Urban Primary Health Care Services Delivery Project Local ...uphcp.gov.bd/cmsfiles/files/Redcard...

Urban Primary Health Care Services Delivery Project

Local Government Division

Ministry of Local Government, Rural Development & Cooperatives

Eusuf and Associates

Project Performance Monitoring and Evaluation Firm

June 2017

Annual Red Card Verification and Updating 2017

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ABBREVIATIONS

ADB Asian Development Bank ANC Ante-natal Care

BAPSA Bangladesh Association for Prevention of Septic Abortion

BCC Barisal City Corporation BRAC Bangladesh Rural Advancement Committee

CS Caesarean Section CoCC Comilla City Corporation

CRHCC Comprehensive Reproductive Health Care Center

DAM Dhaka Ahsania Mission DNCC Dhaka North City Corporation

DSCC Dhaka South City Corporation EPI Expanded Program on Immunization

ESDO Echo Social Development Organization FGD Focus Group Discussion

GaCC Gazipur City Corporation

GM Gopalganj Municipality KCC Khulna City Corporation

KMSS Khulna Mukti Seba Sangstha KsM Kishoreganj Municipality

KstM Kushtia Municipality

LGD Local Government Division LQAS Lot Quality Assurance Sampling

NaCC Narayanganj City Corporation NGO Non-Government Organization

NVD Normal Vaginal Delivery PA Partnership Area

PAHQ Partner Area Headquarters

PA NGO Partnership Area Non-government Organization PHC Primary Health Care

PHCC Primary Health Care Center PNC Post Natal Care

PPM&E Project Performance Monitoring and Evaluation

PPP Public Private Partnership PSKP & PPS Progati Samaj Kalyan Protisthan and Paribar Parikalpana Sangstha

PSTC Population Services and Training Center RaCC Rangpur City Corporation

RCC Rajshahi City Corporation RIC Resource Integration Center

SC Satellite Clinic

SCC Sylhet City Corporation SIDA Swedish International Development Cooperation Agency

SM Sirajganj Municipality UF Users’ Forum

UNFPA United Nations Population Fund

UPHCSDP Urban Primary Health Care Services Delivery Project UTPS Unity Through Population Services

VAW Violence Against Women WUHCC Ward Urban Health Coordination Committee


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EXECUTIVE SUMMARY

1. The Local Government Division (LGD), Ministry of Local Government, Rural Development & Cooperatives of the Bangladesh Government is implementing the Urban Primary Health Care Services

Delivery Project (UPHCSDP) in ten city corporations and four municipalities. The project has started in

July 2012 and is scheduled to complete in June 2017. The UPHCSDP is financed by the Bangladesh Government, Asian Development Bank (ADB), Swedish International Development Cooperation

Agency (SIDA), and the United Nations Population Fund (UNFPA). The project is delivering a package of essential services delivery plus services that include comprehensive emergency obstetric care. The

target beneficiaries include the urban poor, particularly the women and children of the project area. The project is designed to serve at least 30% of all services to ultra poor and poor recipients free of

cost including drugs, and for non-poor at lower costs than market price. The partner NGOs of the

project has issued red cards to the ultra poor and poor for entitlement to get services free of cost.

2. The project engaged Eusuf and Associates as the independent Project Performance

Monitoring and Evaluation (PPM&E) firm to assist project implementation through monitoring project operating performances including measurement of project impacts, outcomes and outputs. The

present report, ‘Red Card Verification and Updating 2017’, is one of the seven agreed deliverables of

the PPM&E firm.

3. The main objective and purpose of the red card verification and updating survey is to verify

whether (a) the red cardholder households are residing at their registered addresses, (b) the red cards are issued only to the eligible poor beneficiaries, and (c) the PA NGOs verify and update the red

cards at regular intervals ensuring that only the active red cards are maintained in the red card issue

registers.

4. The PPM&E firm adopted different approaches for red card verification such as household

survey and focus group discussion and developed specific data collection tools. Lot Quality Assurance Sampling (LQAS) technique was used to select households for survey. In the survey, all 25

partnership areas (PAs) were selected for survey and data collected from the sample red cardholder households. Secondary data was collected from master register and red card registers. The record of

red cardholder household as of 31 December 2016 was considered for sampling and data collection

for verification and updating.

5. In addition to household survey, 25 focus group discussions (FGD) were conducted (one in

each partnership area) with three categories of stakeholders (service recipients, service providers,

and community) with the participation of 283 persons.

6. Nineteen sample red card households were selected for survey and verification from all the

red card holder households per partnership area using Lot Quality Assurance Sampling LQAS) technique. Location and particulars of sample red cardholder households were collected from red card

registers of Primary Health Care Centers (PHCCs). In all, 475 sample households were selected from the 25 partnership areas. In total 434 sampled households found in their addresses and the

remaining 41 households (9%) there are different discrepancies about the red card holders and

issuance of red cards.

7. Among the 41 red card holder households, 17 red card holders (3.6%) left the addresses and

gone back to their villages, 16 red card holders (3.4%) could not be found at the addresses and the people living at that addresses said that no one in those names lived at the address ever, card

holders of 7 households (1.4%) left addresses and their whereabouts are not known, and 1 card

holder (0.2%) are not available due to demolition of their slums.

8. It is assumed from the survey that the respective PA NGOs did not verify the presence of the

red card holders for some time although they were asked to submit the updated list to the PPM&E firm. If there had been verification of the red cards and updated the registers recently the

discrepancies found could have been totally avoided. Because, those who were not available at their

addresses (97.6%) could be replaced by new red cards to eligible beneficiaries.


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9. During the survey, 434 households having been found to live at their registered address of

which 55.2% are ultra poor, 43.19% are poor, and 1.62% non-poor.

10. The beneficiaries participated in the focus group discussions opined that they were informed from the field workers of the PA-NGOs through house to house visits and survey of the project

services particularly about the free health care services including medicines for the poor.

The information was also received from other women of the locality who already possessed red cards. They also mentioned that they also got information from the “Rainbow Clinics” that poor people are

entitled to get red cards. The respondents stated that they are happy with the services of the health service provider as their behavior is cordial and good. It was mentioned that location of clinics are

nearer to the locality and workers are always available. Cost of services in other health facilities is

much higher. Poor people receive free services through red cards.

11. The participants mentioned that they faced some problems in accessing services from PA-

NGOs. The problems are: shortage of medicine, lack of specialized doctors, pediatric complications, absence of X-ray machine at CRHCC and Ultrasonography machine at PHCC. For improvement of

services it suggested that people should be made aware about the health issues and health services. PA-NGO staff should keep constant contact with the poor people and the community leaders. More

numbers of red cards should be distributed to the eligible poor who have not received those. It was

opined that adequate supply of medicine to be available at the service centers. Further, they

mentioned to include dental and eye care services in future; and also to arrange the evening clinic.

12. The community leaders reported in their FGD sessions expressed that outreach workers discussed with them and the people on explaining the eligibility criteria for getting a red card and the

provision of free services and medicines. They also mentioned that red card distribution issues are discussed at their meeting. The participants stated that health service users are happy with the

services of the health service providers. The reasons mentioned by them include free treatment and

medicines for the red card holders and services at reduced cost for others. Other organizations do not provide such services. Only reasons for dissatisfaction mentioned was non availability of some

prescribed medicines in the centers. They suggested for further improvement that include more supply of medicine, full time availability of doctors, increasing number of red card holders, launch

publicity in different forms to attract local community to receive services from the CRHCC/PHCC,

increase in staff at the clinics and provide more training giving emphasis on communication with the

beneficiaries.

13. Feedback of the FGD sessions of service providers indicate that PA-NGOs had personal communication and coordination and network with other health service providing organizations in

particular with the Government Hospitals, and Medical College Hospitals for referring of critical

patients. The participants listed several strengths of the project that include (i) free health services to the poor urban people (red card holders) and services at subsidized cost for others, (ii) provide

diagnostic services, medicine supply at low cost, (iii) availability of ambulance service at the CRHCC, (free for red card holders), and (iv) availability of ambulance service at the CRHCC, (v) good

infrastructure and skilled manpower, (vi) providing health education at community level, and (vii) services provided to specific location on specific dates. They mentioned some weaknesses which

include (i) rented building in some places, (ii) inadequate field staff compared to areas of operation,

(iii) inadequate supply of medicine, (iv) not enough training for the staff: less opportunity for field staff, training mostly to the technical staff and high drop out amongst new staff, (v) difficult to get

experienced doctors with low salary, and (vi) referred cases are to travel long distance from PHCCs to

CRHCC.

14. The PPM&E experts recommend verification of red cards and updating by the respective PA

NGOs on a routine basis and annual stock taking in keeping minimum numbers of absentee red cards due to migration and other socioeconomic reasons in urban areas particularly in the slums. The PA

NGOs should ensure that only the active red cards are counted in the register upon updating and all services to the poor are planned and managed accordingly.


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Table of Contents

Abbreviation i Executive Summary ii-iii

Chapter I Introduction and Methodology 1-4

A. Introduction 1 B. Methodology and process 2

Chapter II Availability of Red Card Holders 5-11

Chapter III Verification of Poverty Level of Red Cardholders 13-16

Chapter IV Feedback of Focus Group Discussions 17-21

A. Introduction 17

B. Focus Group Discussions with Service Recipient Red Cardholders 17 C. Focus Group Discussions with WUHCC, UF and Community People 18

D. Focus Group Discussions and feedback from Health Service Providers 20 E. Overall Suggestions and Improvements 21

Chapter V Recommendations and Conclusions 22

A. Recommendations 22 B. Conclusions 22

Appendixes:

Appendix I Simple Poverty Score Card for Identification of the Ultra Poor and Poor 23

Appendix II Checklists for Administration of Focus Group Discussions 25

Appendix III Lot Quality Assurance Sampling (LQAS) Technique 32

Appendix IV Summary of Causes of Absence of Red Cardholder Households 36

Appendix V Participants of the 25 Focus Group Discussions 37


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CHAPTER I

INTRODUCTION AND METHODOLOGY A. Introduction

1. The Local Government Division (LGD) of the Government of Bangladesh (GOB) has been

implementing the Urban Primary Health Care Services Delivery Project (UPHCSDP) since July 2012 in 14 different cities1 with the financial assistance of the Asian Development Bank (ADB), United Nations

Population Fund (UNFPA), and Swedish International Development Cooperation Agency (SIDA). The

project is designed with program approach, public private partnership (PPP) concept, decentralized project management, and institutional governance capacity building of the local government bodies to

deliver Urban Primary Health Care (PHC) services in a sustainable manner. The target beneficiaries include the poor, particularly the women and children of the project area. The project is scheduled to

close in June 2017.

2. The aim of the UPHCSDP is to improve the health status of the urban population, especially

the poor, women and children, in the project areas. The immediate outcome of the project is sustainable good quality Primary Health Care (PHC) services provided in project area targeting the

urban poor and the needs of women and children.

3. The project will achieve its outputs and outcome in terms of delivering extended service

delivery packages through establishing primary health care service network with Comprehensive Reproductive Health Care Centers (CRHCC), Primary Health Care Centers (PHCCs), and Satellite

Clinics in 25 partnership areas.

