Abstract
BackgroundHow and whether health shocks, care-seeking behaviour and coping strategies are interlinked and influence households resilience to ill-health remains an under-researched subject in the context of Bangladesh. This study investigates whether and how health shocks, care-seeking processes and coping strategies interplay and impact the resilience of extremely poor adivasi (ethnic minority) households in the Chittagong Hill Tracts (CHT), Bangladesh.MethodsOur analysis draws from qualitative data collected through a range of methods (see Additional file 1). We conducted 25 in-depth interviews (IDIs) of two adivasi communities targeted by an extreme-poverty alleviation programme, 11 key informant interviews (KIIs) with project personnel (community workers, field officers, project managers), community leaders, and healthcare providers, and 9 focus group discussions (FGDs) with community members. Data triangulation was performed to further validate the data, and a thematic analysis approach was used to analyze the data.ResultsHealth shocks were a defining characteristic of households’ experiences of extreme poverty in the studied region. Care-seeking behaviours are influenced by an array of cultural and economic factors. Households adopt a range of coping strategies during the treatment or care-seeking process, which are often insufficient to allow households to maintain a stable economic status. This is largely due to the fact that healthcare costs are borne by the household, primarily through out-of-pocket payments. Households meet healthcare cost by selling their means of livelihoods, borrowing cash, and marketing livestock. This process erodes their wellbeing and hinders they attempt at achieving resilience, despite their involvement in an extreme poverty-alleviation programme.ConclusionsLivelihood supports or asset-transfers alone are insufficient to improve household resilience in this context. Therefore, we argue that extreme poor households’ healthcare needs should be central to the design of poverty-alleviating intervention for them to contribute to foster resilience.
Highlights
How and whether health shocks, care-seeking behaviour and coping strategies are interlinked and influence households resilience to ill-health remains an under-researched subject in the context of Bangladesh
This study aimed to understand health shocks experiences, care-seeking behaviours, coping strategies and their implications for the resilience of extreme poor adivasi households living in the Chittagong Hill Tracts (CHT) and benefiting from a poverty-alleviation intervention
Our findings show that an epidemiological transition is underway where Non-communicable Chronic Diseases (NCD) are coming forward in Bangladesh [31, 32]
Summary
How and whether health shocks, care-seeking behaviour and coping strategies are interlinked and influence households resilience to ill-health remains an under-researched subject in the context of Bangladesh. This study investigates whether and how health shocks, care-seeking processes and coping strategies interplay and impact the resilience of extremely poor adivasi (ethnic minority) households in the Chittagong Hill Tracts (CHT), Bangladesh. Studies conducted in Bangladesh show that catastrophic health expenditure (CHE) leads to impoverishment and pushes households into poverty. Alam et al shows 3.5% of the total population (corresponding to approximately 5 million people) in Bangladesh fall into poverty annually due to out-of-pocket (OOP) payment mechanism wherein 16.5% of poorest and 9.2% of the richest households faces CHE [9]. Hamid et al shows that annually 3.4% households are pushed into poverty due to OOP outlays wherein chronic non-communicable diseases are the principle contributor [11]
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