the activities of these ngos are not properly linked with the pourashava activities the absence of an integrated sectoral approach to manage urban health services is the reason for this lack of coordination the prime causes include the following public sector and ngo services are not always cheap for the poor because they often still have to buy medicine in most cases it is not provided for free and make many informal payments in the form of tips at the facilities the institutions are not poorfriendly the poor are not fully aware of the entitlements of the ngo health cards and waiting times are long which leads to a loss of working hours when visiting the health facility low cost attracts the poor to public hospitals mostly as the last resort but varieties of informal payments and the negligence and poor attitudes of providers towards the poor cause them to lose confidence in the facilities and ultimately poor patients feel discouraged from utilizing the services one respondent commented health services are not for the poor it is rather something that the rich can manage through money or power