Smart Healthcare Services for extreme-poor households Bangladesh suffers from large disparities in most of the health indicators across social, economic, and demographic parameters. Rural population and the urban extreme poor (The urban extreme poor makes up one third of the nationwide urban population, living in slums, squatter settlements and city pavements) do not have proper access to essential healthcare services. Currently, 67% of the healthcare cost is being paid by general public, whereas global standard is below 32%. Only one hospital bed is allocated per 1667 people, and 34% of total posts in health sector are vacant due to scarcity of funds.
Municipalities and City Corporations under Ministry of Local Government, Rural Development and Co-operatives (MOLGRD&C) are responsible for delivering Primary Health Care (PHC) services with technical guidance from Ministry of Health and Family Welfare (MOHFW). However, these public health services remain insufficient in terms of policy support and government financing which is reflected in the national budget allocation of 4.9% for the FY 2019-2020, which fails to meet the World Health Organization (WHO) standard of 15%.
The major barriers for extreme poor households in accessing healthcare services includes the cost of treatment and distance of healthcare facilities. According to the Bangladesh Urban Health Survey which covered 45,000 households across city corporations and other urban areas, only 13% of the population in city corporations have access to a governmental health facility within one kilometer. A significant barrier due to travel costs and also the loss of time compounded by long waiting times at overburdened facilities. This unfortunate circumstance has led to people foregoing treatment, avoiding formal healthcare facilities and opting for advice from the informal sectors which often includes retail drug shops. As a result, there is a high prevalence of non-communicable disease (NCDs), such as hypertension and diabetes, in slum areas. 

Sunamganj, one of the most underserved districts in Sylhet division, has a very high rate of maternal mortality of 425 deaths per 100,000 live births compared with the national average of 194. It has also been found that due to major barriers in accessing healthcare services, poor road connectivity, cost of treatment and distance, 89% of pregnant women have home deliveries assisted by non-medical birth attendants. Additionally, given the impact of frequent natural disasters like flooding, low-income communities of the district are highly vulnerable to different diseases and health risks.

Furthermore, a survey conducted with 700 extreme poor to middle income households has found that 87% families rely on overburdened public healthcare facilities and informal healthcare providers such as dispensaries and quacks for general healthcare. To increase access to quality health care for extreme poor households through piloting a smartcard program. During project launch, we will undertake a mapping exercise to identify vulnerable communities whose healthcare needs are the highest. Once identified, the project will share the list with the municipality for their approval. Households comprising of reproductive women, lactating mothers, children and elderly will be given priority.

Direct Beneficiaries: Total Households- 800, Total Beneficiary- 3200, Reproductive age women (15-49 years)-1030, Pregnant and lactating women-64, Children under 05 - 388, Adolescent boys (10-19 years)-395, Adolescent girls (10-14 years)- 194, Elderly, over 60 years- 247, People with disability - 178

Indirect Beneficiary: People living in Sunamganj Sadar with a total population of 367,230 including people living in slums and squatters will benefit from an improved health system with improved quality of care in the long run.