Do poverty alleviation programmes improve human well-being?
Mushtaque Chowdhury and Abbas Bhuiya 

 Poverty is looked at from a holistic viewpoint; it is characterised not only in terms of insufficient income or an absence of employment opportunities but as a complex syndrome which manifests itself in many different forms. In the words of Amartya Sen "The point is not the irrelevance of economic variables such as personal incomes, but their severe inadequacy in capturing many of the causal influences on the quality of life and the survival chances of people."

The major goal of any developmental intervention in Bangladesh is alleviation of poverty. This is not surprising, when majority of the population live in abject poverty without equitable access and entitlement to the basic minimum needs of individuals. Evaluation of such programmes has traditionally looked at their success in increasing the income levels of participants. Less attention has been paid to how far these successes have translated into improvements in various aspects of human well-being. We dwell on women-focused development intervention in terms of its impact on human well-being and health equity.

The new-born Bangladesh in 1971 found the economy wrecked and the infrastructure normally associated with nationhood non-existent. However, over the past several years, there have been many positive changes. Between 1975-76 and 1992-93 food production almost doubled; life expectancy increased by 30 per cent between 1970 and 1996, and under 5 mortality rate decreased by 55 per cent between 1960 and 1996. Bangladesh has also achieved impressive results in many other fields. Immunization coverage reached over 70 per cent in the early 1990's from a low 2 per cent in 1985, although recently it has started to decline. The contraceptive prevalence rate (CPR) has risen to over 50 per cent from under 10 per cent in the mid-1970's, and total fertility rate has declined from over 6 in the 1970's to 3.3 in late 1990's. Net enrolment in primary schools has increased to 77 per cent and the gender gap has all but disappeared. In terms of poverty alleviation, government and non-governmental organizations (NGOs) have made significant progress; micro-credit programmes now serve over eight million families, more than half of the country's 12 million poor households. Based on the direct calorie intake method the percentage of poor households has declined from 63 in 1983-84 to 47 in 1995-96.

Despite these impressive strides, Bangladesh remains one of the world's poorest nations. In the World Bank's new system of measuring the wealth of nations (PPP), Bangladesh ranks 18th from the bottom among 123 countries. Per capita income has grown but at a very slow rate of only two per cent a year, and is currently only US$280.

In Bangladesh the constitutional responsibility for development of the country rests with the government. However, it has not always performed this role to its full potential. This is particularly true in the area of poverty alleviation. The history of poverty alleviation efforts in Bangladesh dates back to the early days of Pakistan in the 1950's when programmes such as the 'green revolution' and the establishment of the Bangladesh (then Pakistan) Academy of Rural Development in Comilla were initiated. However, such efforts did not make any significant dent on the poverty situation.

The War of Liberation in 1971 raised new expectations and provided fresh impetus to create a just and poverty-free Bangladesh. The NGOs, which were born in the aftermath of the War for relief and rehabilitation operations, started involving themselves in this task and the relatively unknown field of development. BRAC was one such organization.

BRAC was set up in 1972 as a response to humanitarian need following the independence of the country. However, it became clear early on to the leaders in BRAC that relief work was a short-term measure given the multiple problems that the people faced. There was a shift in the objectives of the organisation from addressing the 'acute crisis' of the aftermath of the War to dealing with the 'persistent crisis' of development.

Over the years BRAC has grown exponentially in developmental innovation and scale. Considerable experience has been gained; some experiments were successful but others failed. Perhaps the most important lesson learned by BRAC has been that there is no fix-all strategy or blueprints for development and that only through constant learning and adaptation could it effectively serve the poor.

BRAC programmes today

BRAC is now the world's largest NGO in terms of the scale and diversity of its intervention. One of the initial activities, which earned national coverage and international attention, was its oral rehydration therepy (ORT) programme for diarrhoea. During the 1980s hundreds of female BRAC workers visited households in 95 per cent of the country's villages to instruct mothers on how to prepare ORT with home ingredients. Studies have shown that ORT has now become a part of the Bangladeshi culture. The current health programme provides essential health services to villagers with emphasis on women's health and specific diseases, such as tuberculosis, through village-based voluntary health workers, called the Shasthya Shebika.

The education programme runs over 34,000 primary schools that are outside of the formal state system for 1.1 million pupils. Nearly seventy per cent of the BRAC school goers are girls and come from the poorest sections of the community to whom the formal public sector schools are least accessible. The effectiveness of the BRAC schools in terms of dropout, attendance, achievement and costs have been found to be very high.

