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

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 2016

Annual Red Card Verification and Updating 2016

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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 2016’, 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 2015 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 372 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 surveyed from

the 25 partnership areas and addresses of all 475 sample households of red card holders are found

correct. It is also found that there are red card holders in 362 surveyed households and in the

remaining 113 households (24%) there are different discrepancies about the red card holders and

issuance of red cards.

7. Among the 113 red card holder households, card holders of 37 households (7.9%) left

addresses and their whereabouts are not known, 25 red card holders (5.3%) left the addresses and

gone back to their villages, 11 card holders (2.3%) are not available due to demolition of their slums,

28 red cardholders (6.0%) though listed in the register, but did not receive red card yet, and 12 red

card holders (2.5%) 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.

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

red card holders for quite some time since issuing the cards. If there had been periodic verification


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of the red cards and updated the registers the discrepancies could have been totally avoided.

Because, those who have left through voluntarliy and involuntary migration (15.5%) could be

replaced by new red cards to eligible beneficiaries, 6.0% reds could have been delivered soon after

the cards were issued, and the 2.5% cards had been issued to wrong persons could be recitified.

Survey findings suggest that one out of every four cards are not actively used.

9. During the survey, 362 households having been found to live at their registered address of

which 59.12% are ultra poor, 40.60% are poor, and 0.28% non-poor.

10. The beneficiaries participated in the focus group discussions opined that they were informed

of the project services particularly about the free health care services including medicines for the poor

through issuing red cards. The participants reported that field workers of PA-NGOs visit households to

identify the poor and fill up forms. They also expressed satisfaction with the services provided

especially the free health care services through red card. Fewer participants reported that they spent

money for some tests and medicines that are not available in the centers. Few participants reported

that they incurred cost for travel to reach the centers located far away from their home. In general,

the participants reported shortage of medicines, lack of specialized doctors, pediatric complications,

lack of X-ray and ultrasonogram facilities.

11. Feedback of the focus group discussions of service providers indicate that PA-NGOs had

personal communication and coordination and network with other health service providing

organizations including Bangladesh Rural Advancement Committee (BRAC), Marie Stopes,

Government Hospitals, and Medical College Hospitals for referring the critical patients. The

participants listed several strengths of the project such as: free services to the poor, services at

reduced cost to others, diagnostic services and medicine supply at lower cost, ambulatory services

(free for red card holders), and counseling services. They mentioned some weaknesses such as:

health facility in rented building, inadequate number of red cards, insufficient supply of medicine,

inadequate number of field staff compared to area of operation, and insufficient training for service

providing staff.

12. The community leaders reported in their focus group discussion that outreach workers

discussed with them and the people on red card explaining the eligibility criteria for getting a red card

and the provision of free services and medicines. The community leaders also informed that health

service users are happy with the services and also the service providers. They suggested to increasing

supply of medicines and number of red card, extensive publicity of the project facilities and services

in different forms to attract local people to the project health services.

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

NGOs on a routine basis and annual stock taking. 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. All concerned including the UPHCSDP and the respective PA NGOs should

appreciate the high rate of urban migration and the issue is addressed through regular verification

and updating to ensure that the total number of only the active red cards be at least 30% of all

services provided. Timely verification and updating of red cards increase the number of active cards

and the scope of maximizing the use of the project health facilities and services.


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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 12-15

Chapter IV Feedback of Focus Group Discussions 16-20

A. Introduction 16

B. Focus Group Discussions with Service Recipient Red Cardholders 16

C. Focus Group Discussions and feedback from Health Service Providers 17

D. Feedback of Community (WUHCC, UF and Community People 18

E. Overall Suggestions and Improvements 19

Chapter V Recommendations and Conclusions 21

A. Recommendations 21

B. Conclusions 21

Appendixes:

Appendix I Simple Poverty Score Card for Identificat ion of the Ultra Poor and Poor 21

Appendix II Checklists for Administration of Focus Group Discussions 23

Appendix III Lot Quality Assurance Sampling (LQAS) Technique 30

Appendix IV Summary of Causes of Absence of Red Cardholder Households 34

Appendix V Participants of the 25 Focus Group Discussions 35


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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 Clinic

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

presented in Appendix II. The household survey was conducted in sample households for obtaining

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

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



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 described below.

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 2015 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 1.1.

