2026年10月29日（木曜）午前11時00分～午前12時15分

ジェトロ・アジア経済研究所　C23会議室

Background & Objectives

Poverty and poor health are deeply intertwined, especially in developing countries. In Bangladesh, about 14.3% of people still live in extreme poverty and households spend more than 74% of their healthcare costs out of pocket. This heavy burden often drives families back into poverty, with women disproportionately affected. To address this cycle, Sajida Foundation started a program named UTTARAN in 2022, which combined livelihood and healthcare support for 11,000 of the poorest households across six districts. The poor households received partial grants and/or interest-free loans, enterprise training, savings schemes, along with primary care consultations, preventive health services, and subsidized healthcare.

Methods

A three-arm Cluster Randomized Controlled Trial (CRCT) across 90 villages (28% baseline poverty rate) compared livelihood-only, livelihood + health, and control groups, enrolling 1,100 households per arm using the Poverty Probability Index.

Results

The results suggest that providing static clinics and health financing support can help economically disadvantaged households avoid income loss during health-related crises, even if such interventions do not directly increase income levels. Both intervention arms showed improved dietary diversity, though persistent food insecurity highlights the influence of external market and seasonal constraints beyond program control. Importantly, the livelihood + health arm significantly increased awareness of hypertension and diabetes risk factors, while the livelihood-only arm improved adherence to hypertension medication. However, these gains in knowledge and medication use did not translate into broader changes in health-seeking behavior, indicating the need for structural and behavioral interventions to ensure health awareness leads to sustained action.

Conclusion & Implications

The UTTARAN program demonstrated that livelihood interventions alone can substantially reduce poverty, while integrating health components increases income diversity and health risk awareness. However, improvements in awareness did not necessarily translate into behavioral changes or food security gains, indicating that knowledge alone is insufficient to drive systemic health outcomes. Future programs should develop complementary strategies, such as addressing structural barriers to healthcare access and approaches that transform health awareness into lasting behavioral change, aligning economic gains with better health outcomes.

Sajeda Amin 氏（Sajida Foundation）

牧野 百恵