Ambulance for two villagers in Bangladesh

The problem that a large number of poor patients in rural Bangladesh, especially women and children, have no access to health care results from a number of structural and socio-economic factors. Although 70% of the population lives in rural areas, more than 80% of medical care is concentrated in the cities. This means that in an emergency, professional help is far away and associated with increased costs (see WHO 2015).

The financial factor of the cost of travelling from the village to the city is only the most obvious part of the problem. In the state hospitals, patients have to buy everything they need for their treatment, from plasters to blood transfusions, and pay for it in advance. The costs cannot be estimated in advance. This unpredictability presents poor patients with insurmountable mental hurdles. For women, the situation is made even more difficult by the fact that their family environment does not give their needs the same priority as those of men. 98% of the patients who visit MATI's outpatient health workers are women and children, often with serious problems. Most of them have never seen a doctor. Because the family is extremely poor, or because the husband and mother-in-law, who make the decisions in the household, do not see any need for action.

In 2011, the UN Committee on Elimination of Discrimination against Women (CEDAW) stated that it was "concerned about the limited access to health care for women,... particularly in rural areas." In addition, hospitals are overburdened. In Bangladesh, there are statistically around 3,300 patients per doctor. If these statistics are broken down geographically, a doctor in rural areas would have to care for 15,000 patients. Given this, it is not surprising that hospitals are not equipped to help illiterate people fill out the paperwork.

Buying a bus ticket from the village to the city is only the most obvious aspect. In government hospitals in Bangladesh, patients must privately organize and pay for all necessary medical supplies - from bandages to blood transfusions. The total cost is often difficult to estimate in advance. This financial uncertainty creates mental barriers that poor patients struggle to overcome. Women face the additional difficulty that their families often do not give their needs the same priority as those of a man. 98 percent of all patients who seek help from MATI's mobile health workers are women and children - often with serious problems. In most cases, they have never 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, do not see the need for action.

The UN Committee on the Elimination of Discrimination against Women (CEDAW) has expressed its "concern at the limited access of women to health care [...], particularly in rural areas". In addition, hospitals are overcrowded: in Bangladesh, there are an average of 3,300 patients per doctor. Broken down geographically, each rural doctor would have to treat 15,000 patients. Against this background, it is not surprising that hospitals cannot help illiterate people with formalities.