Bangladesh

This case is about Shefa Begum of Manik Nagar, a rural village of Bangladesh under Singair sub-district of Manikgonj. The village is located 60 km north of Dhaka. She is enrolled in the Grameen Health Micro Insurance Scheme, supported by the ILO WEEH project.

Shefa was married at the age of 18 to Salamat. At that time he was a tailor and the only income earner but his income was not adequate to sustain an extended family, including "in-laws". Within four years the couple had three children. In 1990 Shefa became a member of Grameen Bank and received a small loan that she used to purchase a sewing machine. She started tailoring and got engaged in "cow fattening" to earn money and support the family.

One day Salamat fell sick in a serious STD but did not seek treatment until after quite some time. When he eventually was cured he left for Saudia Arabia for a job leaving his wife with the responsibility to care for the family. Soon after, Shefa fell sick, also in a STD. Because of the nature of her illness, she was in a very difficult position and could not talk about the disease without the risk of being rejected and socially excluded by the family and the community. She has a "Health Card" since 1997 and has paid 120 Taka every year, entitling her to claim health care services at affordable costs from Grameen's health center. She sought assistance from a doctor at the health center in Madhabpur. She was tested and diagnosed as having syphilis. From then onwards she was under the doctor's observation until she was cured. The cost of the treatment was 350 Taka (58 Taka = 1 USD) whereas the cost would have exceeded 3000 Taka if she had had to seek treatment elsewhere.

Shefa is now physically and mentally healthy and continues her work to support the family. The difficulties she faced before she was treated represents the situation of many poor women in Bangladesh, where having a sexually transmitted disease may not only lead to rejection and blame from the society, but may also have severe health consequences when left untreated. Shefa was fortunate to be enrolled in the safety network of the Grameen family and the health micro insurance scheme. She received health care at an affordable cost when she really required it. Provision of affordable quality health care is rare in rural areas. The ILO supported scheme of Grameen is one example of a social protection measure that contributes to the well-being of poor people, in particular women.

Grameen Kalyan provides health care to poor people in rural areas through its local health centers. The rates are affordable; the consultation fees are at least five times lower than the market price and 10-30 % discounts are given for medicines and pathology.