4. In effectively reaching the urban poor, the UPHCSDP maintains a provision of serving at least

30% services free of cost including drugs to the poor. The PA NGOs identify the poor and ultra poor beneficiary households following a guideline provided by the project who become eligible for receiving

primary health care services free of cost. The criteria for identifying the urban poor is based on a combination of living conditions, nature of employment, monthly income, house rent and cost of food,

etc using the form “Simple Poverty Scorecard for Identification of the Ultra Poor and Poor”

(Appendix I). The eligible households are provided with a ‘Red Card’ so that they need not to prove their eligibility every time for getting the services. The PA NGOs have to verify and update the red

cards through regular spot checks to see if the cards were issued to ultra poor or poor, whether the red card holder households leave addresses shown in the red card register or have anyone migrated

elsewhere.

5. One of the tasks of the Project Performance Monitoring and Evaluation (PPM&E) firm is to

verify and update red card householder beneficiary households annually on a sample basis to assess whether the red cards were issued to the ultra poor and poor following the project guidelines, if the

respective PA NGOs regularly verified and updated the red cards to ensure that the red card holder households live at the addresses shown in the red card register, and the red cards are not abused

anyway. The PPM&E firm carried out a study of verification and updating of the red cards by the PA

NGOs. The study considered the red cards shown in the registers as of 31 December 2015.

B. Methodology and Process

1. Approach and Methodology

6. A sample household survey of red cardholder households and number of focus group

discussions were carried out to collect quantitative and qualitative information respectively. Semi-structured questionnaire was used as tools in the household survey and checklists were used in the

focus group discussions. Data collection tools including checklists for focus group discussion are

1 Dhaka South, Dhaka North, Barisal, Khulna, Rajshahi, Sylhet, Rangpur, Comilla, Gazipur, and Narayanganj city

corporations; and Gopalganj, Sirajganj, Kushtia, and Kishoreganj municipalities



presented in Appendix II. The household survey was conducted in sample households for obtaining information like living condition, employment, income, house rent, food, and others using the ”Simple

Poverty Scorecard for Identification of the Ultra Poor and Poor”. Focus group discussion was used to collect qualitative information in obtaining views of the community on the services provided by the

project, issuance of the red cards, health services for the poor and satisfaction of the recipients, cost

of services and affordability, and suggestions for improvement of services. .

7. The PPM&E firm used the guidelines of “Simple Community Scorecard for identification of the Ultra Poor, and Poor” as described in the ISI Tool of the UHPCSDP. Using the community scorecard

the poverty status of individual household was determined and classified as Ultra Poor and Poor. In classifying the poverty status, the guidelines developed by the project in classifying the Ultra Poor

and Poor was used which is presented at table 1.1.

Table 1.1: Guidelines Developed by the Project in Classifying the Ultra Poor and Poor

Poverty Status

Poverty Classification

Dhaka North, Dhaka South, Barisal, Narayanganj and Gazipur City

Corporations

Other City Corporations

Municipalities

Level 1 Ultra Poor 0 - 20 0 - 15 0 – 10

Level 2 Poor 21 - 30 16 – 25 11 – 20

Level 3 Non-Poor 31 and above 26 and above 21 and above Source: Project guidelines on filling of scorecard and identification of poor

8. The approach of the study specifically emphasized on proper sampling of households ensuring representativeness of data, quality of data, in-depth analysis and interpretations of data and

feedback, data comparability, dissemination of findings with the project as well as the PA NGOs.

9. The PPM&E firm placed heightened importance on training of enumerators employed for the

household survey and the focus group discussion with participants drawn from the community and interview of respondents of the sample households. Classroom and field-level trainings were

arranged. There was close monitoring of the survey and focus group discussion by supervisors and experts of the PPM&E team. The PPM&E team took special care to data processing and

interpretations and report writing and presentation.

2. Sampling Technique

10. The PPM&E firm adopted separate sampling techniques for household survey and the focus

group discussion. The study gathered secondary information from the PA headquarters and the

PHCCs. The study covered all 25 partnership areas and therefore, sample households were selected and focus group discussions administered in all 25 partnership areas.

a. Sampling Technique for Household Survey

11. The household survey under the study of verification and updating red cards by the

respective PA NGOs used the Lot Quality Assurance Sampling (LQAS) technique for selecting sample

households. Details of Lot Quality Assurance Sampling (LQAS) technique is presented in Appendix III.

12. The LQAS technique assumes following standard statistical considerations that a sample size

of 19 chosen randomly from a homogenous cluster provides an acceptable level of error for making management decisions. In the household survey, all red cards available on red card registers as of 31

December 2016 of a partnership area was considered universe for sampling and randomly selecting

19 red cards using the LQAS technique for household survey.

13. In assimilating all available red cards to form the sampling universe of red cards/households under each partnership area, the numbers of all red cards of all PHCCs of the partnership area were

collected and put together sequentially for sampling of the red cards (households). It may be

mentioned that each red card represents a particular household located at a definite address recorded



in the red card register with the respective PHCC. In this way a master list of all red cards or red card holder households was prepared arranged sequentially indicating the total number of red cards or red

card holder households in the catchments area of the partnership area comprising all PHCCs therein. It may also be mentioned that the red card holder households are numbered consecutively

sequentially by the PHCC for identification. The list has been prepared simply adding the cumulative

numbers of red card holder households.

14. As the LQAS technique suggests only 19 samples, the PPM&E experts in order to getting 19 sample red cards or red card households divided the total number of red cards or households by 19

and found out the “sampling interval” for randomization. The PPM&E experts then using the Website www.random.org chose a random number between 1 and the total number of red cards or red card

holder households.

15. The first household was located within the catchments area of the particular partnership area

that contained the random numbered household and added the sampling interval to the first household and each subsequent household until 19 red cards or red card holder households were

identified. The PPM&E experts collected the addresses of the randomly selected 19 red cards or the

red card holder households from the respective registers maintained in particular PHCC. The household survey in the particular partnership area was conducted only in the sample 19 households

of red card holders.

16. The same technique was followed to identify and select 19 red cards or red card holder households in all 25 partnership areas and found out 475 (19 red cars per partnership area X 25

partnership areas) red cards or red card holder households for household survey. The survey team

selected prepared a survey plan by arranging the 19 red cardholder households sequentially by location for easy and efficient survey and movement for smooth administration of the Poverty

Scorecard for Verification survey and interview. Sampling of the red cardholder households is summarized at table 1.2.

Table 1.2: Sample Size for Household Survey

Item Sample size Coverage

1 PA Headquarters 25 100%

2 PHCC 113 100%

3 Respondents of household survey 475 Covering all 25 PA NGOs

b. Focus Group Discussion (FGD)

17. The study needed considerable amount of qualitative feedback of service recipients, service

providers, and the community to compare the quantitative findings and understanding of the major issues of red card such as voluntary and involuntary migration of the urban population, health

seeking behaviors of urban poor, and complex poverty and purchasing power parity. The survey

utilized the feedback of different meetings of the community, level of awareness of the people, understanding of the people about getting a red card and availing free services including medicine,

system for identification and issuance and distribution of red card, available services and facilities of red card holders, behavior and attitude of service providers, violence against women(VAW), role of

outreach workers during their visits to households, poor people who are yet to receive red card, verification and updating red card, ways to reaching the poor with red card, identifying the urban

poor, problems faced in managing red card, level of satisfaction of beneficiary red card holders, and

suggestions of the community.

18. One focus group discussion was conducted in each of the 25 partnership area to gather feedback of participants comprising of service recipients, service providers, and the community about

the services of the project. The study design included that only similarly profiled participants would

participate and discuss in a focus group session as appropriate. Therefore, the 25 focus group discussions comprised of three sets of focus group discussions of service recipients, service providers,

and community. Accordingly, ten focus group discussions of service recipients, eight focus group discussions of the community and seven focus group discussions with service providers, were

http://www.random.org/



conducted. The checklists developed and used in the focus group discussions are presented in Appendix II.

19. In the 25 focus group discussion 283 participants (260 female and 23 male) comprising of

service recipient beneficiaries, service providing health workers, and members of community

participated. The focus group discussions were guided and supervised by supervisors and PPM&E experts and moderated by enumerators and the sessions were recorded in paper and voice recorder.

The feedback of three types of the focus group discussions were separately synthesized and presented in the report.

20. The field work was carried out by a group of 12 enumerators having master or bachelor

degree with experiences of health sector. An intensive training course of four days comprising three-

day classroom and one-day at field condition was organized by the PPM&E experts. The training course focused on methodology and tools particularly sampling and respondent selection and

interviewing techniques, and pre-testing and improvement of the tools. The experts demonstrated how to fill in the questionnaire, organize focus discussion, interviewing techniques, and appreciate

the respondents for their valuable time.

21. The PPM&E experts supervised the field works of the enumerators and monitored survey

activities to oversee the survey activities and ensure quality. In addition, they re-checked filled in

questionnaire to ensure quality of data. Besides, the experts verified collected quantitative data and

qualitative feedback of focus group discussions for validation with actual situation. The survey data

were checked and entered in a pre-designed computer program, analyzed them in-depth according to

the objectives of the study, and prepared a report.

Training of Enumerators and Supervisors



CHAPTER II

AVAILABILITY OF RED CARD HOLDERS 22. Red card holder households’ record up to 31 December 2016 was considered for sampling

and data collection. A total of random 19 sample red card households were selected for interview in each of the partnership area. Location and particulars of sample red cardholder households were

collected from red card registers of PHCCs and visited during the survey. A total of 475 red card households were verified of which 434 households were found as per address. Availability of

respondents having red card by partnership areas is presented at table 2.1. The percentage of red

cardholder households found at the registered addresses and presented at the table 2.1 is the real number and relative percentage has been assigned later on at tables 3.6-3.9.

Table 2.1: Availability of Red Card Holder Households by Partnership Area

Partnership Area (s) PA NGO(s) City Corporation (s)/

Municipality(ies)

Availability of Red Card Holder Households at Addresses

Sample per PA NGO

Households Present

% of Presence as per LQAS

1 DSCC PA-1 PSTC Dhaka South City Corporation 19 19 95

2 DSCC PA-2 KMSS Dhaka South City Corporation 19 19 95

3 DSCC PA-3 BAPSA Dhaka South City Corporation 19 19 95



6 DNCC PA – 1 Nari Maitree Dhaka North City Corporation 19 19 95

7 DNCC PA – 2 Nari Maitree Dhaka North City Corporation 19 19 95

8 DNCC PA – 3 UTPS Dhaka North City Corporation 19 15 90

9 DNCC PA – 4 KMSS Dhaka North City Corporation 19 16 95

10 DNCC PA – 5 DAM Dhaka North City Corporation 19 19 95

11 RCC PA – 1 RIC Rajshahi City Corporation 19 18 95

12 RCC PA – 2 PSTC Rajshahi City Corporation 19 17 95

13 KCC PA – 1 KMSS Khulna City Corporation 19 19 95

14 KCC PA - 2 KMSS Khulna City Corporation 19 19 95

15 SCC PA - 1 Shimantik Sylhet City Corporation 19 19 95

16 BCC PA - 1 Srizony BD Barisal City Corporation 19 19 95

17 CoCC PA - 1 DAM Comilla City Corporation 19 13 80

18 NaCC PA - 1 PSKP & PPS Narayanganj City Corporation 19 19 95

19 RaCC PA - 1 KMSS Rangpur City Corporation 19 15 90

20 GaCC PA - 1 PSTC Gazipur City Corporation 19 14 85

21 GaCC PA - 2 PSKP & PPS Gazipur City Corporation 19 11 70

22 SM PA - 1 ESDO Sirajgani Municipality 19 16 95

23 KstM PA - 1 Srizony BD Kushtia Municipality 19 18 95

24 KsM PA - 1 Nari Maitree Kishoreganj Municipality 19 17 95

25 GM PA - 1 GM Gopalganj Municipality 19 19 95

Total 475 434 2315

Average 19 17.4 92.6

Source: Red Card Verification and Updating 2017 Survey of PPM&E Firm

23. From the analysis of the data it has found that 434 red cardholder households are found at

their registered addresses out of 475 sample red cardholder households (92.6%, Say 93%) indicating that the remaining 41 (9%) red cardholder households are not found at their registered addresses. In

other words, for every 19 red cardholder households, only 17.4 red cardholder households are present at their registered addresses and 1.7 red cardholder households are not found out at their

registered addresses.

