Challenges of Ultra Poor in Accessing Education and Public Health Services : A Case of Bangladesh

Social protection through the social safety net programs is one of the key policies through which Bangladesh is battling against long-lasting and intergenerational poverty. However, though the pro-poor social protection programs (i.e., education and health) have been largely successful in improving the economic well-being of poor households, extremely poor households still remain excluded. This study exploits a multistage random sampling data of 1440 extremely poor households from four districts of Bangladesh and a qualitative survey of public service providers, mediating stakeholders, and beneficiaries. Built on a mixed method approach, this study diagnoses the ultra-poor's level of access to public health services and education and identifies a number of important mechanisms through which the poorest are excluded from their entitlements. The study finds that poor people are being excluded from accessing education and public health services due to some institutional and self-exclusionary mechanisms. Self-exclusionary mechanisms for not accessing public health services are misperception about the diseases that influence the health-seeking behavior (visiting a kabiraj rather than a doctor), misconception or fear of taking a vaccine, preferring home-delivery over hospital care, etc. Institutional exclusionary mechanisms are financial constraints, infrastructural constraints, not having a companion, missing income during hospital visits, etc. In accessing education, self-exclusionary mechanisms are myopic attitudes of parents, lack of awareness among parents and students, etc. However, institutional exclusionary mechanisms are financial constraints, corporal punishment, child labor, fear of mathematics and English class, early marriage, spatial constraints, etc. To make public services accessible to everyone, the issues that exclude poor households need to be addressed