Table 1.1: 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, seven focus group

discussions with service providers, and eight focus group discussions of the community 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 372 participants (321 male and 51 female) 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 2015 were 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 362 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 in 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)

Status of Availability of Red Card Holder Households at Addresses

Sample Target in

Partnership Area

Red Card Households

Found at Addresses

% Found

at address

1 DSCC PA-1 PSTC Dhaka South City Corporation 19 10 52.63

2 DSCC PA-2 KMSS Dhaka South City Corporation 19 15 78.75

3 DSCC PA-3 BAPSA Dhaka South City Corporation 19 13 68.42



6 DNCC PA – 1 Nari Maitree Dhaka North City Corporation 19 15 78.75

7 DNCC PA – 2 Nari Maitree Dhaka North City Corporation 19 17 89.47

8 DNCC PA – 3 UTPS Dhaka North City Corporation 19 14 73.68

9 DNCC PA – 4 KMSS Dhaka North City Corporation 19 11 57.89

10 DNCC PA – 5 DAM Dhaka North City Corporation 19 14 73.68

11 RCC PA – 1 RIC Rajshahi City Corporation 19 17 89.47

12 RCC PA – 2 PSTC Rajshahi City Corporation 19 18 94.74

13 KCC PA – 1 KMSS Khulna City Corporation 19 17 89.47

14 KCC PA - 2 KMSS Khulna City Corporation 19 14 73.68

15 SCC PA - 1 Shimantik Sylhet City Corporation 19 18 94.74

16 BCC PA - 1 Srizony BD Barisal City Corporation 19 17 89.47

17 CoCC PA - 1 DAM Comilla City Corporation 19 10 52.63

18 NaCC PA - 1 PSKP & PPS Narayanganj City Corporation 19 13 68.42

19 RaCC PA - 1 KMSS Rangpur City Corporation 19 4 21.05

20 GaCC PA - 1 PSTC Gazipur City Corporation 19 12 63.16

21 GaCC PA - 2 PSKP & PPS Gazipur City Corporation 19 13 68.42

22 SM PA - 1 ESDO Sirajganj Municipality 19 11 57.89

23 KstM PA - 1 Srzony BD Kushtia Municipality 19 18 94.74

24 KsM PA - 1 Nari Maitree Kishoreganj Municipality 19 19 100.00

25 GM PA - 1 GM Gopalganj Municipality 19 17 89.47

Total 475 362 76.21

Average 14.48 76.21

23. From the analysis of the data it has found that 362 red cardholder households are found at

their registered addresses out of 475 sample red cardholder households (76.21%, Say 76%)

indicating that the remaining 113 (24%) red cardholder households are not found at their registered

addresses. In other words, for every 19 red cardholder households, only 14.48 red cardholder

households are present at their registered addresses and 4.52 red cardholder households are not

found out at their registered addresses.



24. The information manifests a considerable weakness in the management of red card system as

one out of every four 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

25. 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.

26. The survey noted five reasons of not finding the 113 red cardholder households at the

registered addresses. These are: (i) residents left the household but none know their whereabouts

(37 households), (ii) residents left the households and went back home in their villages (25

households), (iii) residents were compelled to leave the household as their households were

demolished while demolishing the slum (11 households), (iv) residents are present at the registered

addresses but they said that they have not received their red cards yet (28 households), and (v) no

one in the same name lived at the household ever. 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 113

Absentee HH

1 Residents left the household but none know their

whereabouts

37 7.79 32.75

2 Residents left the households and went back to their

home in the villages

25 5.26 22.12

3 Residents were compelled to leave their households

as their households were demolished while

demolishing the slum by land owners

11 2.31 9.73

4 Residents are present at the addresses but they did

not receive their red cards yet

28 5.89 24.78

5 No one in the same name lived at the household ever 12 2.53 10.62

Total 113 23.78 100.00



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

27. It is understood that out of 113 red cardholder households 28 red cardholder households are

present at the registered addresses but they did not receive their red cards even though their name

appeared in the red card registers. This may be due to delay in the process of delivery of the cards by

the respective PA NGO or their mistakes. The matter needs detailed investigation to see that the

cards are delivered immediately and such incidents never happen in the future if cards were really

issued. In case such cards were not issued then the question of any eventual abuse of the red card

facility needs to be looked into in greater details. The information that 12 red cardholders were not

only absent but none in the same names lived in those households is of more serious concerns. If this

is fact, then there must be some mistakes somewhere or it is a doubtful case needing in-depth

investigations and the cause of absence or non-existence to be unearthed.