24. It was found during the verification that 41 red card holders were not available at their

addresses. Out of 41, highest 8 red card holders were not found at their addresses under GaCC PA-2, PSKP & PPS; followed by 6 red card holders of CoCC PA-1, DAM; 5 red card holders of GaCC PA-2,



0

10

20

30

40

50

60

70

80

90

100

Re

dca

rd A

vaila

ble

%

DSCC PA1 DSCC PA2 DSCC PA3 DSCC PA4 DSCC PA5 DNCC PA1 DNCC PA2DNCC PA3 DNCC PA4 DNCC PA5 RCC PA1 RCC PA2 KCC PA1 KCC PA2SCC PA1 BCC PA1 CoCC PA1 NaCC PA1 RaCC PA1 GaCC PA1 GaCC PA2SM PA1 Kst PA1 Kst PA2 GM PA1

PSTC; 4 red card holders each of DNCC PA-3, UTPS and RaCC PA-1, KMSS; 3 red card holders each of DNCC PA-4, KMSS and SM PA-1, ESDO; 2 red card holders each of DSCC PA-5, PSTC, RCC PA-2, PSTC

and KsM PA-1, Nari Maitree; and 1 red holder each of RCC PA-1, RIC, NaCC PA-1, PSKP & PPS, and KstM PA-1, Srizony BD.

25. The information manifests a considerable weakness in the management of red card system as one out of every ten red cards is inactive. In fact, it is possible to maintain all red cards active by

identifying the red cardholder households leaving the registered address (and go out of the catchments area of the PA), the red card is deactivated/ cancelled and a new red card is issued to

another eligible beneficiary.

Figure 2.1: Red Cardholder Households Found at their Registered Addresses

26. In the household survey the information of the red cardholder households not found present

at the addresses shown in the red card registers were gathered from the residents presently reside in

the household located at the addresses, immediate neighbors, and those others who have information about the residents missing. One representative of the respective PA NGO was also

present to assist enumerators to locate the households and also to bear witness of the findings (who signed the fact sheets). Summary of the reasons of leaving the addresses is at Appendix IV.

27. The survey noted five reasons of not finding the 41 red cardholder households at the registered addresses. These are: (i) residents left the household but none know their whereabouts (7

households), (ii) residents left the households and went back home in their villages (17 households), (iii) residents were compelled to leave the household as their households were demolished while

demolishing the slum (1 household), and (iv) no one in the same name lived at the household ever (16 households). Summary of the non-availability of red cardholder households is at table 2.2.

Table 2.2: Summary of the Non-availability of Red Cardholder Households

Reasons of Absence of Red Cardholder Households at Registered Addresses

Absentee Households

% of all 475 Households

% of 41 Absentee HH

1 Residents left the household but none know their

whereabouts

7 1.4 17.1

2 Residents left the households and went back to their home in the villages

17 3.6 41.5

3 Residents were compelled to leave their households as their households were demolished while demolishing

the slum by land owners

1 0.2 2.4

4 No one in the same name lived at the household ever 16 3.4 39.0

Total 41 8.6 100



Figure 2.2: Summary of the Non-availability of Red Cardholder Households

28. It is found that out of 41 red cardholder households 17 returned to village home or

involuntarily left the households, 7 left without knowledge of neighbors, 1 was forced to move out to elsewhere and 16 red cardholders were not only absent but none in the same names lived in those

households is of serious concerns. The respective PA NGOs through routine verification and updating

these households could be taken out from the registers and new beneficiary households included and provided with red cards. Absence of routine verification and updating of red cards by the PA NGOs

has resulted into significant numbers of invalid red cards.

29. The PPM&E team assessed the status of active red cards of the 25 partnership areas and

grouped them into three groups such as: two prime city corporations like Dhaka South City Corporation and Dhaka North City Corporation, eight other major city corporations, and the four

municipalities. It is found that the active red cards as percentage of total red cards issued by all the PA NGOs of the partnership areas under the three groups of city corporations and municipalities vary

particularly in the municipalities compared to the city corporations. The active red cards as percentage of total red cards issued is the highest (95.26%) in the two city corporations of Dhaka

South and North followed by the municipalities (92.11%) and the eight other city corporations

(87.08%).

30. All 19 red card holders were found available at their addresses in four partnership areas of Dhaka South City Corporations and 17 red card holders were found in one partnership area, DSCC

PA-5, PSTC. All 19 red card holders were found available at their addresses in three partnership areas

of Dhaka North City Corporations and 16 red card holders were found in one partnership area, DNCC PA-4, KMSS and 15 red card holders were found in partnership area, DNCC PA-3, UTPS. Details are at

tables 2.3.

7

171

16

Residents left the household but none know their whereabouts

Residents left the households and went back to their home in the villages

Households were demolished while demolishing the slum

No one in the same name lived at the household ever



0

10

20

30

40

50

60

70

80

90

100

Fou

nd

at

add

ress

%

DSCC PA-1 DSCC PA-2 DSCC PA-3 DSCC PA-4 DSCC PA-5

DNCC PA – 1 DNCC PA – 2 DNCC PA – 3 DNCC PA – 4 DNCC PA – 5

Table 2.3: Status of Active Red Cards in Dhaka City Corporations (South and North)

City Corporation (s) Municipality(ies)

PA NGO(s) Partnership Area (s)

Availability of Red Card Holder Households at Address

Sample per PA NGO

Householders Present


1 Dhaka South City Corporation PSTC DSCC PA-1 19 19 95

KMSS DSCC PA-2 19 19 95

BAPSA DSCC PA-3 19 19 95

PSTC DSCC PA-4 19 19 95

PSTC DSCC PA-5 19 17 95

2 Dhaka North City Corporation Nari Maitree DNCC PA – 1 19 19 95

Nari Maitree DNCC PA – 2 19 19 95

UTPS DNCC PA – 3 19 15 90

KMSS DNCC PA – 4 19 16 95

DAM DNCC PA – 5 19 19 95

Total 190 181 94.5 Source: Red Card Verification and Updating 2017 Survey of PPM&E Firm

Figure 2.3: Status of Active Red Cards in Dhaka City Corporations (South and North)

31. All 19 red card holders were found available at their addresses in four partnership areas of

Khulna City Corporations, Sylhet City Corporations and Barisal City Corporations. Eighteen red card

holders were found in one partnership area of Rajshahi City Corporation, RCC PA-1, RIC and Narayanganj City Corporation, NaCC PA-1, PSKP & PPS; 17 red card holders were found in one

partnership area of Rajshahi City Corporation, RCC PA-2, PSTC; 15 red card holders were found in partnership area of Rangpur City Corporation, DNCC PA-1, KMSS; 14 red card holders were found in

partnership area, Rangpur City Corporation, RaCC PA-1, KMSS; 13 red card holders were found in partnership area of Comilla City Corporation, CCC PA-1, DAM; and 11 red card holders were found in

partnership area of Gazipur City Corporation, GaCC PA-2, PSKP & PPS. Details are at tables 2.4.



0

10

20

30

40

50

60

70

80

90

100

Fou

nd

at

add

ress

%

RCC PA – 1 RCC PA – 2 KCC PA – 1 KCC PA - 2 SCC PA - 1 BCC PA - 1

CoCC PA - 1 NaCC PA - 1 RaCC PA - 1 GaCC PA - 1 GaCC PA - 2

Table 2.4: Status of Active Red Cardholder Households in Other City Corporations

City Corporations/ Municipality (ies) PA NGO(s)

Partnership Area (s)


Sample per PA NGO

Householders Present


1 Rajshahi City Corporation RIC RCC PA – 1 19 18 95

PSTC RCC PA – 2 19 17 95

2 Khulna City Corporation KMSS KCC PA – 1 19 19 95

KCC PA - 2 19 19 95

3 Sylhet City Corporation Shimantik SCC PA - 1 19 19 95

4 Barisal City Corporation Srizony BD BCC PA - 1 19 19 95

5 Comilla City Corporation DAM CoCC PA - 1 19 13 80

5 Narayanganj City Corporation PSKP & PPS NaCC PA - 1 19 19 95

7 Rangpur City Corporation KMSS RaCC PA - 1 19 15 90

8 Gazipur City Corporation PSTC GaCC PA - 1 19 14 85

PSKP & PPS GaCC PA - 2 19 11 70

Total 209 183 90 Source: Red Card Verification and Updating 2017 Survey of PPM&E Firm

Figure 2.4: Status of Active Red Cardholder Households in Other City Corporations

32. All 19 red card holders were found available at their addresses in three partnership area of Gopalganj Municipality, GM PA -1, GM; 18 red card holders were found in partnership area of Kushtia

Municipality, KstM PA-1, Srizony BD; 17 red card holders were found in partnership area of Kishoreganj Municipality, KsM PA-1, Nari Maitree; and 16 red card holders were found in partnership

area of Sirajganj Municipality, SM PA-1, ESDO. Details are at tables 2.5.

Table 2.5: Status of Active of Red Cardholder Households in Municipalities

City Corporation (s) Municipality(ies) (s)

PA NGO(s) Partnership Area (s)


Sample per PA NGO

Households Present


1 Sirajganj Municipality ESDO SM PA – 1 19 16 95

2 Kushtia Municipality Srizony BD KstM PA - 1 19 18 95

3 Kishoreganj Municipality Nari Maitree KsM PA – 1 19 17 95

4 Gopalganj Municipality GM GM PA – 1 19 19 95

Total 76 70 95




0102030405060708090

100

Fou

nd

at

add

ress

%

SM PA - 1 KstM PA - 1 KsM PA - 1 SM PA - 1

Figure 2.5: Status of Active of Red Cardholder Households in Municipalities

33. The analysis indicates that that percentage of active red cards varied among partnership

areas as well as city corporations/ municipalities. Therefore, it is not always true that percentage of

active red cards is dependent only on the performance of PA NGO and it is not also correct to say that it is dependent on only the area of the PA NGO. The percentage of active red cards varies due to both

characteristics of the location as well as the performance of the PA NGO in respect of selection of red card holder households as well as monitoring the red cardholder households at regular intervals.

34. The PPM&E experts in addition to the analysis of active and inactive cards calculated a

relative percenatge of active red cards using relative % assigned to active red card households as %

of 19 sample households. (Table 2.6).

Table 2.6: Relative % Assigned to Active RedcCard Households as % of 19 Sample Households

Number 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

Percentage 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95 95 95 95

32. Out of total 130,065 red card households of the major five city corporations of Dhaka South,

Dhaka North, Narayanganj, Gazipur and Barisal there are about 120,255 active red cardholder households (92%) present at their registered addresses and the remaining 9,810 red cardholder

households (8%) are not available at the registered households. Details are at table 2.7.

