Exclusion, cohesion and health In general, cash transfers in Bangladesh have been found to be inefficient and subject to leakage. There are problems with inappropriate targeting, high ad- ministrative costs, and poor programme monitor- ing. Furthermore, the public is not well-informed about the programmes, limiting their participation, support, and civil society monitoring (18). In Bangladesh, the public sector very often works through NGOs, many of which have established strong relationships with the communities they serve. Several examples of public sector and NGO partnership are presented below. NGO or not-for-profit action NGOs play important and diverse roles in promot- ing livelihood in Bangladesh. Examples are given of NGOs developing and implementing their own development strategies; of developing innovations and implementing these with government sup- port, community support, and with the support of the private for-profit sector. Microcredit (19) In the ‘group borrowing’ model of microcredit- based income-earning interventions, small amounts of credit are provided to small groups of people. Many microcredit institutions, including the largest two—Grameen Bank and BRAC—use the regular group loan transaction meetings as ca- pability-enhancing forums focusing on human capital development, promoting gender equity, building legal awareness, and health interven- tions. Twenty million people actively participate in microcredit in Bangladesh: 87% of participants are women, and 78% earn less than US $1 per day. Women are the targeted beneficiaries of microcredit as evidence shows that women are generally more reliable debtors than men and are more likely to spend earned income to benefit the household on items, such as food, education, and assets (20). In a context of purdah [practice of keeping females secluded from all men except those related by blood] and rural poverty, microcredit-based income- earning interventions provide women the access to and support for income-generating activities des- pite their restricted mobility and minimal access to financial resources and assets. This is critical as employment opportunities in the agricultural sec- tor are declining, and long commutes to formal- sector work opportunities are prohibited for many women. Johnston HB suggests strong and positive impacts on health although causality is difficult to determine. Par- ticipation in microcredit programmes is associated with improved knowledge and use of qualified healthcare providers (23,24), smaller desired family size and higher rates of modern contraceptive use (25,26), and better nutritional status, particularly among the girl children of microcredit borrowers (21). Some keys to the success of group-based microcredit are the use of social rather than physical collater- al, encouraging women to develop broader social networks. The weekly meetings of the members provide an opportunity to promote messages on health and rights, and skills building. While mi- crocredit has provided a path to greater economic, social, and even political participation and is alter- ing restrictive cultural norms of purdah, generally the microcredit enterprises work at small scale, and earnings are meagre. Some features of microcredit have been found to increase the poverty and vulnerability of the ex- treme poor and those with no entrepreneurial skills. Microcredit is not beneficial for those who do not work well with the strict discipline of microcredit institutions, who fear monetary transactions, and who have no financial safety-net (27). Furthermore, participation in microcredit programmes can put the extreme poor into further poverty and exclu- sion. BRAC’s Targeting the Ultra-poor Programme, discussed below, is an intervention targeted at those who are too poor to benefit from microcredit. Challenging the frontiers of poverty reduction/ targeting the ultra-poor (28) In Bangladesh, the official poverty-line corresponds to 2,112 kcal per person per day (29). The propor- tion of population falling between upper (corres- ponding to the consumption of 2,112 kcal per person per day) and lower (corresponding to the consumption of 1,805 kcal per person per day) po- verty-line are termed as ‘moderate poor’ while those falling below the lower poverty-line are variously termed as ‘extreme poor’, ‘poorest of the poor,’ or ‘ultra-poor’ (30). These ultra-poor households have little or no asset base, are highly vulnerable to any shock, such as natural disaster, illnesses requiring inpatient or costly outpatient care, death, or dis- ability of an income-earner, and mainly depend on wage-labour for survival. They comprise about 10% of the population in rural Bangladesh (31). Microcredit can be an effective strategy for build- ing social and economic capital (21,22). Evidence BRAC developed an intervention recogniz- ing and responding to the multiple layers of dep- 430 JHPN