Email updates

Keep up to date with the latest news and content from BMC Public Health and BioMed Central.

Open Access Research article

Low coverage but few inclusion errors in Burkina Faso: a community-based targeting approach to exempt the indigent from user fees

Valéry Ridde123*, Slim Haddad12, Béatrice Nikiema2, Moctar Ouedraogo4, Yamba Kafando5 and Abel Bicaba5

Author Affiliations

1 Research Centre of the University of Montreal Hospital Centre (CRCHUM), Canada

2 Department of Social and Preventive Medicine, University of Montreal, Canada

3 Institut de recherche en sciences de la santé (IRSS) du CNRST, Burkina Faso

4 Agence de formation, de recherche et d'expertise en santé pour l'Afrique (AFRICSANTE), Burkina Faso

5 Société d'étude et de recherche en santé publique (SERSAP), Burkina Faso

For all author emails, please log on.

BMC Public Health 2010, 10:631  doi:10.1186/1471-2458-10-631

Published: 21 October 2010

Abstract

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.