor households. We conclude that programmes that combine asset transfer with multifaceted training such as TUP can have significant long-term positive health effects.

How far does a big push really push? : Mitigating ultra-poverty in Bangladesh

BRAC launched its Challenging the Frontiers of Poverty Reduction: Targeting the Ultra Poor (CFPR-TUP) program in 2002 to address ultrapoverty in Bangladesh using an asset transfer approach combined with multifaceted training over a 2-year period. However, evidence of long-term employment trajectories is limited, and it is crucial to understand whether the program truly has a transformative long-term income effect. We evaluate the long-term impact of TUP on employment using difference-in-differences techniques on panel data from a 9-year period (2002–11). We confirm earlier findings of the positive short-term TUP impact: participants are more likely to switch from less productive occupations (e.g., working as maids, begging, day laboring) to entrepreneurship (up 10 percentage points) and generally maintain these new occupations for the medium term. In the long term, however, a substantial proportion of participating households—especially those with members starting out as beggars or maids, those without adult sons, and those headed by males—are switching back to their lower-income baseline occupations, causing the long-term impact to be smaller (a 5 percentage point increase). As this paper is the first to provide impact estimates over a 9-year period of the TUP program, the findings highlight the need for further research on the causes for this reversal and the extent to which it is found in other settings.