When 35 cents mean life or death

Medical care for women and children in rural Bangladesh

Imagine you are in pain and urgently need to see a doctor, but your husband cannot afford 35 cents for a bus fare. Imagine you are injured but they only let you into the hospital if you know a member of staff. Imagine your child has had an accident, but at the hospital they will only start operating on him once you have bought all the necessary bandages and drugs at a nearby pharmacy. Unimaginable? In Bangladesh, this is quite common.


In rural Bangladesh, many poor patients, mostly women and children, have no access to health care. This is the result of a number of structural and socio-economic factors. Although 70 % of the people live in rural areas, 80 % of health facilities are concentrated in cities. This means that in case of an emergency, professional help is far away and getting to it entails great costs (vgl. WHO 2015).

Buying a bus ticket from the village to the city is just the most obvious aspect. In state hospitals in Bangladesh, patients have to privately organize and pay for all the required medical supplies - from a band-aid to a blood transfusion. The total cost is often hard to estimate in advance. This financial uncertainty creates mental barriers that poor patients find hard to get around. Women have the additional difficulty that their families tend not to give their needs the same priority as those of a man. 98 % of all patients that seek help from MATI's itinerant health workers are women and children - often suffering from severe problems. In most cases they have never even seen a doctor before. Either because the family is extremely poor or because their husband or mother-in-law who make the decisions in the household see no need to take action.

The UN Committee on Elimination of Discrimination against Women (CEDAW) has voiced its "concern in light of limited access of women to health care […] particularly in rural areas". Add to this that hospitals are overcrowded: on average there are 3.300 patients per doctor in Bangladesh. Broken down geographically, every rural doctor would have to treat 15.000 patients. With this in mind it is not surprising that hospitals are not able to assist illiterate people with their paperwork.

The good deed

In Bangladesh, about 75 % of the population lives in villages, often without access to health care. For poor families, a trip to see the doctor usually has to be abandoned because they cannot pay for the bus ticket. MATI health workers treat women and children locally and in urgent cases arrange for transportation to a hospital to be treated there. Simultaneously, MATI lobbies the authorities to send more doctors to villages


The greatest challenge is to reconcile the structural requirements of the hospital with the reality in the families: the hospital assigns an appointment; the husband or the mother-in-law might decide the night before, that the wife is needed to cook for relatives that are coming to visit on the day of the operation, or that no one has the time to take care of her in hospital (because all nursing services such as buying medicines or preparing meals are the responsibility of the relatives of the patient). That is why MATI's social workers need to talk to all members of the family and prepare them for the hospital stay. That takes time.

Countable output

After around 7 months


After around 3 years

Systemic effect

After around 7 years

Access to medical treatment for poor patients in rural areas of northern Bangladesh.
Staff of a local NGO organizes transfers of patients to hospitals and helps to ensure treatment.
Number of supervized transfers of patients to hospital and number of patients who have been given access to medical care.
Compared to the previous year, the state of health has improved in 2.400 families. Adults can contribute to income generation.
The disparity when it comes to access to public health care services has been reduced, economic discrimination in the hospital has lessened measurably.


Association register
VR 3345
Certified by
Transparency International
Related links
Do you have further questions about the project? Please contact our 24GoodDeeds contact person Helena Reingen mati-deutschland@web.de or ask your question on our facebook page: www.facebook.com/24guteTaten
Initiative Transparente Zivilgesellschaft