Ahmed Syed Masud, Petzold Max, Kabir Zarina Nahar, Tomson Göran
BRAC, Dhaka, Bangladesh.
Soc Sci Med. 2006 Dec;63(11):2899-911. doi: 10.1016/j.socscimed.2006.07.024. Epub 2006 Sep 6.
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.
现在人们已经充分认识到，定期的小额信贷干预不足以有效惠及孟加拉国农村地区的极端贫困人口，事实上，由于结构性原因，这种干预反而将他们排除在外。为此开发了一种基于赠款的综合干预措施（包括健康投入以减轻疾病对收入的侵蚀影响），以研究这种有针对性的干预措施是否能够改变极端贫困人口在患病期间的就医行为，使其更多地使用医疗服务和“正规对抗疗法”提供者，同时改善他们的贫困状况和医疗支出能力。该研究在孟加拉国北部三个极端贫困家庭密度高的地区进行，采用了干预前/干预后对照组设计。2002年进行了干预前基线调查（2189个干预对象和2134个对照组），随后进行了为期18个月的干预，并于2004年对同一家庭进行了干预后随访调查。通过结构化访谈收集家庭成员就医行为的信息。研究结果显示，研究人群的就医行为总体上发生了变化，但干预措施使自我护理减少了7个百分点，正规对抗疗法护理增加了9个百分点。干预措施使非赤字家庭的比例增加了43个百分点，同时在参考期间用于疾病治疗的支出超过25塔卡的能力增加了11个百分点。较高的医疗支出和时间（从干预前到干预后）与更多地使用正规对抗疗法提供者的医疗服务相关。然而，也注意到在就医和医疗支出方面存在不利于女性的性别差异。在提高卫生系统惠及极端贫困人口能力的背景下，讨论了这些研究结果对项目的影响。