28. Leaving these 40 red card holder households (28 present but did not receive cards and 12

had never been there), there are 73 red card holder households who were either voluntarily (25

returned to village home) or involuntarily left the households (37 left without knowledge of neighbors

and 11 were forced to move out to elsewhere). 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 (85.53%) in the municipalities followed by the two

city corporations of Dhaka South and North (75.79%) and the eight other city corporations (73.20%).

Details are at tables 2.3, table 2.4 and table 2.5.



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)

Status of Availability of Red Card Holder Households at Address

Sample

Target in Partnership

Area

Red Card

Holders Found at

Address

% Found

at address

1 Dhaka South City Corporation PSTC DSCC PA-1 19 10 52.63

KMSS DSCC PA-2 19 15 78.75

BAPSA DSCC PA-3 19 13 68.42

PSTC DSCC PA-4 19 18 94.74

PSTC DSCC PA-5 19 17 89.47

2 Dhaka North City Corporation Nari Maitree DNCC PA – 1 19 15 78.75

Nari Maitree DNCC PA – 2 19 17 89.47

UTPS DNCC PA – 3 19 14 73.68

KMSS DNCC PA – 4 19 11 57.89

DAM DNCC PA – 5 19 14 73.68

Total 190 144 75.79

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

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

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

Area (s)

Status of Availability of Red Card Holder

Households at Address

Sample Target in Partnership

Area

Red Card Holders Found

at Address

% Found at address

1 Rajshahi City Corporation RIC RCC PA – 1 19 17 89.47

RCC PA – 2 19 18 94.74

2 Khulna City Corporation KMSS KCC PA – 1 19 17 89.47

KCC PA - 2 19 14 73.68

3 Sylhet City Corporation Shimantik SCC PA - 1 19 18 94.74

4 Barisal City Corporation Srizony BD BCC PA - 1 19 17 89.47

5 Comilla City Corporation DAM CoCC PA - 1 19 10 52.63

5 Narayanganj City Corporation PSKP & PPS NaCC PA - 1 19 13 68.42

7 Rangpur City Corporation KMSS RaCC PA - 1 19 4 21.05

8 Gazipur City Corporation PSTC GaCC PA - 1 19 12 63.16

PSKP & PPS GaCC PA - 2 19 13 68.42

Total 209 153 73.20



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

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

City Corporation (s)

Municipality(ies) (s)

PA NGO(s) Partnership

Area (s)

Status of Availability of Red Card Holder

Households at Address

Sample Target in Partnership

Area

Red Card Holders Found

at Address

% Found at

address

1 Sirajganj Municipality ESDO SM PA – 1 19 11 57.89

2 Kushtia Municipality Srizony BD KstM PA - 1 19 18 94.74

3 Kishoreganj Municipality Nari Maitree KsM PA – 1 19 19 100.00

4 Gopalganj Municipality GM SM PA – 1 19 17 89.47

Total 76 65 85.53

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

30. 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.

31. 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 139,877 red card households of the major five city corporations of Dhaka South,

Dhaka North, Narayanganj, Gazipur and Barisal there are about 117,303 active red cardholder

households (83.86%) present at their registered addresses and the remaining 22,574 red cardholder

households (16.14%) 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, Narayangong, 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 13,796 8,967 65.00

KMSS DSCC PA-2 6,962 6,267 90.00

BAPSA DSCC PA-3 11,107 8,886 80.00

PSTC DSCC PA-4 7,691 7,306 95.00

PSTC DSCC PA-5 12,686 12,052 95.00

2 Dhaka North City Corporation Nari Maitree DNCC PA – 1 9,580 8,622 90.00

Nari Maitree DNCC PA – 2 10,100 9,595 95.00

UTPS DNCC PA – 3 11,827 10,053 85.00

KMSS DNCC PA – 4 14,841 10,389 70.00

DAM DNCC PA – 5 16,865 14,335 85.00

3 Narayanganj City Corporation PSKP & PPS NaCC PA - 1 2,020 1,616 80.00

4 Gazipur City Corporation PSTC GaCC PA - 1 4,351 3,263 75.00

PSKP & PPS GaCC PA - 2 7,982 6,386 80.00

5 Barisal City Corporation Srizony BD BCC PA - 1 10,069 9,566 95.00

A Sub-total-5 City Corporations 14 Partnership Areas 139,877 117,303 83.86

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

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

33. Out of total 79,830 red cardholder households of the five remaining city corporations

(Rajshahi, Khulna, Sylhet, Comilla, Rangpur), there are 66,730 active red cardholder households

