Kliniken & Institute … Institute Heidelberger Institut… Groups & Projects Working Groups Implementation research… Research Health Results-Based… Poor

Targeting the poor

Investigators: Aurélia Souares, Devendra Prasad Gwanali, Rainer Sauerborn

Collaborative partner: Germain Savadogo, Dr Ali Sié (Nouna Health Research Centre, Burkina Faso)

Poverty reduction is now a main issue in all middle and low-income countries and become a main objective in their Poverty Reduction Strategy Paper (PRSP) and also main agenda for International Donor Community. If poor are not targeted, the benefit expected to reach poor could go to non-poor, consequently it widen the gap between poor and non-poor. Targeting is necessary in order to identify different types of poor people, ensure the benefits reach poor people, and prevent the benefits being captured by non-poor.

Improved accesses to health care contribute better health outcomes. People living in the low income setting have financial barrier to access health care. Since 2004, Community-based health insurance has been implemented in the DSS area of Nouna Health District of Burkina Faso. The enrolment rate remained very low (<6%) since its implementation. The enrolment rate was low especially among the poor people who are unable to pay the premium (1500 F CFA / adult and 500 F CFA / child) per annum. Burkina Faso population is divided into five income quintiles: the 5th quintile is the poorest (EPP, 1998).

Community Wealth Ranking

We implement community wealth ranking in the DSS area of Nouna Health District. The objective of this study is to determine the 20% poorest households from each village and to subsidize the premium by 50% to each individual (750 F CFA / adult and 250 F CFA / child) so that poor households could enroll in the CBI scheme.

To identify the poorest households in each village, we use a self-assessment method, called community wealth ranking. The poverty is a relative term. One village could be richer than another and the process could be complicated to identify the poor. Therefore we decided to implement wealth ranking process in each village. We invite all households’ members to join a general meeting to discuss on poverty, wealth, and finally to select three local key-informants. The main task of the selected key informants is to sort out all households in the village and identify 20% of the households as a poor. In the first round three key informants make a list of poor households independently. If any differences arise, they have to reach in consensus to make the final list of identified poor households.