Table 2.7: Status of Active Red Cards in the two City Corporations of Dhaka

Major Five City Corporations of Dhaka South, Dhaka North, Narayanganj, Gazipur and Barisal

Major Five City Corporation(s) PA NGO(s) Partnership Area(s)

Number of Red Cardholder Household

Total RC Total Active RC %

1 Dhaka South City Corporation PSTC DSCC PA-1 9,390 8,921 95

KMSS DSCC PA-2 6,939 6,592 95

BAPSA DSCC PA-3 11,167 10,609 95

PSTC DSCC PA-4 7,058 6,705 95

PSTC DSCC PA-5 12,839 12,197 95

2 Dhaka North City Corporation Nari Maitree DNCC PA – 1 9,082 8,628 95

Nari Maitree DNCC PA – 2 9,268 8,805 95

UTPS DNCC PA – 3 11,997 10,797 90

KMSS DNCC PA – 4 13,161 12,503 95

DAM DNCC PA – 5 11,832 11,240 95

3 Narayanganj City Corporation PSKP & PPS NaCC PA - 1 2,742 2,605 95

4 Gazipur City Corporation PSTC GaCC PA - 1 5,866 4,986 85

PSKP & PPS GaCC PA - 2 8,485 5,940 70

5 Barisal City Corporation Srizony BD BCC PA - 1 10,239 9,727 95

A Sub-total-5 City Corporations 14 Partnership Areas 130,065 120,255 92 Source: Red Card Verification and Updating 2017 Survey of PPM&E Firm



0

10

20

30

40

50

60

70

80

90

100To

tal A

ctiv

e R

C %

DSCC PA-1 DSCC PA-2 DSCC PA-3 DSCC PA-4 DSCC PA-5DNCC PA – 1 DNCC PA – 2 DNCC PA – 3 DNCC PA – 4 DNCC PA – 5NaCC PA - 1 GaCC PA - 1 GaCC PA - 2 BCC PA - 1

0

10

20

30

40

50

60

70

80

90

100

Tota

l Act

ive

RC

%

RCC PA – 1 RCC PA – 2 KCC PA – 1 KCC PA – 2 SCC PA – 1 CoCC PA – 1 RaCC PA – 1

Figure 2.6: Status of Active Red Cards in the two City Corporations of Dhaka

Major Five City Corporations of Dhaka South, Dhaka North, Narayanganj, Gazipur and Barisal

35. Out of total 78,502 red cardholder households of the five remaining city corporations (Rajshahi, Khulna, Sylhet, Comilla, Rangpur), there are 72,606 active red cardholder households

(92%) are available at their registered addresses and the rest 5,896 red cardholder households (8%)

are not available at the respective registered addresses meaning that these red cards are not active. Details are at table 2.8.

Table 2.8: Status of Active Red Cards in Other City Corporations

Other Five City Corporations of Rajsahi, Khulna, Sylhet, Comilla, and Rangpur Other Five City Corporation(s) PA NGOs Partnership

Area Number of Red Cardholder Household


1 Rajshahi City Corporation RIC RCC PA – 1 10,646 10,114 95 PSTC RCC PA – 2 15,221 14,460 95

2 Khulna City Corporation KMSS KCC PA – 1 9,012 8,561 95 KMSS KCC PA – 2 7,646 7,264 95

3 Sylhet City Corporation Shimantik SCC PA – 1 16,951 16,103 95

4 Comilla City Corporation DAM CoCC PA – 1 10,195 8,156 80

5 Rangpur City Corporation KMSS RaCC PA – 1 8,831 7,948 90

B Sub-Total-5 City Corporations 7 Partnership Areas 78,502 72,606 92


Figure 2.7: Status of Active Red Cards in Other City Corporations

Other Five City Corporations of Rajsahi, Khulna, Sylhet, Comilla, and Rangpur



0

20

40

60

80

100

Tota

l Act

ive

RC

%

SM PA - 1 KstM PA - 1 KsM PA - 1 GM PA - 1

36. Again, out of 21,674 red cards issued by the PA NGOs in the four municipalities (Sirajganj, Kushtia, Kishoreganj, and Gopalganj), 20,591 (95%) active reds cardholder households are available

in the registered addresses. This elaves 1,083 red cardholder households (5% missing for five different reasons. Details are at Table 2.9.

Table 2.9: Status of Active Red Cards in Four Municipalities Four Municipalities of Sirajganj, Kushtia, Kishoreganj and Gopalganj

Four Municipalities PA NGOs Partnership Area

Number of Red Cardholder Household


1 Sirajganj Municipality ESDO SM PA - 1 7,679 7,295 95 2 Kushtia Municipality Srizony BD KstM PA - 1 6,329 6,013 95 3 Kishoreganj Municipality Nari Maitree KsM PA - 1 4,699 4,464 95 4 Gopalganj Municipality GM GM PA - 1 2,967 2,819 95 C Sub-Total-4 Municipalities 4 Partnership Areas 21,674 20,591 95

Grand Total (A+B+C) 25 Partnership Areas 230,241 213,452 93


Figure 2.8: Status of Active Red Cards in Four Municipalities

Four Municipalities of Sirajganj, Kushtia, Kishoreganj and Gopalganj



CHAPTER III

VERIFICATION OF POVERTY LEVEL OF RED CARDHOLDERS

37. The PPM&E firm has assessed level of poverty of the red card holders. In this assessment,

same sample households identified through Lot Quality Assurance Sampling technique was used. As discussed in earlier, total 475 households were selected from all 25 partnership areas from which 434

red cardholder households were found at their registered addresses. Therefore, socio-economic

information and poverty status of the 434 red cardholder households were analyzed.

38. The enumerators collected specific socioeconomic information of the households through interview of one respondent from each household preferably the head of the household. A unique

structured data collection tool called “Sample Poverty Score Card for Identification of the Ultra Poor and Poor” was used for the household survey (Appendix I). The poverty score card included 19

different indicators with point assigned considering weight and relevance to measurement of ultra

poor and poor socioeconomic status. The poverty score card also provided weight to development index of the city corporations and municipalities. Higher weights were assigned to richer status and

lower weight to poorer status. A total of 34 score was assigned for the 19 indicators.

39. The enumerators obtained the information for each indicator and assigned score as specified

in the particular indicator item of the poverty score card. The data of all 434 red card holder households surveyed were analyzed to find how many households are ultra poor, poor and rich.

Scores thus obtained based on the answers were summed up and arrived at the total score of each surveyed household. The project provides guideline to classify the ultra poor, poor and rich based on

range of scores depending on the development index of the city corporations and municipalities.

Assigned score ranges are at table 3.1.

Table 3.1: Range of Scores Assigned to Different City Corporations/Municipalities

Group(s) City Corporation(s)/Municipalities Partnership

Areas

Sample

Active Red Cardholder

HH

Range of Scores for City

Corporations/Municipalities

Ultra

Poor Poor

Non-

Poor

Group A Dhaka South, Dhaka North, Narayanganj, Gazipur and

Barisal

14 244 0-20 21-30 >30

Group B Rajshahi, Khulna, Sylhet, Rangpur and Comilla

7 120 0-15 16-25 >25

Group C Sirajganj, Kushtia, Kishoreganj

and Gopalganj

4 70 0-10 11-20 >20


40. Based on the guidelines, the ten city corporations and four municipalities are grouped as: (i)

major five city corporations of Dhaka South, Dhaka North, Narayanganj, Gazipur and Barisal in group

A, (ii) other five city corporations of Rajshahi, Khulna, Sylhet, Rangpur and Comilla in group B, and (iii) the four municipalities of Sirajganj, Kushtia, Kishoreganj and Gopalganj in group C. The summary

of the proportion of ultra poor, poor and non-poor red cardholder households of the 25 partner areas of the 10 city corporations and four municipalities grouped in three types are presented at following

table 3.2. The status of poverty score of the red cardholder households of all partnership areas by group of city corporations and municipalities are presented separately at tables 3.3, 3.4, and 3.5.

41. Practically, almost all (427 out of 434) sample red cardholder households surveyed fall under per category (ultra poor – 55.30%, and poor – 43.09% and only seven household – 1.61% non-

poor). It is noted that ultra poor is the highest (63.33%) in the group B other city corporations (Rajshahi, Khulna, Sylhet, Rangpur, and Comilla) and lowest in the four municipalities under group C

(Sirajganj, Kushtia, Kishoreganj, and Gopalganj). Reciprocally, highest numbers of poor red

cardholder households are in group C municipalities (67.14%) and lowest is in group B city



corporations (Rajshahi, Khulna, Sylhet, Rangpur, and Comilla). In the group A, although the numbers of ultra poor and poor red cardholder households are the highest but percentage of ultra poor and

poor are moderate (Table 3.2).

Table 3.2: Summary of the Proportion of Ultra Poor, Poor and Non-poor Red Cardholder Households

Group(s) City Corporation(s)/Municipalities Partnership

Areas

Sample

Active Red

Cardhold

er HH

Percentage Active Red

Cardholder HH

Ultra Poor

Poor Non-Poor

Group A Dhaka South, Dhaka North,

Narayanganj, Gazipur and Barisal

14 244 59.02 40.16 0.82

Group B Rajshahi, Khulna, Sylhet, Rangpur and Comilla

7 120 63.33 35.00 1.67

Group C Sirajganj, Kushtia, Kishoreganj and

Gopalganj

4 70 28.57 67.14 4.29

Aggregate 25 434 55.30 43.09 1.61 Source: Red Card Verification and Updating 2017 Survey of PPM&E Firm

42. In the major five city corporations of group A (City Corporations of Dhaka South, Dhaka North,

Narayanganj, Gazipur and Barisal) there are on average 59.02% ultra poor, 40.16% poor and 0.82% non-poor red cardholder households among the sample 244 households under the five city

corporations (Table 3.3). It is noted that the identification of and selection of eligible beneficiary

households for red card and issuance of red cards to only the ultra poor and the poor have been ensured. It was also noted that red cards were provided to only 2 non-poor households out of 11

households by GaCC Pa-2, PSKP & PPS.

Table 3.3: Poverty Status of Active Red Card Households Major Five City Corporations of Dhaka South, Dhaka North, Narayanganj, Gazipur and Barisal

City Corporation(s) PA NGO(s) Partnership

Area(s) Number of Households

Total HH of Active Red Cards

Ultra Poor

Poor Non-Poor

Poverty Score Range 0-20 21-30 >30

1

Dhaka South City Corporation

PSTC DSCC PA-1 19 9 10 0

KMSS DSCC PA-2 19 8 11 0

BAPSA DSCC PA-3 19 7 12 0



2

Dhaka North City Corporation

Nari Maitree DNCC PA – 1 19 14 5 0

Nari Maitree DNCC PA – 2 19 12 7 0

UTPS DNCC PA – 3 15 6 9 0

KMSS DNCC PA – 4 16 12 4 0

DAM DNCC PA – 5 19 13 6 0

3 Narayanganj City Corporation PSKP & PPS NaCC PA – 1 19 14 5 0

4 Gazipur City Corporation

PSTC GaCC PA – 1 14 10 4 0

PSKP & PPS GaCC PA – 2 11 0 9 2

5 Barisal City Corporation Srzony BD BCC PA – 1 19 19 0 0

A Sub-total-14 City Corporations 244 144 98 2

Percent 100 59.02 40.16 0.82 Source: Red Card Verification and Updating 2017 Survey of PPM&E Firm

43. In the other five city corporations of group B (Rajshahi, Khulna, Sylhet, Rangpur and Comilla)

there are on average 63.33% ultra poor, 35% poor and 1.67% non-poor red cardholder households among the sample 120 sample households of the seven partnership areas under the five city



corporations (Table 3.4). It is noted that the identification of and selection of eligible beneficiary households for red card and issuance of red cards to only the ultra poor and the poor have been

ensured. It was also noted that red cards were provided to only 2 non-poor households out of 120 households. One red card was issued to non-poor households by both SCC PA-1, Shimantik, and

CoCC, PA-1, DAM.

