Exclusion, cohesion and health rivation that exclude the ultra-poor: ‘Challenging the Frontiers of Poverty Reduction/Targeting the Ultra-poor’ (CFPR/TUP). CFPR/TUP, launched in 2002, integrates components specifically designed to address sociocultural, political and economic ex- clusion, including income generation, skills train- ing, a monthly stipend for subsistence (US$ 0.17 per day), social development and mobilization of the local elite for support. A mid-term evaluation showed that the CFPR/TUP programme positively impacted livelihood, economic, social and health status to the extent that some households main- tained asset growth after ‘graduation’ and joined a regular microcredit programme: 55% of the 5,000 poorest households from the poorest districts in the country gained sufficient resources to benefit from joining a microcredit programme; the percent- age living on <US $1 per day decreased from 89% to 59% during the first three years of the project, and improvements were observed in quantity and quality of dietary intake (32-33). Despite successes associated with explicitly address- ing multiple dimensions of exclusion, it is clear that some extreme poor have not yet been able to benefit from CFPR/TUP. Reasons for this need to be explored to facilitate further interventions. NGO-state partnerships Severalexamplesillustratethestrengthofmultisecto- ralapproaches.TherearemanyexamplesinBang- ladesh of NGOs identifying community needs, showing leadership in developing innovations, and working with the public sector to scale up pro- grammes. In this section, interventions of NGOs working with the public sector facilitating access to healthcare and safe water-supply and to gen- erate civil society action to promote public sector accountability to the citizenry are described. Healthcare services: Urban Primary Health Care Project (34) As informal settlements, or slums, are considered ‘illegal’, populations who live in these areas often have no official addresses and are commonly denied basic rights and entitlements, including the right to access water, sanitation, education, and healthcare. A review of health services for people who live in informal settlements in Dhaka city found that only 7.3% have access to a public-health clinic. While the situation remains dismal for many urban poor residents who, at public-sector clinics, report being mistreated, waiting long hours, receiving poor- quality care, and remaining uninformed of their Volume 27 | Number 4 | August 2009 Johnston HB rights (35,36), there have also been some successful projects implemented to promote access to health services for the urban poor. The Urban Primary Healthcare Project was first implemented in the four major metropolitan are- as of Dhaka, Khulna, Chittagong, and Rajshahi. Through city corporation-NGO partnership agree- ments, first signed in May 2000, the Government contracted with NGOs to establish primary health- care clinics in low-income areas of the four cities. Through these services, the poorest women and children living in informal settlements are offered affordable and accessible primary healthcare servic- es of high quality. This population constitutes more than 75% of all project beneficiaries. In 2001, the coverage included 400,000 people in four city cor- poration areas. In December 2004, a project review showed that 5 million people were covered, the quality of services was very good, the services were user-friendly, patients received services for a subsi- dized rate, and the hardcore poor received services free of charge. The project has expanded to six city corporations and five municipalities (35). The Ur- ban Primary Healthcare Project has decreased the spatial and economic exclusion of urban poor from healthcare services. Safe water supply: Dushtha Shasthya Kendra and Dhaka Water Supply and Sewerage Authority (34) Dhaka’s Water Supply and Sewerage Authority (WASA), the public-sector water-utility agency, has had a policy that they would not provide water services to households without a legal land-holding permit, which effectively excludes informal settle- ments from access to safe water-supply. To circum- vent this obstacle, the NGO—Dushtha Shasthya Kendra (DSK: Vulnerable Poor Health Centre)—ap- proached WASA in 1992 with a proposal to deliver water services to two informal settlements where residents accessed water from a pool of contami- nated factory wastes (37). The DSK offered to act as the guarantor for the security deposit and the bill payments for the beneficiaries (35). After negotia- tions, WASA agreed to waive their policy and au- thorized two water points. The initial cost was Tk 70,000 (approximately US$ 1,000). The first water-point installation was not successful as the local informal power structure took control of the water-point and refused to pay the weekly in- stallments. The DSK tried again, installing the sec- ond water-point in 1994. Prior to installation, two groups of elected Water Management Committees 431