1. How do you measure the concept of poverty? BRAC Experiences Syed Masud Ahmed MBBS, PhD BRAC Research and Evaluation Division

2. 2 Discussion topics Introduction Setting the context: BRAC BRAC’s concept of poverty Measuring the concept of poverty Summing up

3. 3 Tubeculosis: Bangladesh Scenario (WHO estimates per 100,000 population, 2004) Ranks 5 th among world’s 22 high- burden disease (WHO) Incidence of all TB cases: 221 Incidence of new smear+ve cases: 99 Prevalence of smear+ve cases: 188 TB mortality of all cases: 52 MDR among new cases of TB: 1.4%

4. 4 BRAC Indigenous NGO working with the twin objectives of Alleviation of poverty and Empowerment of the poor http://www.brac.net http://www.bracresearch.org

5. 5 BRAC”s TB Programme Community based DOTS programme with CHWs at the nucleus Partnership with GoB and NGOs Recipient of GFATM since July 2004 Coverage: 82 million (2/3 rd of the population) Average case detection rate: 44% (2004) Treatment success rate for new sputum+ve cases: 89% (2003)

6. 6 Cost-effectiveness of community health workers in tuberculosis control in Bangladesh. Bull World Health Organ. 2002;80(6):445-50. Success with the DOTS strategy. Lancet. 1999 Mar 20;353(9157):1003-4. BRAC”s TB Programme

7. 7 Relevance of poverty measurement in TB control programme Poor are more vulnerable Equity: ‘inverse care law’ Making DOTS pro-poor Income-erosion effect of illness Poverty reducing effect of TB control programme

8. 8 BRAC’s concept of poverty: “Lack of an enabling environment” “ Minimum” income and employmen t Entitlement to food & “safety net ” Access to housing Institutional mechanism for savings and credit Enabling environment Investibl e surplus Power (to fight exploitation) Human rights and their enforcement Access to appropriate technology Gender equity Access to health care Institutions of the poor Access to education Entitlement to assets (such as land )

9. 9 Dimensions of poverty measurement Economic Lack of income or employment Non-economic Lack of entitlement to basic necessities of life Poverty is increasingly seen as a multi-dimensional phenomenon

10. 10 BRAC’s targeting criteria for identifying the poor households Households possess ≤50 decimals of land Sells manual labour for at least 100 days a year for subsistence Labour-selling HHs represent low SES given their dependence on variable seasonal employment

11. 11 Self-rated poverty status of HH Respondent’s perception about the state of HH’s annual expenditure in relation to income during the referral period (say, past one year) Always deficit Occasional deficit No deficit a valid indicator of HH stratification in rural Bangladesh, used by poverty researchers

12. 12 Challenging the MC/MF paradigm Empirical evidence (from BRAC’s own and other development practitioners) showed that micro-credit programmes failed to reach the ‘poorest of the poor’/’ultra-poor’ for various reasons Heterogeneity of the poor Customized programme needed for different sections of the poor

13. 13 CFPR/TUP (Challenging the Frontiers of Poverty Reduction/Targeting the Ultra-Poor) Programme of BRAC ”To enable ultra-poor attain a level of sustainable development so that they can participate in and benefit from mainstream (including microcredit-based) development interventions” Grants-based productive asset transfer Subsistence allowance and skill-training Health inputs to mitigate income-erosion effect of illnesses

14. 14 How to target the ultra-poor households ? Based on experiences of working with the poor/review of poverty literature and empirical evidence Inclusion criteria Exclusion criteria

15. 15 Inclusion indicators IndicatorsRationale Land owned by household ≤ 10 decimals including homestead land Landlessness and extreme poverty highly correlated, though not all landless are extreme poor No adult working man in householdAbsence of able bodied male labour power is an important characteristic of extreme poor households School-going aged children workingChild labour is predominant in extreme poor households Adult woman selling labourAdult woman selling labour is more prevalent in extreme poor households; signals desperation and motivation of the household No productive assetsExtreme poor households tend not to own any productive assets

16. 16 Exclusion indicators IndicatorsRationale Any member of the household has current NGO participation Targeting those extreme poor who do not/cannot participate in existing NGO programme Any member of the household receives benefit from GoB programmes Targeting those extreme poor who do not/cannot participate in existing GoB programme No physically able adult woman in household This is a women-targeted enterprise programme

17. 17 Poverty measured as shortfall in fulfillment of basic needs: Basic needs approach Basic needs Food Clothing Shelter Health Education Social involvement

18. 18 Basic needs approach: steps Items representing various dimensions selected Four items per dimension All items have three answers 3 for highest level 1 for lowest level Total poverty score range: from 24 to 72 The higher the score, the poorer the HH

19. 19 An example: lack of health How frequently do the HH members on average suffer from illness or ill health? In case of illness of the HH members, how often an allopathic doctor is contacted? In case of diarrhoeal illnesses of the HH members, how frequently ORS is administered How common it s to wash hands with soap after defaecation among the HH members? Scoring: 1=quite frequently/most of the time (more than half); 2=sometimes; 3=once in a while/never

20. 20 Conclusion: It’s possible to conceptualize poverty from non-economic dimension Very simple, easy to use and valid indicators can be developed to measure the concept of poverty Useful approach for targeting particular poverty group