(83.59%) are available at their registered addresses and the rest 13,100 red cardholder households

(16.41%) 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

Total RC Total Active RC % 1 Rajshahi City Corporation RIC RCC PA – 1 9,22,9 8,768 95.00

PSTC RCC PA – 2 15,221 14,460 95.00

2 Khulna City Corporation KMSS KCC PA – 1 9,012 8,561 95.00 KMSS KCC PA – 2 8,205 6,974 85.00

3 Sylhet City Corporation Shimantik SCC PA – 1 18,459 17,536 95.00 4 Comilla City Corporation DAM CoCC PA – 1 11,782 7,658 65.00

5 Rangpur City Corporation KMSS RaCC PA – 1 7922 2,773 35.00 B Sub-Total-5 City Corporations 7 Partnership Areas 79,830 66,730 83.59

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


34. Again, out of 21,669 red cards issued by the PA NGOs in the four municipalities (Sirajganj,

Kushtia, Kishoregonj, and Gopalgonj), 18,614 (85.90%) active reds cardholder households are

available in the registered addresses. This elaves 3,055 red cardholder households (14.10% 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 Total RC Total Active RC %

1 Sirajganj Municipality ESDO SM PA - 1 7,888 5,522 70.00 2 Kushtia Municipality Srizony BD KstM PA - 1 5,962 5,664 95.00

3 Kishoreganj Municipality Nari Maitree KsM PA - 1 4,867 4,624 95.00 4 Gopalganj Municipality GM GM PA - 1 2,952 2,804 95.00

C Sub-Total-4 Municipalities 4 Partnership Areas 21,669 18,614 85.90

Grand Total (A+B+C) 25 Partnership Areas 241,376 202,647 83.95

Figure 2.8: Status of Active Red Cards in Four Municipalities




CHAPTER III

VERIFICATION OF POVERTY LEVEL OF RED CARDHOLDERS

35. 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 362

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

information and poverty status of the 362 red cardholder households was analyzed.

36. 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 100 score was assigned for the 19 indicators.

37. 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 362 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 Number of

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

14 199 0-20 21-30 >30

Group B Rajshahi, Khulna, Sylhet, Rangpur

and Comilla

7 98 0-15 16-25 >25

Group C Sirajaonj, Kushtia, Kishoreganj

and Gopalganj

4 65 0-10 11-20 >20

38. 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.

39. Practically, all (361 out of 362) sample red cardholder households surveyed fall under ultra

poor (59.12%) and poor (40.60%) category and only one household (0.28%) is non-poor. It is noted

that ultra poor is the highest 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 (75.38%) 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

Cardholder

HH

Percentage Active Red

Cardholder HH

Ultra

Poor

Poor Non-

Poor

Group A Dhaka South, Dhaka North,

Narayanganj, Gazipur and Barisal

14 199 63.82 36.18 0.00

Group B Rajshahi, Khulna, Sylhet, Rangpur

and Comilla

7 98 73.47 26.53 0.00

Group C Sirajganj, Kushtia, Kishoreganj

and Gopalganj

4 65 23.08 75.38 1.54

Aggregate 25 362 59.12 40.60 0.28

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

Narayangonj, Gazipur and Barisal) there are on average 59.80% ultra poor, 40.20% poor and no

non-poor red cardholder households among the sample 199 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.

Table 3.3: Poverty Status of Active Red Card Households

Major Five City Corporations of Dhaka South, Dhaka North, Narayangang, 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 10 2 8 0 KMSS DSCC PA-2 15 10 5 0

BAPSA DSCC PA-3 13 7 6 0 PSTC DSCC PA-4 18 15 3 0 PSTC DSCC PA-5 17 10 7 0

2 Dhaka North City Corporation Nari Maitree DNCC PA – 1 15 5 10 0 Nari Maitree DNCC PA – 2 17 9 8 0

UTPS DNCC PA – 3 14 2 12 0 KMSS DNCC PA – 4 11 11 0 0

DAM DNCC PA – 5 14 5 9 0 3 Narayanganj City Corporation PSKP & PPS NaCC PA – 1 13 10 3 0

4 Gazipur City Corporation PSTC GaCC PA – 1 12 11 1 0 PSKP & PPS GaCC PA – 2 13 5 8 0

5 Barisal City Corporation Srizony BD BCC PA – 1 17 17 0 0 A Sub-total-14 City Corporations 199 119 80 0

Percent 100 59.80 40.20 0.00

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

there are on average 72.45% ultra poor, 27.55% poor and no non-poor red cardholder households

among the sample 98 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. However, absentee red cardholder households are the lowest as 14.03% of 114 red

cardholder households of the seven partnership areas of the five city corporations could not be found

at their registered addresses.





