A multidimensional approach to measure poverty in rural Bangladesh.

Poverty is increasingly being understood as a multidimensional phenomenon. Other than income-consumption, which has been extensively studied in the past, health, education, shelter, and social involvement are among the most important dimensions of poverty. The present study attempts to develop a simple tool to measure poverty in its multidimensionality where it views poverty as an inadequate fulfillment of basic needs, such as food, clothing, shelter, health, education, and social involvement. The scale score ranges between 72 and 24 and is constructed in such a way that the score increases with increasing level of poverty. Using various techniques, the study evaluates the poverty-measurement tool and provides evidence for its reliability and validity by administering it in various areas of rural Bangladesh. The reliability coefficients, such as test-retest coefficient (0.85) and Cronbach's alpha (0.80) of the tool, were satisfactorily high. Based on the socioeconomic status defined by the participatory rural appraisal (PRA) exercise, the level of poverty identified by the scale was 33% in Chakaria, 26% in Matlab, and 32% in other rural areas of the country. The validity of these results was tested against some traditional methods of identifying the poor, and the association of the scores with that of the traditional indicators, such as ownership of land and occupation, asset index (r=0.72), and the wealth ranking obtained from the PRA exercise, was consistent. A statistically significant inverse relationship of the poverty scores with the socioeconomic status was observed in all cases. The scale also allowed the absolute level of poverty to be measured, and in the present study, the highest percentage of absolute poor was found in terms of health (44.2% in Chakaria, 36.4% in Matlab, and 39.1% in other rural areas), followed by social exclusion (35.7% in Chakaria, 28.5% in Matlab, and 22.3% in other rural areas), clothing (6.2% in Chakaria, 8.3% in Matlab, and 20% in other rural areas), education (14.7% in Chakaria, 8% in Matlab, and 16.8% in other rural areas), food (7.8% in Chakaria, 2.9% in Matlab and 3% in other rural areas), and shelter (0.8% in Chakaria, 1.4% in Matlab, and 3.7% in other rural areas). This instrument will also prove itself invaluable in assessing the individual effects of poverty-alleviation programmes or policies on all these different dimensions.

Global Equity Gauge Alliance: reflections on early experiences.

The paper traces the evolution and working of the Global Equity Gauge Alliance (GEGA) and its efforts to promote health equity. GEGA places health equity squarely within a larger framework of social justice, linking findings on socioeconomic and health inequalities with differentials in power, wealth, and prestige in society. The Alliance's 11 country-level partners, called Equity Gauges, share a common action-based vision and framework called the Equity Gauge Strategy. An Equity Gauge seeks to reduce health inequities through three broad spheres of action, referred to as the 'pillars' of the Equity Gauge Strategy, which define a set of interconnected and overlapping actions. Measuring and tracking the inequalities and interpreting their ethical import are pursued through the Assessment and Monitoring pillar. This information provides an evidence base that can be used in strategic ways for influencing policy-makers through actions in the Advocacy pillar and for supporting grassroots groups and civil society through actions in the Community Empowerment pillar. The paper provides examples of strategies for promoting pro-equity policy and social change and reviews experiences and lessons, both in terms of technical success of interventions and in relation to the conceptual development and refinement of the Equity Gauge Strategy and overall direction of the Alliance. To become most effective in furthering health equity at both national and global levels, the Alliance must now reach out to and involve a wider range of organizations, groups, and actors at both national and international levels. Sustainability of this promising experiment depends, in part, on adequate resources but also on the ability to attract and develop talented leadership.

Immunization divide: who do get vaccinated in Bangladesh?

This paper examines inequalities in the use of, and access to, vaccination service in Bangladesh by analyzing national and small area-based datasets. The analysis showed that female children had a lower immunization coverage than male children--the difference persists for all antigens and widens against girls for higher doses. The immunization coverage was higher for children whose mothers were more educated. Children whose fathers had a higher-status occupation (salaried employment) were two-and-a-half times more likely to be immunized than children whose fathers held a lower-status job, e.g. day-labourer. The coverage for the poorest quintile was 70% of the well-to-do. Children residing in urban areas were more likely to be fully immunized than their rural counterparts (70% vs 59% for children aged 12-23 months). Within urban areas, the situation in slums was worse. Large differences existed among the various administrative regions of the country. Ethnic minorities in the Chittagong Hill Tracts had a lower immunization coverage than the Bangalees. In Sylhet, children of non-local workers in Bangladesh-owned tea estates had a lower coverage than their counterparts in foreign-owned tea estates. The study identifies children of various disadvantaged groups as having a lower coverage. Managers of immunization programmes must realize that only through removal of such disparities among groups will overall coverage be increased. Affirmative actions in targeting could be effective in reaching such groups.