Table 3.4: Poverty Status of Active Red Card Households Other Five City Corporations of Rajsahi, Khulna, Sylhet, Comilla, and Rangpur

City Corporation (s) PA NGO(s) Partnership Area(s)

Number of Households

Total HH of Active Red

Cards

Ultra Poor

Poor Non-Poor

Range of Poverty Score 0-15 16-25 >25

1 Rajshahi City Corporation RIC RCC PA – 1 18 11 7 0

PSTC RCC PA – 2 17 10 7 0

2 Khulna City Corporation KMSS KCC PA – 1 19 12 7 0

KMSS KCC PA – 2 19 10 9 0

3 Sylhet City Corporation Shimantik SCC PA – 1 19 8 10 1

4 Comilla City Corporation DAM CoCC PA – 1 13 10 2 1

5 Rangpur City Corporation KMSS RaCC PA – 1 15 15 0 0

B Sub-Total-7 City Corporations 120 76 42 2

Percentage 100 63.33 35 1.67


44. In the four municipalities of group C (Sirajganj, Kushtia, Kishoreganj and Gopalganj) there are on average 28.57% ultra poor, 67.14% poor and only 4.29% non-poor red cardholder households

among the sample 70 households of the four partnership areas under the four municipalities (Table

3.5). Here, it is noted that the identification of and selection of eligible beneficiary households for red card and issuance of red cards to the ultra poor and the poor have been ensured. It was also noted

that red cards were provided to 3 non-poor households out of 18 households by KstM PA-1, Srizony BD.

Table 3.5: Poverty Status of Active Red Card Households

Four Municipalities of Sirajganj, Kushtia, Kishoreganj and Gopalganj

Municipalities PA NGOs Partnership Area(s)

Number of Households

Total HH of Active Red

Cards

Ultra Poor

Poor Non-Poor

Range of Poverty Score 0-10 11-20 >20

1 Sirajganj Municipality ESDO SM PA – 1 16 16 0 0

2 Kushtia Municipality Srizony BD KstM PA – 1 18 1 14 3

3 Kishoreganj Municipality Nari Maitree KsM PA – 1 17 0 17 0

4 Gopalganj Municipality GM GM PA – 1 19 3 16 0

C Sub-Total-4 Municipalities 70 20 47 3

Percentage 100 28.57 67.14 4.29

Grand Total 434 239 187 7

100 55.30 43.09 1.61


45. The percentage of active red cardholder household fall under ultra poor, poor, and non-poor categories according to the poverty score are presented in the following four diagrams for

comparative reference at figures 3.1 (Summary of all three groups), figure 3.2 (five major city

corporations of group a), figure 3.3 (other five city corporations of group B), and figure 3.4 (four municipalities of group C).



63.33

35

1.67

Ultra Poor Poor Non-Poor

55.3

43.09

1.61


59.02

40.16

0.82


28.57

67.14

4.29


Figure 3.2: Major Five City Corporations of Dhaka South, Dhaka North, Narayanganj,

Gazipur and Barisal

Figure 3.1: Summary of the Proportion of

Ultra Poor, Poor and Non-poor Red Cardholder Households

Figure 3.3: Poverty Status of Active Red Card Households Other Five City Corporations of

Rajsahi, Khulna, Sylhet, Comilla, and

Rangpur

Figure 3.4: Poverty Status of Active Red Card Households Four Municipalities of Sirajganj,

Kushtia, Kishoreganj and Gopalganj



CHAPTER IV

FEEDBACK OF FOCUS GROUP DISCUSSIONS A. Introduction

46. The red card verification and updating survey equally emphasized on and collected qualitative

information through focus group discussion (FGD). The PPM&E team conducted 25 focus group discussions (one in each of the 25 partnership areas). The 25 focus group discussions were

conducted with three different categories of stakeholders of the project. The categories are: (i) ten

focus group discussions with the service recipient red cardholders, (ii) eight focus group discussions with the community including members of WUHCC, UF and Community at large, and (iii) seven focus

group discussions with the service provider health workers of the project/PA NGOs were conducted. Administration of focus group discussions, feedback, and overall outcome are summarized in the

following paragraphs.

B. Focus Group Discussions with the Service Recipient Red Cardholders

47. In all ten focus group

discussions were conducted with beneficiary group who are red

cardholders. Out of the ten focus

group discussions, two were conducted in each of Dhaka South

City Corporation, Dhaka North City Corporation and one in each of

the Rajshahi City Corporation,

Barisal City Corporation, Narayanganj City Corporation, and

Rangpur City Corporation, Gazipur City Corporation; and Sirajganj

Municipality. In the ten focus

group discussions 118 red card holder service recipient participants participated including 117 female and 1 male participants

(Appendix V).

48. In each focus group discussion follow overarching themes and issues were discussed and feedback of the discussions was recorded.

• Information on red cards

• Health services provided by UPHCSDP

• Cost of services and affordability

• Problems faced in accessing services and suggestions for solving the problems

49. The participants informed that they came to know about the red cards and subsequent free

services include medicine from the field workers of the PA-NGOs through house to house visits and survey. The information was also received from other women of the locality who already possessed

red cards. They also mentioned that they also got information from the “Rainbow Clinics” that poor

people are entitled to get red cards. They knew from the field workers of the PA-NGOs that the poor people were entitled to get red cards that bring them free services including medicines, services of

NVD and C/S. They also got information from other people particularly from the members of the WUHCC/User Forum and local community leaders. The respondents informed that field workers of PA-

NGOs visit the households to identify the poor by filling forms.

50. The respondents mentioned that poor people who have low income that include daily labor,

rikshaw-puller, garments workers, orphans, house-maids, separated women, beggar etc. are the receiver of red cards. The participants opined that there are poor people at the locality who are yet to



receive the red cards. The field workers of the PA-NGO should visit each household, identify the new poor households, and distribute more red cards as needed. The participants generally expressed their

satisfaction for good and cordial attitudes and behaviors of the service providing workers and getting the kind of excellent services in their locality.

51. In response to the query of services rendered by the project, the participants informed that they are aware of the type of services available at CRHCC, PHCC and Satellite Clinic. They also

mentioned that essential health care services such as ANC, PNC, family planning, child health, EPI, adolescent health, NVD, C/S, Ultrasonogram, pathological tests, measurement of weight and blood

pressure (for all particularly the pregnant mothers) are available in the health facilities of the UPHCSDP. It was also mentioned that services are available for male patients too. The field workers

of the PA NGOs also do house to house visits for follow up of cases of ANC, PNC and to identify the

poor people who are eligible in receiving red cards.

52. Most of them expressed that red card holders do not have to pay for services, as they receive all the services free of charges. However, they have to spend for some diagnostic tests and purchase

some medicines from open market which are not available. No extra amount is to be paid for

services/ medicines. People who cannot bear the little cost they usually go to the government hospitals. Cost is very low. People who cannot afford the cost sometimes they are compelled to spend

some money. In that case they have to curtail some family expenditure or take loan from others. Other clinics do not provide services/facilities like urban clinics. The respondents stated that they are

happy with the services of the health service provider as their behavior is cordial and good. It was mentioned that location of clinics are nearer to the locality and workers are always available. Cost of

services in other health facilities is much higher. Poor people receive free services through red cards.

53. The participants mentioned that they faced some problems in accessing services from PA-

NGOs. The problems are: shortage of medicine, lack of specialized doctors, pediatric complications, absence of X-ray machine at CRHCC and Ultrasonography machine at PHCC. For improvement of

services it suggested that awareness of people is to be made about the health issues and health

services. PA-NGO staff may keep constant contact with the poor people and the community leaders. More numbers of red cards are to be distributed to the eligible poor who have not received those. It

was opined that adequate supply of medicine to be available at the service centers. Further, they mentioned to include dental and eye care services in future; and also to arrange the evening clinic.

C. Focus Group Discussions with WUHCC, UF and Community People

54. Eight focus group discussions were conducted with the community people comprising of WUHCC, UF and community leader, social workers etc. Out of the eight focus group discussions, two

were conducted in each of Dhaka South City Corporation and Dhaka North City Corporation, the remaining four focus group discussions were conducted one each in Khulna City Corporation, Gazipur

City Corporation, Kishoreganj Municipality and Gopalganj Municipality. In the eight focus group

discussion, 84 participants comprising 76 females and 8 males participated (Appendix V).

55. The focus group discussions with the community discussed the following qualitative aspects of the primary health care services delivery so that the opinion and suggestions of the local level

community people can be obtained for future improvements of the service delivery.

▪ Committee meetings

▪ Issuance of red cards ▪ Health services for the poor and satisfaction of recipients

▪ Cost of services and affordability ▪ Problems faced in accessing services and suggestions for solving the problems

56. The participants informed that quarterly meetings of the committees of Ward Urban Health Coordination Committee (WUHCC) and Users’ Forum (UF) are regularly held and almost all members

attend. The minutes of the meetings are recorded and preserved in the respective PHCC/Urban office. Red card distribution always remains in the list of agenda of the meetings. Red card distribution



issues are discussed at the meeting. Opinions were taken from the committee members during household survey and the committee members sometimes accompanied the PA-NGO personnel to

identify the eligible households.

57. Almost all participants of the focus group discussions mentioned that the poor people of the

area are adequately aware about the criteria and requirements for getting red card. The ultra poor and poor people of the area also know that red card brings primary health care services including the

medicines free of cost after getting it for the household. The participants added that they are aware of 30% poor people are eligible to receive red cards. Few participants believe that small number of

ultra poor and poor people may not receive red cards as they are not aware of red card and related facilities. Almost half of the participants expressed that, they know the number of red card holders in

their locality. In other places they stated that they know that many of the poor households in their

locality have received red cards, but do not have any idea about the number. They could not mention the possible reasons for not knowing the actual number. Participants in all the FGDs stated that

outreach workers during their visits to households discuss the red card issues with the community people and local leaders. They mentioned that the workers discuss on red cards during their house

visits.

58. The participants of the focus group discussions mentioned that household survey was

conducted by the PA-NGOs to identify the poor. Some FGD participants mentioned that they know from the quarterly meetings of the WUHCC/UF. In addition to the household survey, the issue on

distribution of red card was discussed in the quarterly meeting of WUHCC/UF. It was mentioned that they knew from their neighbourers and field workers of the PA-NGOs on distribution of red cards in

their locality.

59. It was found from the discussions that almost all participants were found to know that

UPHCSDP provide primary health care services free of cost to the ultra poor and poor including medicine against red cards. Majority of the participants stated that health service receivers are happy

with the services of the health service providers. Almost all of them mentioned that health services

for the poor in their locality are highly satisfactory as services at reduced cost for others, good behavior of the service providers, easy access to the service providers, primary health care facilities

are at their door step, service providers regularly visit the potential beneficiary households, and services are of good quality.