The BRAC Development Programme (BDP) is the primary poverty alleviation effort which is the focal-point of our attention here. It is active in over 60,000 of Bangladesh's 84,000 villages and involves over four million poor women, representing as many families. The twin goals of poverty alleviation and empowerment of women, are reflected on the activities and strategies of BDP. Poverty is looked at from a holistic viewpoint; it is characterised not only in terms of insufficient income or an absence of employment opportunities but as a complex syndrome which manifests itself in many different forms. In the words of Amartya Sen "The point is not the irrelevance of economic variables such as personal incomes, but their severe inadequacy in capturing many of the causal influences on the quality of life and the survival chances of people."

Along with income and employment generation, BRAC helps in forming organisations of the poor, conscientization and awareness raising, gender equity, and human resource development training. The logic of these programmes is the creation of an 'enabling environment' in which the poor can participate in their own development and in improving the quality of their lives.

BDP works through a process of social mobilization, delivery of inputs and creation of an environment of choice for the poor. The poor are defined as those having half an acre of land or less. The process of social mobilisation in a village starts with the identification of those who fulfill this definition of the poor. As soon as an adequate number of eligible individuals show definite interest an institution of the poor, called a village organization (VO), is formed. In Bangladesh about half of the households would fall under the BRAC eligibility criteria and about 30 to 40 per cent of the eligible in the villages where BRAC has a presence have so far joined the VOs. The emphasis on gender has changed over time at pre cent over 95 percent of VO members are women. A VO has 40 to 50 members, but it can start functioning with as few as 20.

Once a VO is established two activities start simultaneously: a programme to raise consciousness and awareness and one for compulsory savings. Through the consciousness-raising programme, the women are made aware of the society around them; they analyse the reasons for the existent exploitative socio-economic and political system and what they could do to change it in their favour. A formal course on Human Rights and Legal Education (HRLE) is provided to the members, which covers Constitutional/Citizen's Rights, and Family, Inheritance and Land Law. Members also participate in a compulsory savings scheme, which has a minimal level of 5 Taka per week. Savings are considered as a form of old age security.

The educational process occurs in a variety of situations: weekly and monthly meetings of the VO, training programme at different centres outside the community, and the continuous interactions that take place between the VO members and BRAC staff from organising meetings to disbursement and collection of loans. In each VO, members are trained in different trades. Thus one member may be trained as a village health worker, and another as poultry vaccinator. These cadres cater to the need of VO members and also sell their services to other villagers for a small fee.

Within a month of formation, VO members are allowed to apply for BRAC loans on an individual basis with collective responsibility. The impressively high proportion of loans that are repaid is the result of a combination of members' consciousness, peer group pressure and BRAC staff supervision. An important feature of poverty alleviation activities is that an attempt is made to create a 'backward and forward linkage' for most of the technology-based activities. For example, in the case of poultry programmes, these are started by providing training to women on how to rear high yielding varieties (HYV) of chickens. Loans are given for operating a low-cost hatchery to supply day-old chicks to other village women. The women then rear these chicks until they start laying eggs. The eggs are then sold to the hatchery as well as to consumers. One of the major problems of poultry rearing in Bangladesh is the high mortality of the birds. The government livestock department keeps stock of vaccines but these are very much underused. A VO member is trained to vaccinate poultry, and she is then linked to the local livestock department of the government which supplies vaccines. After receiving the vaccine, the VO member inoculates village chickens for a small fee. The woman increases her own income and ensures survival of her neighbours' chicken. Similar backward and forward linkages have been established for other programmes such as sericulture, where BRAC has established a highly successful marketing outlet for the producers through a shop-chain called Aarong.

The definition of the poor (i.e., owning half an acre of land or less) was a functional one but other characteristics, such as whether family members sold their manual labour for survival (a very low status occupation in Bangladesh) were also considered in choosing VO members. It became evident that among the 'poor' (as defined through the criteria), there were further stratifications; there were the extreme poor who belonged to households headed by a woman (where there was no male member or the male member(s) were invalids), households having neither land nor homestead, and the marginal or moderate poor who are better off than the extreme poor. There were also the vulnerable non-poor, also called 'tomorrow's poor'.

There has been a particular concern about the composition of the people involved in the BRAC micro-credit based poverty alleviation programmes, specifically whether the poorest VO members were included or not. It was estimated that the poorest 20 per cent of the population were excluded from micro-credit programmes in Bangladesh and that 20 per cent of the BRAC membership came from the very poor and vulnerable group. Researchers developed a conceptual framework that examined the barriers to participate in micro-credit programmes. These included programme-related barriers (such as insufficient supply of micro-credit, membership requirements, peer group expectations and institutional incentives) and client-related barriers (such as insufficient resources, ill-health or vulnerability to crisis, female head of household, lack of education and individual and household preferences). This framework was used to analyse in the programme using a large population-based survey of 24,234 households. It was concluded that poorer households were more likely to be BRAC members compared to non-poor or less poor. They found that although the VO membership did include some people outside of the target groups, the overwhelming majority was poor as defined by BRAC and the share of the poorest of the poor in VO's was greater than their proportion of the population.