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 17 11 6 0 PSTC RCC PA – 2 18 17 1 0

2 Khulna City Corporation KMSS KCC PA – 1 17 13 4 0 KMSS KCC PA – 2 14 8 6 0

3 Sylhet City Corporation Shimantik SCC PA – 1 18 13 5 0 4 Comilla City Corporation DAM CoCC PA – 1 10 5 5 0 5 Rangpur City Corporation KMSS RaCC PA – 1 4 4 0 0

B Sub-Total-7 City Corporations 98 71 27 0 Percentage 100.00 72.45 27.55 0.00

42. In the four municipalities of group C (Sirajganj, Kushtia, Kishoreganj and Gopalganj) there

are on average 21.54% ultra poor, 76.92% poor and only less two percent point non-poor red

cardholder households among the sample 65 households of the four partnership areas under the four

municipalities (Table 3.5). Here also it 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. However, absentee red cardholder households are as low as 14.47% of 76 sample red

cardholder households of the four partnership areas of the four city corporations could not be found

at their registered addresses.



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 11 7 4 0 2 Kushtia Municipality Srizony BD KstM PA – 1 18 1 17 0

3 Kishoreganj Municipality Nari Maitree KsM PA – 1 19 4 15 0 4 Gopalganj Municipality GM GM PA – 1 17 2 14 1

C Sub-Total-4 Municipalities 65 14 50 1 Percentage 100.00 21.54 76.92 1.54

Grand Total 362 204 157 1 100.00 56.35 43.37 0.28

43. 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).



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

RedCard 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

44. 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) seven focus group discussions

with the service provider health workers of the project/PA NGOs, and (iii) eight focus group

discussions with the community including members of WUHCC, UF and Community at large 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

45. In all ten focus group discussions

were conducted with beneficiary group

who are red cardholders. Out of the ten

focus group discussions, three were

conducted in Dhaka North City

Corporations, and one in each of the

Dhaka South City Corporation, Rajshahi

City Corporation, Khulna City Corporation,

Sylhet City Corporation, and Comilla City

Corporation; and Kushtia Municipality and

Kishoreganj Municipality. In the ten focus

group discussions 153 red card holder

service recipient participants participated

including 16 male and 137 female participants (Appendix V).

46. 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

47. The participants informed that they came to know about the red cards and free services

including medicine from the field workers of the PA-NGOs and other women of the locality who

already possessed 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. They also got

information from others people particularly the community leaders of the locality. Field workers of

PA-NGOs visit the households to identify the poor by filling forms. The participants suggested that the

field workers of the PA-NGO should visit each household, identify the new poor households, and

distribute more and 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.

48. The participants expressed 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

abundance in the health facilities of the UPHCSDP.



49. Majority of the participants expressed that red card holders need not to prove their eligibility

every time after getting the red card and go getting health services including medicines for all

members of the household. The participants are overly happy for the generous health care services at

their doorstep. Fewer participants indicated that they had to spend money to have some tests done

and medicines purchased from outside as such tests and medicines are not available in the project

facilities. The participants also discussed and appreciated that the non-red card holders are also

provided with the same services on payment of Tk.40.00 as doctors’ fees per visit, charges of

laboratory tests at prescribed rate (lower than market rates), medicine at 10% discount. In one focus

group discussion, few red card holders reported that 50% charges are taken for laboratory test and

also normal and caesarian deliveries (PA-01, RIC, Rajpara, Rajshahi). Fewer participants informed

that they were not able to pay the cost and sometimes they were compelled to spend money for the

health care services including medicines before getting the red card. In one focus group discussion,

few participants mentioned that essential medicines were not available in the facilities particularly the

costly items.

50. 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 and Ultrasonography machine at PHCC. In one focus group discussion, few

participants stated that they did not get any importance in the PHCC and had to go to the CRHCC for

three days for a single ultrasonogram. In general, several red cardholders expressed that in most of

the cases they did not get the services of Ambulance and red cardholders were also charged 50% of

the actual charge (PA-01, RIC, Rajpara, Rajshahi). The participants in general stated that people

should be made aware enough on health services and the staff of the PA-NGO should keep constant

contact with the people particularly the ultra poor and poor especially the women and children.