60. Almost all participants of the focus group discussions commonly termed the primary health care services delivered by the project cheap and affordable for all and free to the ultra poor and poor

and there is no additional cost as much. They also admitted that the kind of services delivery is new and there are no other sources and agencies that provide similar services in the urban areas. The

respondents opined that facilities are good compared to many big clinics. The project clinics take much care of the patients. Field workers provide counseling in increasing health awareness through

campaign and house visits, court yard meeting (Uthan Baithak). Campaigns are done for diagnostic

tests (blood and urine etc.), health education on prevention of diseases, immunization, family planning and others. The participants also appreciated that if there had been no UPHCSDP services in

the area, the people especially the ultra poor and poor might not get these types of health services.

61. The participants of all the FGDs stated that health service users are happy with the services

of the health service providers. The reasons mentioned by them were; free treatment and free medicines for the red card holders and services at reduced cost for others. Other organizations do not

provide such services. Besides, cordial behavior of the service providers was also mentioned. Only reasons for dissatisfaction mentioned was non availability of some prescribed medicines in the

centers.

62. The participants highlighted the problems faced by the urban poor in getting services from

Govt. or private service providers, which were due to: (i) monetary problem, as they do not know where free medical services are available; (ii) poor people do not get good behavior from the Govt.

Hospitals; (iii) Doctor’s fee is very high in the private clinics/chambers; (iv) several tests are given, which the poor cannot afford due to high cost. Almost half of the participants mentioned problems in



the context of UPHCSDP, which include (i) Inadequate supply of medicines; (ii) non availability of Ultrasonograph machine at the PHCC (iii) patients have to go to other clinics/centers for some

diagnostic tests.

63. The respondents expressed some suggestions for further improvement that include more

supply of medicine, full time availability of doctors, increasing number of red card holders, launch publicity in different forms to attract local community to receive services from the CRHCC/PHCC,

increase in staff at the clinics and provide more training giving emphasis on communication with the beneficiaries. Besides, FGD participants in one PA-NGO suggested improving quality of services.

D. Focus Group Discussion and Feedback from Health Service Providers

64. Seven focus group discussions were conducted with service providing health workers of the PA NGOs. Out of the seven FGD sessions, two were administered in Dhaka South City Corporation

and Dhaka North City Corporation, one each in the Rajshahi City Corporation, Khulna City Corporation, Sylhet City Corporation; Comilla City Corporation and Kushtia Municipality. In the seven

focus group discussions, 81 participants including 67 females and 14 males participated (Appendix

V).

65. In each of the focus group discussions of the service providing health works, the following important themes and issues were discussed in detail and feedback recorded.

▪ Coordination with other health service providers

▪ Behavior and attitude of other service providers

▪ Strengths and weakness of the service providers ▪ Suggestions for improving responsiveness of other service providers

66. The participants of the focus group discussion in general stated that PA-NGOs have

coordination or networking with other health service providing organizations in the respective areas.

Few participants mentioned that they have coordination and networking with BRAC, Marie Stopes, Government Hospitals, Medical College Hospitals for referring the critical patients to them and

personal communication was also maintained. It was mentioned that some PA NGOs extended financial helps to poor mothers after delivery.

67. The participants mentioned that services at low cost; medicines are at subsidized price for general patients; free of cost for NVD and C/S services for red card holders; cost of laboratory tests

are 50% less compared to other clinics; regular communication with ANC and PNC mothers by the field workers; and doctors are available in CRHCC for 24 hours which other NGOs or agencies do not

provide.

68. Majority of the respondents mentioned that provision for counseling is there in most of the

other health service giving agencies. They do not give sufficient time to patients and usually refer cases to specialized (government) hospitals. Almost half of the participants stated that they have

heard from the people that behavior of other service providers are not generally good, they have to wait for long in receiving services. FGD participants of two PA-NGOs mentioned that the behavior and

attitude of other service providers towards the urban poor is more or less good. Most of the

participants mentioned that urban poor are not fully satisfied with the services received from other service providers, as they are not given due importance, many diagnostic tests are given before

treatment, which incurs big amount of money. No system for free consultation and treatment. Charges for services are high, long waiting time and medicines are mostly not available.

69. The participants in general expressed satisfaction with services provided by PA-NGOs. They

stated that the service providing staff built up relationship with the beneficiaries through field level

motivation and acquaintance with the patients over longer periods and visits. The participants in general mentioned that the service providers are caring enough to the ultra poor and poor especially

the red cardholders.



70. In the focus group discussion, the participating service providers mentioned that increasing the urban poor service receivers are becoming more and more demanding. Few beneficiaries compare

the services received from the project with other similar service providers particularly BRAC and other NGOs/service agencies. Fewer participants mentioned that often the project facilities prescribe

number of tests and investigations outside that are expensive and beyond their capacity. In all focus

group discussions, the participants in general stated that they refer cases mostly to the nearest government hospitals or medical college hospitals as needed by the patient.

E. Overall Suggestions for Improvements

71. The participants identified few strengths of the project such as: (i) free health services to the

poor urban people (red card holders) and services at subsidized cost for others, (ii) provide diagnostic

services, medicine supply at low cost, (iii) availability of Ambulance service at the CRHCC, (free for red card holders), and (iv) availability of Ambulance service at the CRHCC, (v) good infrastructure and

skilled manpower, (vi) providing health education at community level, and (vii) services provided to specific location on specific dates.

72. The participants also identified fewer weaknesses of the project such as: (i) rented building in some places, (ii) inadequate field staff compared to areas of operation, (iii) inadequate supply of

medicine, (iv) not enough training for the staff: less opportunity for field staff, training mostly to the technical staff and high drop out amongst new staff, (v) difficult to get experienced doctors with low

salary, and (vi) referred cases are to travel long distance from PHCCs to CRHCCs.

73. The health service providing participants in general expressed their satisfaction with the

services provided by the PA-NGOs particularly the provision of free health services including medicines to the poor through red cards. The participants suggested that in order to making the

services more effective, there should be facilities such as X-ray, Ultrasonography at each PHCC level, normal delivery services at PHCC, improved and better services, and sufficient medicines. They also

suggested to provide services to the clients cordially, decreasing amount of fees and charges for

treatment to general patients and also providing appropriate counseling.



CHAPTER V

RECOMMENDATIONS AND CONCLUSIONS 74. Based on the findings of household survey for red card verification and updating the following

recommendations and conclusions have been made.

A. Recommendations

75. The red cards need updating at regular intervals as number of active cards in keeping

minimum numbers of absentee red cards due to migration and other socioeconomic reasons in urban areas particularly in the slums. The PA NGOs must update the list of red cards on quarterly basis.

76. Future planning for the facilities and providing support services may be based on updated list

of red card. The staff of PA-NGO should take the help of various committees to verify and update the

red cardholder households.

77. Names of red cardholders should be recorded in the red card register immediately after issuing the red cards and delivery of the cards should be ensured through acknowledgement by the

beneficiary.

78. Migration and change of addresses are to be monitored regularly and this monitoring can be

done with the help of neighbors and local elites/committee members. At the time of issuance of red card, the card holders should be advised to surrender the red card to the PHCC before leaving the

slum and changing the address.

B. Conclusions

79. The project is reaching to the urban poor and providing services free of cost. The project is

also reaching the non poor and providing them with primary health care services on payment at lower costs than the market prices of services and drugs. The community at large prefers receiving health care

services from the UPHCSDP compared to other providers providing same types of services as the cost of

services are affordable to the community close to their residences. At least 8.84% sample red card holders are not available at the address which indicated that the updating is not updated in case of some

PA NGOs. It is important to note that the percentage of absentees red card holder households has reduced from 24% found in Red Card Verification 2016 to 8.84 in Red Card Verification 2017. This is a

positive sign of the value of updating red cards at regular intervals. Therefore, red cards should be verified and updated through issuing new cards to the deserving poor households and canceling inactive

cards.



Appendix I



Appendix II

FGD with WPHCCC, UF and Community People

Red Card Verification and Updating

1. Name of Partner NGO:.......................................................................................................

2. PA number:.......................................................................................................................

3. Address of PHCC- 1:.................................................................. Ward No:........................

4. Date of interview or FGD:..................................................................................................

5. Total time of discussion: Start:................................. End:..................................

6. Place of FGD......................................................................................................................

7. Whether quarterly meetings of the committee held regularly? Have any minutes of those

meetings? Where it is kept?

KwgwUi wgwUs wbqwgZ ˆÎgvwmK AbywôZ nq wK?

wmØvননন mg~n wjwLZ Av‡Q wK?

_vK‡j †Kv_vq?

8. Do you take any decision regarding Red Card distribution?

†iW KvW© weZib msµvননন ‡Kvb wmØvননন wb‡q‡Qb wK?

9. Whether poor people were aware that they were entitled to get red cards and consequently free services with medicines.

`wi ª̀ RbMY wK Zv‡ì jvj KvW© cvIqvi K_v Ges GKB mv‡_ webv g~‡j¨ Jla cvIqvi K_v Rv‡bb? 10. Whether they knew or were aware of anybody in their community or in their neighbourhood

having red cards?

Zviv wK Rv‡bb Zv‡ì GjvKvq A_ev cvk¦©eZ©x GjvKvq Kviv jvj KvW© †c‡q‡Qb?

11. Did they have any idea about how many poor households received red cards in their

locality/neighbourhood? If they did not know what would be the possible reasons for this? Did the outreach workers during their visits to households discuss about this issue?

Zv‡ì wK †Kvb aviYv Av‡Q Zv‡ì cvovq/ cÖwZ‡ekx‡ì g‡a¨ KZ¸‡jv evwo jvj KvW© †c‡q‡Q? hw` Zviv †R‡b bv _v‡Kb Zvi m¤¢ve¨ KviY¸‡jv wK? AvDUwiP Kg©xiv evwo cwi`k©‡bi mgq GB welqwU wb‡q wK Av‡jvPbv K‡ib?

12. How/do they know about the distribution of red cards in their locality/neighbourhood?

Whether anybody visited them to take information regarding the poor.

Zviv ‡Kgb K‡i Rv‡bb cvovq/cÖwZ‡ekx GjvKvq Kv‡ì‡K jvj KvW© weZiY Kivi K_v? `wi`ª‡ì m¤ú‡K© Rvbvi Rb¨ Zv‡ì Kv‡Q wK †KD G‡mwQ‡jb?

13. If in your area poor people did not receive any red cards then could you suggest how these

cards can be distributed among the poor?

hw` Avcbv‡ì cvovq Mixeiv †Kvb jvj KvW© bv †c‡q _v‡Kb, Zvn‡j Avcbv‡ì g‡Z wKfv‡e `wi ª̀‡ì g‡a¨ jvj KvW© weZiY Kiv DwPZ?



14. What is your opinion about health services for the poor in your locality/neighbourhood from UPHCSDP/NGO Partners? Do you have any suggestions on how health care services of the

poor can be effectively done?

Avcbv‡ì cvovq/cvk¦©eZx© GjvKvq Avievb cÖvBgvwi †nj&_ †Kqvi cÖ‡R±/GbwRI cvU©bv‡ii `wi`ª‡ì ¯^v¯’¨ †mev m¤ú‡K© Avcbvi wK gZvgZ? G e¨vcv‡i Avcbv‡ì wK †Kvb cÖ¯—ve Av‡Q? wKfv‡e `wi`ª‡ì Rb¨ ¯̂v¯’¨ †mev Av‡iv Kvh©Kvix Kiv m¤¢e?

