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This paper from the DFID Health Systems Resource Centre explores the experiences of the Bangladeshi non-governmental organisation "BRAC" in implementing a customised development programme for the poorest named "Challenging the frontiers of poverty reduction/targeting ultra-poor" (CFPR/TUP). The paper outlines the design of CFPR/TUP, which includes: income-generating asset grants, subsistence allowance, skills-training, tailor-made health interventions, social awareness development training and pro-poor advocacy.

The authors argue that CFPR/TUP has been successful in enabling the extreme poor to build a foundation for sustainable livelihoods and thus to participate in and benefit from mainstream development programmes. Long-term impact has been enhanced by the health component of the programme, which acts as a safety net by minimising the income-erosion effects of illness and enabling the poor to engage in livelihood activities. Lessons learned highlight the importance of: sensitising different sections of society to the plight of the ultra-poor, mobilising community support (including that of village elites), providing consumer information on locally available health services, and providing tools such as identity cards for facilitated access to government health facilities. The importance of providing financial support to reduce the income-erosion effect of ill health is also emphasised, especially for moderate to severe illnesses requiring hospitalisation. [adapted from author]

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