Impact of the poverty alleviation programmes on human well-being

Although BRAC works all over Bangladesh, the data for the present analysis comes mostly from one sub-district called Matlab, the field station of the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B). The ICDDR,B has maintained this surveillance area since 1963 and the many studies conducted there on demographics and action research bear testimony to its worldwide reputation.

In 1992, BRAC started its poverty alleviation programme in Matlab. The inputs introduced in the villages included: VO formation and organization of the poor, micro-credit, training of VO members on human and legal rights, and skills, and non-formal primary education for children. In 75 villages a total of 164 VOs were formed with 6,736 members (all woman), covering over half of the villages' poor households. Since 1993 BRAC village organisation members saved over US$ 500,000 and an amount of US$ 3 million was disbursed to them as loans with 99 percent recovery rate. In addition BRAC opened 81 non-formal schools, which enrolled 2,658 students. In the period up to 1998 4,098 students completed the 3-year cycle of education (70% girls) and 94 percent of them gained entry to the formal government primary schools.

Given the availability of reliable individual level data, BRAC and ICDDR,B initiated a research project to examine the impact of the development related activities on the health and well-being of the population which became known as the BRAC-ICDDR,B Joint Research Project. Several studies using a variety of scientific methods have been carried out and the following provides some results.

Impact on nutritional status of children: The project collected mid upper arm circumference (MUAC) of children at two points of time: 1992 when the BRAC intervention was about to start and 1995 when the intervention was about three years old. The prevalence of severe PEM significantly declined over the period among the children of BRAC member households but there was no such change among the children of non-members. The same information when analysed disaggregated by the sex of the children showed a significantly higher prevalence of severe PEM in females among both BRAC members and poor non-members, but not among non-poor non-members.

Impact on child survival: Survival rates of children belonging to BRAC member households in comparison to poor non-member and non-poor non-member households is seen in Figure 2. It shows that survival of children belonging to BRAC households is better than that for children from poor non-member households, and is in fact rather similar to survival of children from non-poor households. It was striking that the survival advantage associated with BRAC membership among the poor was largely the result of mortality differences in the first few months of life, particularly in the neonatal period.

Food and family expenditures: The patterns in intra-family food distribution were explored through observations of a small sample of 25 households having both girls and boys. It showed that among BRAC member households girls more commonly received equal treatment; boys were more favoured in terms of being given culturally preferred/superior parts of the fish, chicken, meat, etc.

In a separate assessment conducted in a larger geographic area, BRAC member households spent more overall and spent significantly more on consumption of food items than poor non-members. Proportion of non-food expenditures, indicating the capacity of households to spend money beyond food, was also greater among BRAC member households. Finally, the per-capita calorie intake was also significantly higher in BRAC households.

Education: The level of education achieved by children 11-15 years old, at baseline in 1992 and in 1995 was compared. Educational achievement was determined using a competency test. This test, which was curriculum-independent, was administered on children aged 11-15 years. A child satisfying a minimum level of competency in reading, writing, arithmetic and life skills was considered to have 'basic education'. Educational performance improved for both member and non-member groups but the gain was much greater in the case of BRAC member households than poor non-member households and more in girls than boys.

Violence against women: The prevalence of self-reported violence against women was studied. A total of 2,038 currently married women aged 15-55 years were interviewed with a structured questionnaire. Women were asked about occurrence of five types of violence in previous four months: (a) physical abuse; (b) money taken against will; (c) prevented from going to natal home; (d) prevented from working outside; (e) jewelry taken against will. In the present analysis we report only the first one, which is physical violence. The incidence of reported physical violence against women between BRAC member and non-member households was compared. It showd a higher incidence of violence among BRAC members than among non-member households. When the incidence figures were analysed according to length and 'depth' of membership, however, the prevalence tended to decrease with increasing membership length. The peak in violence is reached when credit is introduced, but tapers off when other inputs, such as 'training' are offered.

Impact on health networks: The change in the network of health providers, a proxy for rural power structure, as a result of BRAC interventions was examined. As mentioned previously, BRAC traind village health workers take care of the health needs of VO members and other villagers for most common illnesses. We compared two villages. In one of them BRAC had been active for over ten years (the BRAC village) and a Shebika had been trained and in another BRAC was introduced only recently (with no significant input and impact yet). Using Participatory Rural Appraisal (PRA) techniques, the study reconstructed households present in the first village at the time BRAC started and the networking relationship that they had with the various health providers in the village. This web of relationship was compared with the present one to find the change that has happened over the years. It showd that the networking relationships between providers and their clients have undergone some major changes. While some of the provid ers such as the homoeopath have gone out of business, the networking relationship of BRAC Shebika has flourished, and became more equitable, with households belonging to poor and non-poor utilizing their services.

