Thought-provoking blog Pete, thanks for sharing your experience and open ended questions/reflections. People like Susan will probably only ever be noticed, cared about and reached by tiny grassroots groups like the women’s association youvisited. The situation is little better in developed countries for those who fall between the cracks of the mainstream, including the official welfare and benefits systems.
The question then is, does an agency such as DFID have a role to play in providing funding to the sorts of groups who can actually see, understand and help Susan and others?
Currently it feels as though you’re in a cleft stick of the Daily Mail’s making: give money to informal groups and they shout about leakage and lack of governance; build them up through strict criteria, due diligence and capacity development into professional NGOs and they shout about high overheads instead. https://www.theguardian.com/global-development-professionals-network/2017/jul/07/why-grassroots-activists-should-resist-being-professionalised-into-an-ngo
So, in order to help the very most marginalised people despite national progress towards middle income status (a very flawed proxy for well-being as you acknowledge), perhaps the question is whether DFID and others have the appetite and political will to face down the naysayers, and back local groups with sensitive amounts of safety-net funding, whilst relaxing some of the fiduciary risk management strictures?