15. What types of community awareness programmes regarding the health services and centres

provided by UPHCSDP (PHCC/Static Clinic, CRHCC, Satellite Clinic, mini clinic [outreach

centre]) and others) exist for men, women, children, adolescents and elderly people?

cyi“l, gwnjv, wkï, wK‡kvi-wK‡kvix Ges eq¯‹‡ì Avievb cÖvBgvwi †nj&_ †Kqvi cÖ‡R‡±i ¯^v¯’¨ ‡mev I †mev cÖ`vbKvix ms¯’vi (wcGBPwmwm/÷¨vwUK wK¬wbK, wmAviGBPwmwm, m¨v‡UjvBU wK¬wbK, wgwb wK¬wbK, [AvDUwiP †m›Uvi]) Ges Ab¨vb¨‡ì e¨vcv‡i m‡PZbZv KwgDwbwU‡Z we`¨gvb Av‡Q wK?

i. PHCC

ii. CRHCC

iii. Satellite clinic

iv. Mini clinic

v. Others

16. What types of community awareness programmes exist for providing special emphasis on urban poor by UPHCSDP / NGOs Partners and other organizations

Avievb cÖvBgvwi †nj&_ †Kqvi cÖ‡R± cvU©bvi GbwRI Ges Ab¨vb¨ ms¯’v †_‡K Mixe‡ì R‡b¨ †h we‡kl †mev cÖ`vb Kiv nq †m m¤ú‡K© KwgDwbwU‡Z wK ai‡Yi m‡PZbZv cÖPwjZ Av‡Q?

17. Are the health service users happy with the services of health service providers? If yes, why?

If not, why not?

¯^v¯’¨ †mev MÖnYKvixiv wK ¯^v¯’¨ †mev cÖ`vbKvix‡ì †mevq mš‘ó? DËi nüv n‡j- †Kb? DËi bv n‡j - †Kb bq? Gi eY©bv Ki“b|

18. How much do they spend on services (doctor’s fees, laboratory tests, medicines, transport

cost, for non-service providers etc...)?

Zviv †mev cvIqvi Rb¨ wK ai‡Yi LiP K‡i _v‡Kb? (†hgb: Wv³v‡ii wdm, j¨ve‡iUwi †U÷ Gi LiP, Jla, hvZvqvZ, ‡mev cÖ`vbKvix bb A_P †mev cvIqvi Rb¨ Zv‡ì‡K †`qv BZ¨vw`)|

i. Doctor’s fees

ii. Laboratory tests

iii. Medicines

iv. Transport cost

19. Can they afford the cost of these services? If not, what do they do? What type of support do

they receive for different services from UPHCSDP/NGO partners and other organisations in

their area? Do they get the same type of support from all these organizations?

†mev †bevi Rb¨ GB ai‡Yi LiP Zviv wK enb Ki‡Z cv‡ib? hw` bv cv‡ib Zvn‡j wK K‡ib? wb‡R‡ì GjvKvq wewfbœ ai‡Yi †mev cvIqvi Rb¨ Avievb cÖvBgvwi †nj&_ †Kqvi cÖ‡R± / GbwRI cvU©bv‡iiv Ges Ab¨vb¨ ms¯’v †_‡K Zviv wK ai‡Yi mn‡hvwMZv ‡c‡q _v‡Kb? Zviv wK GB mKj ms¯’v †_‡K GKB ai‡Yi mn‡hvwMZv †c‡q _v‡Kb?



20. What is their level of satisfaction? Please explain the variation of satisfaction level of different organisations.

Zviv †mev †c‡q KZUyKz mš‘ó Zv wKfv‡e †evSv hvq? wewfbœ ms¯’vi †mev cÖ`v‡bi e¨vcv‡i Zv‡ì mš‘wói e¨vcviwU eywS‡q ejyb|

21. What kinds of problems do the urban poor face when getting health services? Please mention

and prioritise the problems.

kn‡ii `wi`ª RbMY Zv‡ì ¯^v¯’¨ †mev cvIqvi mgq wK ai‡Yi Amyweavi m¤§yLxb n‡q _v‡Kb? mgm¨vi AMÖMY¨Zvbyhvqx D‡jL Ki“b|

22. How can the problems be solved? What are their suggestions based on experience?

GB mgm¨v¸‡jvi mgvavb wKfv‡e Kiv m¤¢e? Zv‡ì AwfÁZvi wfwË‡Z G wel‡q Zv‡ì cÖ¯—ve wK n‡e?

¯^v¶vrKvi MÖnYKvixi bvg t DËi`vZvi bvg t

¯^v¶vrKvi MÖnYKvixi ¯^v¶i t DËi`vZvi ¯^v¶i t



FGD with Red Card Holders Beneficiary Group


Schedule No. .

1. Name of PA:......................................................................................................................

2. PA number:........................................................................................................................

3. Address of the Slum :...................................................................Ward No:........................

4. Date of FGD:......................................................................................................................

5. Total time of discussion: Start:........................................... End:...................................

6. Place of FGD: ....................................................................................................................

7. How poor people were aware that they were entitled to get red cards and consequently free services with medicines.

`wi ª̀ RbMY wKfv‡e Zv‡ì jvj KvW© cvIqvi K_v Ges GKB mv‡_ webv g~‡j¨ Jla cvIqvi K_v Rv‡bb ? 8. Whether they knew or were aware of anybody in their community or in their neighbourhood

having red cards?

Zviv wK Rv‡bb Zv‡ì GjvKvq A_ev cvk¦©eZ©x GjvKvq Kviv jvj KvW© †c‡q‡Qb?

9. How they know about the distribution of red cards in their locality/neighbourhood? Whether

anybody visited them to take information regarding the poor.

Zviv ‡Kgb K‡i Rv‡bb cvovq/cÖwZ‡ekx GjvKvq Kv‡ì‡K jvj KvW© weZiY Kivi K_v? `wi`ª‡ì m¤ú‡K© Rvbvi Rb¨ Zv‡ì Kv‡Q wK †KD G‡mwQ‡jb?

10. If in your area poor people did not receive any red cards then could you suggest how these

cards can be distributed among the poor?

hw` Avcbv‡ì cvovq Mixeiv †Kvb jvj KvW© bv †c‡q _v‡Kb, Zvn‡j Avcbv‡ì g‡Z wKfv‡e `wi ª̀‡ì g‡a¨ jvj KvW© weZiY Kiv DwPZ?

11. What is your opinion about health services for the poor in your locality/neighbourhood from UPHCSDP/NGO Partners? Do you have any suggestions on how health care services of the

poor can be effectively done?

Avcbv‡ì cvovq/cvk¦©eZx© GjvKvq Avievb cÖvBgvwi †nj&_ †Kqvi cÖ‡R±/GbwRI cvU©bv‡ii `wi`ª‡ì ¯^v¯’¨ †mev m¤ú‡K© Avcbvi wK gZvgZ? G e¨vcv‡i Avcbv‡ì wK †Kvb cÖ¯—ve Av‡Q ? wKfv‡e `wi`ª‡ì Rb¨ ¯̂v¯’¨ †mev Av‡iv Kvh©Kvix Kiv m¤¢e?

12. What types of community awareness programmes regarding the health services and centres

provided by UPHCSDP (PHCC/static clinic, CRHCC, Satellite clinic, mini clinic [outreach

centre]) and others exist for men, women, children, adolescents and elderly people?

cyi“l, gwnjv, wkï, wK‡kvi-wK‡kvix Ges eq¯‹‡ì Avievb cÖvBgvwi †nj&_ †Kqvi cÖ‡R‡±i ¯^v¯’¨ †mev I †mev cÖ`vbKvix ms¯’vi (wcGBPwmwm/÷¨vwUK wK¬wbK, wmAviGBPwmwm, m¨v‡UjvBU wK¬wbK, wgwb wK¬wbK, [AvDUwiP †m›Uvi]) Ges Ab¨vb¨‡ì e¨vcv‡i m‡PZbZv KwgDwbwU‡Z we`¨gvb Av‡Q wK?

i. PHCC

ii. CRHCC

iii. Satellite clinic

iv. Mini clinic?



13. Are the health service users happy with the services of health service providers? If yes, why? If not, why not?

¯^v¯’¨ †mev MÖnYKvixiv wK ¯^v¯’¨ †mev cÖ`vbKvix‡ì †mevq mš‘ó? DËi nüv n‡j- †Kb? DËi bv n‡j - †Kb bq? Gi eY©bv Ki“b|

14. How much do they spend on services (doctor’s fees, laboratory tests, medicines, transport

cost, for non-service providers etc...)?

Zviv †mev cvIqvi Rb¨ wK ai‡Yi LiP K‡i _v‡Kb? (†hgb: Wv³v‡ii wdm, j¨ve‡iUwi †U÷ Gi LiP, Jla, hvZvqvZ, †mev cÖ`vbKvix bb A_P †mev cvIqvi Rb¨ Zv‡ì‡K †`qv BZ¨vw`)|

I. Doctor’s fees

II. Laboratory tests

III. Medicines

IV. Transport cost

15. Can they afford the cost of these services? If not, what do they do? What type of support do they receive for different services from UPHCSDP/NGO partners and other organisations in

their area? Do they get the same type of support from all these organizations?

†mev †bevi Rb¨ GB ai‡Yi LiP Zviv wK enb Ki‡Z cv‡ib? hw` bv cv‡ib Zvn‡j wK K‡ib? wb‡R‡ì GjvKvq wewfbœ ai‡Yi †mev cvIqvi Rb¨ Avievb cÖvBgvwi †nj&_ †Kqvi cÖ‡R±/GbwRI cvU©bv‡iiv Ges Ab¨vb¨ ms¯’v †_‡K Zviv wK ai‡Yi mn‡hvwMZv ‡c‡q _v‡Kb? Zviv wK GB mKj ms¯’v †_‡K GKB ai‡Yi mn‡hvwMZv †c‡q _v‡Kb?

16. Do they get all the medicine as prescribed free from clinics? If not how they get rest of themedicines?

‡cÖw¯‹cm‡bi mKj Jla Zviv wK wK¬wbK n‡Z cvq ? bv †c‡j Aewkó Jla wK fv‡e msMÖn K‡i ?

17. What kinds of problems do the urban poor face when getting health services? Please

mention and prioritise the problems.

kn‡ii `wi`ª RbMY Zv‡ì ¯^v¯’¨ †mev cvIqvi mgq wK ai‡Yi Amyweavi m¤§yLxb n‡q _v‡Kb? mgm¨vi AMÖMY¨Zvbyhvqx D‡jL Ki“b|

18. How can the problems be solved? What are their suggestions based on experience?

GB mgm¨v¸‡jvi mgvavb wKfv‡e Kiv m¤¢e? Zv‡ì AwfÁZvi wfwË‡Z G wel‡q Zv‡ì cÖ¯—ve wK n‡e?

¯^v¶vrKvi MÖnYKvixi bvg t DËi`vZvi bvg t




FGD with Service Providers/Health Worker


Schedule No.

1. Name of Partner NGO:........................................................................................................

2. PA number: ......................................................................................................................

3. Name and Address of the CRHCC:........................................................... Ward No:............

4. Date of interview:...............................................................................................................

5. Total time of discussion: Start:................................. End:..................................

6. Do the service providers of UPHCSDP/Partner NGO providers have coordination or networking with other health service providing organizations (GOVT., NGO and private organizations)?

Ab¨vb¨ †mev cÖ`vbKvix ms¯’v (miKvwi, †emiKvwi I e¨w³MZ) Gi mv‡_ Avievb cÖvBgvwi †nj&_ †Kqvi cÖ‡R±/GbwRI cvU©bv‡ii †mev cÖ`vbKvix‡ì mv‡_ †hvMv‡hvM ev †bUIqvwK©s Av‡Q wK?

