Bridging the Gap: How BRAC UPGI is Working with Governments to Provide Services to Those Most in Need During a Pandemic

By Bobby Irven, UPGI Communications Officer

Understanding the challenges the poor face when trying to access basic needs such as health care and designing programs with them in mind has never been more important or urgent. Nearly two months after WHO declared COVID-19 a pandemic, it continues to infect people in every corner of the world. While the reach of the virus may be global, the impact it is having on different populations varies. Those living in extreme poverty are the most affected and most at risk population, having limited access to health care, food, clean water, steady income, and public services, and often an inability to practice social distancing.

Given the multidimensional nature of extreme poverty, health, or rather lack thereof, can be a major factor of whether someone remains stuck in poverty and why the poorest are most vulnerable to crises. Building resilience while meeting basic needs is critical for helping them overcome key barriers that keep them impoverished.

As governments respond to COVID-19 and attempt to limit the infectious virus, those most affected are at risk of being left behind without resources or services to overcome the many impacts. From a general lack of knowledge around water, sanitation, and hygiene (WASH) topics to traveling longer distances to seek care in cramped or unsanitary living and working conditions, the poor face substantial access barriers that will only grow as COVID-19 continues to affect all aspects of life.

BRAC’s Ultra-Poor Graduation Initiative (UPGI) integrates health interventions in all of our Graduation programs and pilots. We work to bridge the major health-related gaps that exist for the poorest by connecting individuals to available government services (via social protection programming) through our Graduation approach. We have found that layering our program interventions on top of existing programs and resources is the most strategic investment for both governments and the long-term benefits of extreme poor households. Graduation can, and has, enhanced these existing investments and provides further opportunities for the extreme poor to have their most basic needs met, whether it be more frequent healthcare visits or access to a national insurance plan.

Existing social protection programs that place focus on the physical and economic well-being are an ideal point of entry for interventions that serve the poorest in this pandemic. With the growing threat of COVID-19 and related and potentially long-lasting negative economic impacts, we explore how our pilots in the Philippines and Egypt are responding and adapting in real time.

PHILIPPINES

With the aim to provide comprehensive and integrated support to the poorest households and build their resilience, the Government of Philippines Graduation pilot leverages and complements the strengths of two existing government programs, the Kabuhayan (livelihoods) program under the Department of Labor and Employment (DOLE) and the Pantawid Pamilyang Pilipino Program (4Ps) cash transfer program under the Department of Social Welfare and Development (DSWD). All pilot participants are beneficiaries of 4Ps and are enrolled in the national health insurance plan PhilHealth. The coaches of the Graduation pilot, known as Graduation community facilitators (GCFs), provide guidance to the participating households on how to use the insurance and take advantage of its many benefits. This support helps poor households access affordable and quality healthcare services, which is crucial in times of emergency.

The GCFs also raise awareness and reinforce government messages on key health topics such as WASH, maternal and child health, and solid waste management, among others typically shared during Family Development Sessions organized by DSWD. These sessions provided the participants with an opportunity to ask unresolved questions on the topics and expand their knowledge in an intimate setting. With restrictions now in place limiting face-to-face interactions in response to COVID-19, the GCFs are utilizing digital technology such as SMS text messages and mobile phones to check-in on participants and share important information guidelines on health and hygiene from the government. They are now the vital intermediaries who ensure life-saving health messages are reaching the most vulnerable. The field team is also tracking the distribution of additional financial assistance through the government’s emergency Social Amelioration Program to ensure eligible poor households are receiving top-up cash for their monthly transfers, and to inform local government units if for some reason any poor household does not receive the assistance.

The GCFs also provide critical linkages to other emergency government social assistance such as ensuring distribution of food aid, and maintain regular communication with health officials at municipal and community levels to report high risk families in need. During COVID-19, this has led to responses such as convincing municipal officials to loosen movement restrictions on remote households unable to travel to seek services at their local municipal offices to provide closer access points for care.

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Typically in-person training sessions like the one shown above are now being conducted virtually via SMS and through mobile conversations.

The Philippines Graduation pilot was launched in 2018 in partnership with the Government of the Philippines, Asian Development Bank, and BRAC.

EGYPT

Households in Assiut and Sohag, the two poorest governorates in Egypt, are faced with daily challenges resulting from food and nutrition insecurity, lack of viable and diverse livelihoods, erratic access to markets, and poor health-seeking behavior. The Bab Amal Graduation program, aims to address these barriers by building a holistic and integrated program for this hard-to-reach population. The goals of the Bab Amal program are to enable households to build sustainable livelihoods and resilience to shocks that are sustained long after official Graduation interventions end. It will also inform integration of the Graduation approach with social protection programs such as the government’s existing Takaful and Karama (T&K) cash transfers.

With the ongoing COVID-19 pandemic, households in Assiut and Sohag are faced with an unprecedented health and economic shock. Experts are saying that Egypt and Lebanon will be among the top 10 countries hit hardest by the decline in remittances[1]. As the program ramps up its adaptations for a comprehensive response, the teams on the ground are coordinating with local authorities and community development associations (CDAs) to ensure that program participants and vulnerable communities are protected from the potentially debilitating impacts of COVID-19.

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A Bab Amal program participant and her family pose for a photo out front of their home in Bani Wasel, Sohag governorate, Egypt.

Frontline staff are ensuring that eligible households benefit from the government’s decision to expand coverage of T&K and other emergency cash transfers in the area. For households that are not on T&K, the Graduation program is providing additional consumption support to help meet basic needs. In order to restrict movement of large groups and limit the chances of further transmission of the virus, a community representative now collects and distributes the stipend to multiple households. These safely conducted touchpoints also provide an opportunity to monitor loss or progress of livelihoods, incidence of illness due to the pandemic as well as distribute supplies like in-kind food packages and sanitation kits. With the existing knowledge of the communities and their real-time situations, staff can ensure knowledge and assistance are in fact reaching the poorest and most invisible members who are often left out of social protection mechanisms. For those who are out of reach or when the safety of staff cannot be guaranteed, life skills training and coaching to participating households with a focus on sanitation and COVID-19 prevention can be made via phone calls and SMS, as is being done in our pilot in the Philippines.

With resources being limited and in high demand, SFSD has kickstarted efforts to map out and collect data on existing services being offered by food banks, CDAs, and other local NGOs to ensure the Bab Amal program staff are leveraging existing support and filling gaps. As the virus continues to spread throughout communities, coordination between the government and local implementers becomes even more vital to the safety and resilience of vulnerable households.

The Bab Amal Graduation program is a collaborative effort between BRAC, Sawiris Foundation for Social Development (SFSD), Abdul Latif Jameel Poverty Action Lab (J-PAL), Egyptian Human Development Association (EHDA), and Giving Without Limits Association (GWLA).

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Breaking the cycle of extreme poverty by providing a pathway out of persistent uncertainty and destitution through our Graduation programs.

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