Low coverage but few inclusion errors in Burkina Faso: a community-based targeting approach to exempt the indigent from user fees
| Autor: | Moctar Ouedraogo, Béatrice Nikiéma, Valéry Ridde, Slim Haddad, Yamba Kafando, Abel Bicaba |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2010 |
| Předmět: |
Male
Population Vulnerability Health Services Accessibility 03 medical and health sciences 0302 clinical medicine Surveys and Questionnaires Environmental health Burkina Faso Health care Humans Medicine 030212 general & internal medicine 10. No inequality education Poverty Extreme poverty education.field_of_study business.industry 030503 health policy & services Rural health lcsh:Public aspects of medicine 1. No poverty Public Health Environmental and Occupational Health lcsh:RA1-1270 Middle Aged Social Class Fees and Charges Female Rural area 0305 other medical science business Research Article Poverty threshold |
| Zdroj: | BMC Public Health, Vol 10, Iss 1, p 631 (2010) BMC Public Health |
| ISSN: | 1471-2458 |
| Popis: | Background User fees were generalized in Burkina Faso in the 1990 s. At the time of their implementation, it was envisioned that measures would be instituted to exempt the poor from paying these fees. However, in practice, the identification of indigents is ineffective, and so they do not have access to care. Thus, a community-based process for selecting indigents for user fees exemption was tested in a district. In each of the 124 villages in the catchment areas of ten health centres, village committees proposed lists of indigents that were then validated by the health centres' management committees. The objective of this study is to evaluate the effectiveness of this community-based selection. Methods An indigent-selection process is judged effective if it minimizes inclusion biases and exclusion biases. The study compares the levels of poverty and of vulnerability of indigents selected by the management committees (n = 184) with: 1) indigents selected in the villages but not retained by these committees (n = 48); ii) indigents selected by the health centre nurses (n = 82); and iii) a sample of the rural population (n = 5,900). Results The households in which the three groups of indigents lived appeared to be more vulnerable and poorer than the reference rural households. Indigents selected by the management committees and the nurses were very comparable in terms of levels of vulnerability, but the former were more vulnerable socially. The majority of indigents proposed by the village committees who lived in extremely poor households were retained by the management committees. Only 0.36% of the population living below the poverty threshold and less than 1% of the extremely poor population were selected. Conclusions The community-based process minimized inclusion biases, as the people selected were poorer and more vulnerable than the rest of the population. However, there were significant exclusion biases; the selection was very restrictive because the exemption had to be endogenously funded. |
| Databáze: | OpenAIRE |
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