C. Focus Group Discussion and Feedback from Health Service Providers

51. 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 the Dhaka South City Corporation

and one in each of the Dhaka North City Corporation, Rajshahi City Corporation, Khulna City

Corporation, Gazipur City Corporation; and Gopalganj Municipality. In the seven focus group

discussions, 107 participants including seven male and 100 females participated (Appendix V).

52. 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

53. 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 effectively, there should be facilities such as X-ray, Ultrasonography and VIA test at each

PHCC level, normal delivery services at PHCC, improved and better services, and sufficient medicines.

54. 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.

55. The participants mentioned that doctors are available in CRHCC for 24 hours, red cardholders

receive free services including medicine, services are provided to the poor free of cost including

medicines, other patients get 10% discount on the cost of medicines, fully fledged operation theatres

are available in the health facilities, special discount is allowed to general poor patients which other

NGOs or agencies do not provide.



56. Few participants of the focus group discussion stated that provision for counseling are there

in most of the health service providing agencies, but the counselors do not give sufficient time to the

clients. The participants however appreciated that UPHCSDP has counseling room and full-time

counselor for counseling. There may be some exceptional cases.

57. The participants in general expressed satisfaction with attitudes and behavior of the doctors

and service providing technical staff of 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. Few participants mentioned that attitude and behavior of limited

number of service providers was not good enough as expected towards the ultra poor and poor. The

participants in general mentioned that the service providers are caring enough to the ultra poor and

poor especially the red cardholders.

58. 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.

D. Feedback of Community (WUHCC, UF and Community People)

59. 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 Dhaka South City Corporation and the remaining six focus group discussions were

conducted one each in Dhaka North City Corporation, Barisal City Corporation, Rajshahi City

Corporation, Narayanganj City Corporation, Gazipur City Corporation, and Sirajganj Municipality. In

the eight focus group discussion, 112 participants comprising 28 males and 84 females participated

(Appendix V).

60. 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

61. 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. Red card

distribution always remains in the list of agenda of the meetings.

62. 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. 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. According to them, red cardholders of the locality are more or less known to the

participants but actual number of red cardholders of the area was known to only few of them and

many of them do not know. They could not mention the possible reasons for not knowing the actual

number of red cards issued and distributed in the locality. Participants in all the focus group

discussions with the community mentioned that outreach workers discuss the red card issues with the

people and community leaders during their visits to households.



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

conducted by the respective PA-NGOs to identify the ultra poor and poor households in their

partnership area. In addition to the household survey, the issue on distribution of red card was

discussed in the quarterly meeting of WUHCC/UF. They knew from their neighbors and field workers

of the PA-NGOs about distribution of red cards in their locality.

64. Almost all participants of the eight focus group discussions 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. Participants of all the focus group discussions stated that health service

receivers are happy with the services of the health service providers. They identified the reasons of

satisfaction as: free treatment with medicines for the red cardholders, 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. The participants in general mentioned one reason for

some dissatisfaction on non-availability of all medicines they need in the centers.

65. Numbers of important and useful suggestions came out from the right focus group

discussions. The suggestions are: increasing supply of medicine, increasing number of red

cardholders, increased publicity in different forms and media to attract local community to receive

services from the project facilities, and increasing manpower in the health centers and providing them

necessary trainings.

66. 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

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. Few participants

mentioned that not only the poor many non-poor are also unable to bear the expenses of caesarean

section delivery in even in the government hospitals let alone the private clinic.

67. The participants of the eight focus group discussions emphasized on several problems the

urban poor face in getting services from government and private service providers. These problems

include: (i) financial constraints, (ii) lack of access to and proper attention and services by the poor

from public hospitals, (iii) high consultation fees of doctors in private clinics, (iv) inability to pay for

too many important or less important tests suggested by doctors, insufficient supply of medicines and

non availability of Ultrasonography machine in the PHCC. The participants suggested to increasing the

number of red cardholders, providing Ultrasonography and x-Ray machine at the PHCC, and supply of

sufficient medicines.

