University of Montreal School of Public Health (ESPUM), Montreal, Canada.
Int J Equity Health. 2014 Apr 16;13:31. doi: 10.1186/1475-9276-13-31.
In most African countries, indigents treated at public health centres are supposed to be exempted from user fees. In Africa, most of the available knowledge has to do with targeting processes in rural areas, and little is known about how to select the worst-off in an urban area. In rural communities of Burkina Faso, trials of participatory community-based selection of indigents have been effective. However, the process for selecting indigents in urban areas is not yet clear.
This study evaluates a community-funded participatory indigent selection process in both a formal (loti) and an informal (non-loti) neighbourhood in the urban setting of Burkina Faso's capital. This was an exploratory study to evaluate the processes and effectiveness of participatory targeting. We conducted individual interviews (n = 26) and analyzed secondary qualitative data (eight focus groups, 16 individual interviews). We also used the results of a socioeconomic survey (carried out by the Ouaga HDSS in 2011) of all the households established in the areas, including those of selected indigents.
The coverage of indigent targeting was very low: 0.33% (loti) and 0.22% (non loti). In the non loti neighbourhood, the level of poverty among people selected was higher than the mean level of the poor who were not selected. Some indigents selected in the loti neighbourhood were not among the worst-off. The process was difficult to organize in the loti neighbourhood; people knew each other less well and were not very available, and there were cases of collusion. The process worked well in the non loti neighbourhood.
This intervention research provides new evidence about the feasibility of a community-based selection process in an urban setting in Africa by comparing two different urban settings. The participatory community-based selection process appeared to be suitable for the non loti neighbourhood, but other targeting strategies need to be found for loti areas. Specific budgets need to be allocated to increase the coverage of indigent targeting.
在大多数非洲国家，在公共卫生中心接受治疗的穷人应该免除用户费用。在非洲，大多数现有知识都与农村地区的目标人群确定过程有关，而对于如何在城市地区确定最贫困人群知之甚少。在布基纳法索的农村社区，基于社区的穷人参与式选择试验已经取得了成效。然而，城市地区确定穷人的程序尚不清楚。
本研究在布基纳法索首都的一个正规（卢比）和一个非正规（非卢比）社区中，对社区资助的参与式穷人选择程序进行了评估。这是一项探索性研究，旨在评估参与式目标确定的过程和效果。我们进行了个人访谈（n=26），并对二级定性数据（8 个焦点小组、16 个个人访谈）进行了分析。我们还利用在两个地区（包括选定的穷人）开展的所有家庭的社会经济调查（由瓦加杜古卫生和人口动态监测系统于 2011 年进行）的结果。
穷人目标确定的覆盖面非常低：正规社区为 0.33%（卢比），非正规社区为 0.22%。在非正规社区，所选穷人的贫困程度高于未被选中的穷人的平均贫困程度。在卢比社区中选择的一些穷人并不属于最贫困人群。在卢比社区，该过程难以组织；人们彼此不太熟悉，也不太容易获得，并且存在勾结现象。该过程在非正规社区运作良好。
这项干预研究通过比较两个不同的城市环境，为在非洲城市环境中实施基于社区的选择过程提供了新的证据。参与式社区基础的选择过程似乎适用于非正规社区，但需要为卢比社区找到其他的目标人群确定策略。需要分配特定预算来增加穷人目标确定的覆盖面。