The data presented above suggest that there was a measurable improvement in terms of different human well-being indicators for the BRAC household members in comparison to a 'comparable' non- member group and that these differences were equally discernible for male and female family members of BRAC households. Two important questions arise: Firstly, how can we explain these differences according to BRAC membership? Are they the result of the BRAC programmes or could they be artefacts due to selection bias in the recruitment process, whereby the "poor" who become BRAC members are better off in a number of important ways at entry. Secondly, if the differences are due to BRAC programmes, what was the mechanism or pathways through which the interventions led to these improvements?

BRAC recruits poor women with a landholding of half an acre or less. Studies have documented that a certain proportion of BRAC and other NGO participants come from a less poor group. There are several reasons why people from outside the target group are recruited. Participants may lie to field staff about their actual landholding at the time of joining or they may have improved their situation since joining. A recent study found that women who had joined BRAC for four years or more had each added ten decimals to their landholding. The 'comparison' group selected for the present study conformed to the definition of BRAC membership. One author examined the background of the two groups in Matlab sub-district and found that 29 percent non-poor women were also VO members. When compared with members who actually conformed to the BRAC eligibility criteria (i.e., landholding of 0.5 acre or less), the comparison group had more land, assets and number of earners in the family. Information presented in the text from other studies indicated that the majority of BRAC membership conformed to the eligibility criteria of BRAC and the share of the poorest of the poor in the village organisations was more than their proportion in the population. Nevertheless, researchers have speculated that there may still be a 'natural selection' mechanism that favours the more credit-worthy among the poor, thus allowing room for self-selection. Further studies to detect the possible presence of selection bias and its impact on the present results were carried out. One analysis traced the mortality history of children belonging to BRAC and non-BRAC poor prior to 1992 when the intervention started, using the data available through the Health and Demographic Surveillance System of ICDDR,B. Although both groups were similar prior to 1992 in mortality levels, the BRAC group children experienced a greater fall in mortality over the period. Results from an analysis of nutritional status data collected in 1992 and 1995 showed similar results. One researcher noted that the women members who did not qualify BRAC eligibility criteria but were inducted into VOs were the better-off poor but were not village elites. The mortality data presented in the text showed that the BRAC members were actually very close to the elites; even when the non-poor members were excluded from the analysis, the better performance of BRAC members still persisted.

Most of the impact on mortality occurred during the neonatal period. Yet most of the child survival technologies, such as immunizations, have their impact later in childhood; something is happening to the women during pregnancy and/or during the birth process that is affecting the neonates. One of the determinants could be the psychological well-being (PW); and the initial analyses of a study on PW showed that BRAC members PW was marginally higher. Research is underway to better understand this phenomenon.

It is suggested that various factors affect well-being. One of these is improved nutritional status. In BRAC participant households, the intra-family allocation of food is more equitable, although there is still the tendency to favour boys. The average calorie consumption is higher among BRAC participants. The per capita monthly expenditure is greater as is the proportion of the expenditure spent on food. BRAC women were greater users of family planning methods, which may have given them a longer time between pregnancies, and opportunity to participate in micro-credit financed income-generating activities. The increased violence against women that occurs in the earlier phases of the BRAC was reduced over time when credit was accompanied by other inputs such as human development and skill training. When a woman receives a loan, a new transaction and relationship emerges in her own and extended family. A small amount of money works as a miracle in a cash-hungry society and significantly raises the woman's power in the family. Not all men are ready to accept this new power relationship and some may resort to violence to express their anger. The changes in women's economic role within the family may initially be met with resistance/resentment and in extreme cases with violence. We also need to be somewhat cautious in accepting and interpreting this information. It may be that BRAC members, because of their increased awareness, report more details of their marital life. Other studies have also documented reduced incidence of violence in households that are served by micro-credit programmes.

Improvement in the level of basic education of children is dramatic, and more so in girls than boys. This might be expected as BRAC schools are positively discriminative in favour of girls. In recent years, there have been improvements in performance of basic education at the national level as well and this is reflected in Matlab.

Based on the above observations it can be said that poverty alleviation programmes focused on women are effective in improving well-being of the poor.

Chowdhury and Bhuiya work for BRAC and ICDDR,B respectively


Source: The Daily Star, Dhaka, February 13, 2002


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