E. Overall Suggestions for Improvements

68. The participants identified few strengths of the project such as: (i) provision of free health

care services including medicines to the poor urban people through red card and service at a reduces

cost to others, (ii) diagnostic services and medicine supply at low cost, (iii) availability of ambulatory

service at the CRHCC (free for red card holders), and (iv) standard counseling services.

69. The participants also identified fewer weaknesses of the project such as: (i) all facilities are

not in suitable buildings own by the project, (ii) inadequate numbers of red cards than needed, (iii)

insufficient supply of medicines, inadequate number of field staff compared to area of operation, and

(iv) lack of training for the service providing staff working in the health facilities.

70. The participants in order to further improving the urban primary health care services,

suggested to remove the identified weaknesses of the project and fully utilizing the project strengths

and opportunities. In addition, they suggested for strengthening behavioral change communication

and marketing, service delivery with more commitment in cordial manner, and reducing fee rates and

cost of medicines and service charges.



CHAPTER V

RECOMMENDATIONS AND CONCLUSIONS

71. Based on the findings of household survey for red card verification and updating the following

recommendations and conclusions has been made.

A. Recommendations

72. The red cards need updating at regular intervals as number of active cards continues to

reduce due to migration and other socioeconomic reasons in urban areas particularly in the slums. The

PA NGOs should update the list of red cards quarterly.

73. 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.

74. Names of red cardholders should be recorded in the red card register only after issuing the

red cards and delivery of the cards acknowledged by the beneficiary.

75. 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 of slum

and changing the address.

B. Conclusions

76. 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 number of red card distributed to the poor

households are less than the numbers of sample size due to migration of urban poor leaving the slums

and other socio-economic reasons. 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?

wmØvন্ত mg~n wjwLZ Av‡Q wK?

_vK‡j †Kv_vq?

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

†iW KvW© weZib msµvন্ত ‡Kvb wmØvন্ত 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`ª 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`ª‡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`ª 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`ª‡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 ª̀ 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 ª̀ 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 will be 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. Obtain a map of the catchment area for the PA-NGO.

2. Mark off sections of the catchment area by block or neighborhood so that the approximate number of households in the section may be estimated. (We will call these sections the “sampling units”.) If the sampling units do not have names, they may be numbered consecutively on the map.

3. Make a listing of the sampling units in the catchment area with the approximate number of households in each.

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

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

6. 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.

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

8. 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.

9. Select a random starting point within the sampling unit to select households.

10. Administer the Poverty Scorecard. If the household is poor, ask the additional survey questions.

11. Measure indicators in the table below.

Result

F2.1 Percentage of poor households who are properly identified as eligible for free healthcare

F2.1a How many of the households that were identified as poor had a red

card? ___/19

F2.1b Convert the number to a percentage using the table below. ____%

F2.2 Percentage of the poor who access project health services when needed

F2.2a How many of the households that were identified as poor said that

they could access health care when they needed to? ___/19

F2.2b Convert the number to a percentage using the table below. ____%

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

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

Signature of Investigator Signature of the Physician of PHCC



LQAS Example

1. Obtain a map of the catchment area for the PA-NGO.

2. Mark off sections of the catchment area by block or neighborhood so that the approximate number of households in the section may be estimated. (We will call these sections the “sampling units”.) If the sampling units do not have names, they may be numbered consecutively on the map.

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

households in each.

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

5. 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

6. 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

7. 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



8. To get the site of the second household, add the random number to the sampling interval. 548+38=586.

9. 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 4 Location 3+sampling interval 662

5 Location 4+sampling interval 700

6 Location 5+sampling interval. 700+38=738; number is over 720, so subtract 720: 738-720=18

18







19 Location 18+sampling interval 512

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

location.

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

12. 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

13. Now that you have determined how many households will be interviewed in each block of the

catchment area, you need to select households from within the block. Households should be selected randomly, using one of the following methods:

a. If a household listing is available, it can be used to select the specified households identified above.



b. Make a rough map of the households on the block. Number the households and select the households using the numbers in the table above.

c. A location within the block may be selected randomly. For example, number the well-known landmarks in the block and select one randomly. Start with the nearest household to the landmark and then choose every Xth household after that one until the desired number is reached (where X is the sampling interval).

14. Administer the Poverty Scorecard to the selected household. If the household is not poor, go on to the nearest household until a poor household is found.

15. When a poor household is found, administer the additional survey questions to the selected household.

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

Doubt about R/C

holder’s living

In register but. R/C

is not issued.

