The Ultra-Poor Graduation (UPG) program is a BRAC initiative designed to lift the poorest households in developing countries out of poverty. While prior studies established the economic benefits of such programs, little was known about their long-term impact on health outcomes such as morbidity and mortality. Using data from a randomized controlled trial (RCT) conducted over seven years, this study investigates whether poverty reduction initiatives can also improve health outcomes and life expectancy among ultra-poor households.
Researchers: Tamim, Sheikh Arman; Das, Narayan C.; Matin, Imran; and Sulaiman, Munshi
Timeline: 2007-2008 (baseline); 2009, 2011, 2014, 2024 (follow-ups)
Status: Completed
Contact: Sheikh Arman Tamim; arman.tamim@bracu.ac.bd
Context
There is a large body of evidence on the impact of various poverty reduction initiatives, including transfer programs, in alleviating poverty. However, evidence on the effects of these initiatives on morbidity and mortality—two significant indicators of human well-being—remains relatively sparse. Over the years, the UPG program has undergone numerous modifications, but its core model employs an innovative, multifaceted approach, offering beneficiaries a combination of productive asset transfers, training, short-term cash allowances, and coaching.
The long-running RCT was conducted on the 2007 cohort of the UPG program implemented by BRAC in Bangladesh’s 13 poorest districts; the data from this cohort served as the foundation for this study. The intervention targeted ultra-poor women, providing them with productive assets such as livestock and comprehensive support, including entrepreneurial training, cash allowances, and access to healthcare guidance.
Objective
The objective of this study was to assess the long-term impact on health outcomes such as morbidity and mortality. This study intends to understand whether and how poverty reduction initiatives can improve health outcomes and life expectancy among ultra-poor households.
Methodology
A cluster RCT was carried out in 20 sub-districts, with branch offices randomly assigned to either the treatment or control group. Eligible households in all selected sub-districts were then identified through participatory wealth ranking. Eligible households in the treatment areas received the program benefits— assets valued at USD 560 in purchasing power parity (PPP) terms, coupled with extensive support. The program included a 40-week consumption stipend and ongoing technical training to transition beneficiaries from precarious casual labour to
sustainable self-employment.
The study tracked 7,950 households and 25,802 individuals, with baseline data collected in 2007 and follow-ups conducted in 2009, 2011, 2014, and 2024. Along with economic indicators, detailed data on illness and mortality status were also collected during the surveys. Data on illness and treatment were available for all members up to the third follow-up in 2014.
Findings
The most significant finding of this paper is the impact of the UPG program on reducing mortality. While the study does not observe any impact on female cumulative mortality in the first three follow-ups, a notable reduction in the cumulative mortality rate is observed among older women (aged 55 and above at baseline) during the final follow-up.
The widening gap in cumulative mortality rates between males in the control and treatment groups over time demonstrates that the intervention had both immediate and sustained effects on male mortality, particularly among those aged 25 and above at baseline.
The study also finds that the UPG program significantly reduced morbidity among members of ultra-poor households. Among females, the morbidity rate in the treatment group remained consistently lower than in the control group across all follow-ups.
This study underscores the potential of poverty reduction programs like UPG to not only improve economic well-being but also enhance health and longevity. By tackling the root causes of ill health, such as inadequate income and limited access to healthcare, the program achieved sustained reductions in morbidity and male mortality.