7. Is there any difference between the nature of services provided by the UPHCSDP/

Partner NGO and the others service providing organizations. If yes, why? Please explain elaborately.

Avievb cÖvBgvwi †nj&_ †Kqvi cÖ‡R±/GbwRI cvU©bvi Ges Ab¨vb¨ †mev cÖ`vbKvix ms¯’vi †mevi ai‡Yi g‡a¨ ‡Kvb Zdvr Av‡Q wK? hw` Zdvr †_‡K _v‡K, Z‡e ‡Kb Zv we¯ÍvwiZ eywS‡q ejyb|

8. Do other service providers counsel properly? Do they give sufficient time to patients? Do they

take immediate actions on what the patients require?

Ab¨vb¨ †mev cÖ`vbKvixMY wK wVKgZ KvD‡Ýwjs K‡ib? Zviv wK †ivMx‡ì h‡_ó mgq w`‡q _v‡Kb? Zvr¶wYKfv‡e †ivMxi wPwKrmvi †¶‡Î †Kvb iKg Ri“wi c`‡¶c wb‡Z n‡j Zviv wK wb‡q _v‡Kb?

9. How is the behaviour and attitude of other service providers of different organizations

towards the urban poor?

kn‡ii `wi`ª RbM‡Yi cÖwZ Ab¨vb¨ ms ’̄vi †mev cÖ`vbKvix‡ì eënvi Ges AvPiY †Kgb?

10. Are the urban poor happy with the service received from other service providers? If yes,

why? If not, why not?

kn‡ii `wi`ª RbMY wK Ab¨vb¨ †mev cÖ`vbKvixi ‡mevq mš‘ó? hw` mš‘ó n‡q _v‡Kb, Zvn‡j †Kb? Ges bv n‡q _vK‡j †Kb bq?

11. Do service providers of UPHCSDP/Partner NGO refer cases to other service providers?

Avievb cÖvBgvwi †nj&_ †Kqvi cÖ‡R±/GbwRI cvU©bv‡ii †mev cÖ`vbKvixiv †ivMx‡ì wPwKrmvi Rb¨ Ab¨ ms¯’vq †idvi K‡ib wK? hw` K‡i _v‡Kb Zvn‡j †Kb?

12. What are the strengths and weaknesses of service providers of UPHCSDP/Partner NGO for

taking a responsive role in the community?

KwgDwbwU‡Z Avievb cÖvBgvwi †nj&_ †Kqvi cÖ‡R±/GbwRI cvU©bv‡ii †mev cÖ`vbKvix‡ì g‡a¨ `vwqZ¡kxjZvi mv‡_ KvR Kivi Rb¨ mej Ges `ye©j w`K¸wj wK wK?



i. Strength

……………………………………………………..……………………………………………………………………………..

……………………………………………………..……………………………………………………………………………..

……………………………………………………..……………………………………………………………………………..

ii. Weakness

……………………………………………………..……………………………………………………………………………..

……………………………………………………..……………………………………………………………………………..

……………………………………………………..……………………………………………………………………………..

13. What do the respondents (other service providers) suggest for improving the

responsiveness of other service providers in the community of the urban poor?

kn‡ii Mixe KwgDwbwU‡Z Ab¨vb¨ †mev cÖ`vbKvixi g‡a¨ `vwqZ¡kxjZvi KvR DbœZ Kivi Rb¨ DËi`vZv wK wK cÖ¯—ve iv‡Lb? ¯^v¶vrKvi MÖnYKvixi bvg t DËi`vZvi bvg t




Appendix III

Lot Quality Assurance Sampling (LQAS) Technique Lot Quality Assurance Sampling (LQAS) is a method that has been used globally to monitor health

indicators. It is used to make decisions about whether or not catchment areas are meeting targets or

benchmarks. It is based on the statistical principle that a sample size of 19 provides an acceptable

level of error for making management decisions. Additional background material about LQAS is

available from the PMU. An LQAS household survey was conducted to measure two of the project

indicators.

The steps for conducting the LQAS survey to measure these two indicators are as follows (with an

example on the following pages):

1. Mark off sections of the catchment area by block or neighborhood so that the approximate number

of households in the section may be estimated. These sections are called “sampling units”. If the

sampling units do not have names, they may be numbered consecutively.

2. Make a listing of the sampling units in the catchment area with the approximate number of

households in each.

3. Sum the cumulative number of households in the next column of the list.

4. Divide the total number of households by 19. The result is the “sampling interval”.

5. Use a random number generator or website such as www.random.org to choose a random number

between 1 and the total number of households.

6. Locate the first household within the sampling unit that contains the random numbered household.

7. Add the sampling interval to the first household and each subsequent household until 19 are

identified. From this obtain the number of households to be interviewed within each sampling

unit.

8. Administer the Poverty Scorecard in the sampled households.

Signature of Investigator Signature of the Physician of PHCC



LQAS Example

1. Mark off sections of the catchment area by block or neighborhood so that the approximate number

of households in the section may be estimated. These sections are called the “sampling units”.

The sampling units were numbered consecutively.

2. Make a listing of the sampling units in the catchment area with the approximate number of

households in each.

3. Sum the cumulative number of households in the next column of the list.

4. Divide the total number of households by 19. The result is the “sampling interval”.

720/19=37.9 rounded to 38.

Block

Number

Estimated

Number of

Households

Cumulative

Number of

Households

1 120 120

2 80 200

3 80 280

4 80 360

5 100 460

6 60 520

7 100 620

8 100 720

5. Use a random number generator or website such as www.random.org to choose a random number

between 1 and 720 (the total number of households). Random number=548

6. The site of the first interview will be the block where the random number falls in the

cumulative number of households.

1

2

3 4 5

6

7

8



7. To get the site of the second household, add the random number to the sampling interval.

548+38=586.

8. Continue adding the sampling interval to get the site of all 19 selected households. When

the number is over 720, subtract 720 and continue adding the sampling interval.

LQAS # Calculation Household Location

1 Random number 548

2 Random number + sampling interval=548+38=586 586

3 Location 2+sampling interval 624



6

Location 5+sampling interval. 700+38=738; number is

over 720, so subtract 720: 738-720=18 18














9. Block 7 contains household 521 to 620, which includes household 548. This is the first household

location.

10. Block 7 also contains household 586, the second household location.

11. Continue locating all 19 households identified in the table above within the 8 blocks of the

catchment area.

Block

Number

Estimated Number

of Households

Cumulative Number

of Households

Interview Location

Number

Number of Interviews

1 120 120 18, 56, 94 3

2 80 200 132, 170 2

3 80 280 208, 246 2

4 80 360 284, 322, 360 3

5 100 460 398, 436 2

6 60 520 474, 512 2

7 100 620 548, 586 2

8 100 720 624, 662, 700 3

12. Now determining number of households to be interviewed in each block of the catchment area

and selecting sampled households from within the block and administer the Poverty Score Card

Instrument for survey.

Signature of Investigator Signature of the Physician of PHCC



Appendix IV

Summary of the Cause of Absence of Red Cardholder Households

Sl.No. PA Area Location PA NGO Reasons

Slum

demolished

R/C holder left address.

Went to village

R/C holder left address.

Where about is not

known

No one in same name

lived at household

ever

Total

1 DSCC PA 1 Golapbag, Dhaka PSTC - - - - -

2 DSCC PA 2 Bangshal, Dhaka KMSS - - - - -

3 DSCC PA 3 Hazaribag, Dhaka BAPSA - - - - -

4 DSCC PA 4 Mughda, Dhaka PSTC - - - - -

5 DSCC PA 5 South Goran, Dhaka PSTC - 1 1 - 2

6 DNCC, PA-1 Moghbazar, Dhaka Nari Maitree - - - - -

7 DNCC, PA-2 Banshbari, Dhaka Nari Maitree - - - - -

8 DNCC, PA-3 Mirpur, Dhaka UTPS - 1 2 1 4

9 DNCC, PA-4 Pallabi, Dhaka KMSS - 1 - 2 3

10 DNCC, PA-5 Uttara, Dhaka DAM - - - - -

11 RCC, PA-1 Kadirhoni, Rajshahi RIC - 1 - 1 2

12 RCC, PA-2 Naodapara, Rajshahi PSTC - 1 - - 1

13 KCC PA 1 Khalispur, Khulna KMSS - - -

14 KCC PA 2 City Corporation, Khulna

KMSS - - - - -

15 SCC PA 1 Dhopadighir Par, Sylhet

Shimantik - - - - -

16 BCC PA 1 Kawnia Rd. Barisal Srizony - - - - -

17 CoCC PA 1 Chakbazar, Comilla DAM - - -

1 5 6

18 NaCC PA 1 Shahi Mosjid Rd. Bandar

PSKP&PPS - - - - -

19 RaCC PA 1 Rangpur KMSS - 1 - 3 4

20 GaCC PA 1 Joydebpur, Gazipur PSTC - 2 1 2 5

21 GaCC PA 2 Tongi, Gazipur PSKP&PPS 1 5 1 1 8

22 SM PA 1 Sirajganj ESDO - 2 - 1 3

23 KstM PA 1 SN Rd. Kustia Srizony - - 1 - 1

24 KsM PA 1 Narasundha, Kishoreganj

Nari Maitree - 2 -

- 2

25 GM PA 1 Gopalganj Gopalganj Municipality.

- - - - -

Total 1 17 7 16 41

1. R/C holder left address. Went to village: 17 (3.6%)

2. No one in the same name lived at the address ever: 16 (3.4%)

3. R/C holder left address. Where about is not known: 7 (1.4%)

4. Slum demolished: 1 (0.2%)



Appendix V

Participants of the 25 Focus Group Discussions 1. FGD with Beneficiaries

Beneficiaries group for FGD session

Name of NGO Name of Person

Female Male Total

1 DSCC, PSTC, PA-01 13 0 13

2 DSCC, BAPSA, PA-03 12 0 12

3 DNCC, Nari Maitree, PA-01 12 0 12

4 DNCC, KMSS, PA-04 12 0 12

5 RCC, PSTC, PA-02 10 0 10

6 BCC, Srizony B, PA-01 12 0 12

7 NaCC, PSKP&PPS, PA-01 12 0 12

8 RaCC, KMSS, PA-01 13 0 13

9 GaCC, PSKP&PPS, PA-02 1 9 1 10

10 SM, ESDO, PA-01 12 0 12

Total Person 117 1 118

2. FGD with Community

WPHCCC, UF and Community people for FGD session


Female Male Total

1 DSCC, PSTC, PA-04 14 14

2 DSCC, PSTC, PA-05 12 0 12

3 DNCC, UTPS, PA-03 6 1 7

4 DNCC, DAM, PA-05 10 0 10

5 KCC, KMSS, PA-02 7 4 11

6 GaCC, PSTC, PA-01 8 1 9

7 KsM, Nari Maitree, PA-01 7 2 9

8 GM, GM, PA-01 12 0 12


3. FGD with Service Providers

Service providers/Health workers for FGD session


Female Male Total

1 DSCC, KMSS, PA-02 11 1 12

2 DNCC, Nari Maitree, PA-02 8 3 11

3 RCC, RIC, PA-01 9 3 12

4 KCC, KMSS, PA-01 12 0 12

5 SCC, Shimantik, PA-01 10 0 10

6 CoCC, DAM, PA-01 8 4 12

7 KstM, Srizony B, PA-01 9 3 12


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