Total

1 DSCC PA 1 Golapbag, Dhaka PSTC 3 2 3 - 1 9

2 DSCC PA 2 Bangshal, Dhaka KMSS - 1 2 1 - 4 3 DSCC PA 3 Hazaribag, Dhaka BAPSA - 3 3 - - 6 4 DSCC PA 4 Mughda, Dhaka PSTC - 1 - - - 1 5 DSCC PA 5 South Goran, Dhaka PSTC 1 1 - - - 2 6 DNCC, PA-1 Moghbazar, Dhaka Nari Maitree - 1 3 - - 4

7 DNCC, PA-2 Banshbari, Dhaka Nari Maitree - 2 - - - 2 8 DNCC, PA-3 Mirpur, Dhaka UTPS 1 2 2 - - 5 9 DNCC, PA-4 Pallabi, Dhaka KMSS - 1 5 - 2 8

10 DNCC, PA-5 Uttara, Dhaka DAM 4 1 - - - 5 11 RCC, PA-1 Kadirhoni, Rajshahi RIC - - 2 - - 2

12 RCC, PA-2 Naodapara, Rajshahi PSTC - - 1 - - 1 13 KCC PA 1 Khalispur, Khulna KMSS 2 - - 2

14 KCC PA 2 City Corporation, Khulna

KMSS - 3 1 - 1 5

15 SCC PA 1 Dhopadighir Par, Sylhet

Shimantik - - 1 - - 1

16 BCC PA 1 Kawnia Rd. Barisal Srizony - 1, 1 - - 2

17 CoCC PA 1 Chakbazar, Comilla DAM - - -

3 - 6 9

18 NaCC PA 1 Shahi Mosjid Rd. Bandar

PSKP&PPS 1 2 1 2 - 6

19 RaCC PA 1 Rangpur KMSS - - - 5 10 15 20 GaCC PA 1 Joydebpur, Gazipur PSKP&PPS - 1 5 1 - 7

21 GaCC PA 2 Tongi, Gazipur PSKP&PPS - 1 2 3 - 6 22 SM PA 1 Sirajganj ESDO 1 - 1 - 6 8 23 KstM PA 1 SN Rd. Kustia Srizony - - 1 - - 1

24 KsM PA 1 Narasundha, Kishoreganj

Nari Maitree - - -

- - 0

25 GM PA 1 Gopalganj Gopalganj Municipality.

- - - - 2 2

Total 11 25 37 12 28 113

1. Slum demolished=11 (2.3%)

2. R/C holder left address. Went to villag=25 (5%)

3. R/C holder left address. Where about is not known=37 (8%)

4. Doubt about R/C holder’s living=12 (2.5%)

5. In register but. R/C is not issued.=28 (6%)



Appendix V

Participants of the 25 Focus Group Discussions

1. FGD with Beneficiaries

Name of NGO Number of Person

Male Female Total

1 DNCC, UTPS, PA-3 0 17 17

2 DNCC, Nari Maitree, PA-2 0 16 16

3 DNCC, Nari Maitree, PA-1 1 15 16

4 DSCC, PSTC, PA-4 3 12 15

5 KsM, Nari Maitree, PA-1 5 10 15

6 SCC, Shimantic, PA-1 5 10 15

7 CoCC, DAM, PA-1 0 15 15

8 KstM, Srizony Bd. PA-1 2 15 17

9 KCC, KMSS, PA-1 0 12 12

10 RCC, RIC, PA-1 0 15 15

Total Person 16 137 153

2. FGD with Community


Male Female Total

1 DSCC, PSTC, PA-1 1 14 15

2 NaCC, PSKP&PPS, PA-1 5 11 16

3 DSCC, BAPSA, PA-1 1 14 15

4 GaCC, PSKP&PPS, PA-2 5 10 15

5 SM, ESDO, PA-1 4 11 15

6 RaCC, KMSS, PA-1 7 6 13

7 BCC, Srizony Bd. PA-1 4 8 12

8 DNCC, KMSS, PA-4 1 10 11


3. FGD with Service Providers


Male Female Total

1 DSCC, KMSS, PA-2 1 15 16

2 RCC, PSTC, PA-2 1 12 13

3 KCC, KMSS, PA-2 0 18 18

4 DSCC, PSTC, PA-5 0 15 15

5 GaCC, PSTC, PA-1 1 14 15

6 DNCC, DAM, PA-5 1 14 15

7 GM, GM, PA-1 3 12 15


Date post:	25-Oct-2019
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