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How much does community-based targeting of the ultra-poor in the health sector cost? Novel evidence from Burkina Faso

Author

Listed:
  • Yvonne Beaugé

    (Heidelberg University)

  • Jean-Louis Koulidiati

    (Heidelberg University)

  • Valéry Ridde

    (Universités Paris Sorbonne Cités, ERL INSERM, SAGESUD and University of Montreal, Public Health Research Institute (IRSPUM))

  • Paul Jacob Robyn

    (The World Bank)

  • Manuela De Allegri

    (Heidelberg University)

Abstract

Background Targeting efforts aimed at increasing access to care for the poorest by reducing to a minimum or completely eliminating payments at point of use are increasingly being adopted across low and middle income countries, within the framework of Universal Health Coverage policies. No evidence, however, is available on the real cost of designing and implementing these efforts. Our study aimed to fill this gap in knowledge through the systematic assessment of both the financial and economic costs associated with designing and implementing a pro-poor community-based targeting intervention across eight districts in rural Burkina Faso. Methods We conducted a partial retrospective economic evaluation (i.e. estimating costs, but not benefits) associated with the abovementioned targeting intervention. We adopted a health system perspective, including all costs incurred by the government and its development partners as well as costs incurred by the community when working as volunteers on behalf of government structures. To trace both financial and economic costs, we combined Activity-Based Costing with Resource Consumption Accounting. To this purpose, we consulted and extracted information from all relevant design/implementation documents and conducted additional key informant structured interviews to assess the resource consumption that was not valued in the documents. Results For the entire community-based targeting intervention, we estimated a financial cost of USD 587,510 and an economic cost of USD 1,213,447. The difference was driven primarily by the value of the time contributed by the community. Communities carried the main economic burden. With a total of 102,609 ultra-poor identified, the financial cost and the economic cost per ultra-poor person were respectively USD 5,73 and USD 11,83. Conclusion The study is first of its kind to accurately trace the financial and economic costs of a community-based targeting intervention aiming to identify the ultra-poor. The financial costs amounted to USD 5,73 and the economic costs to USD 11,83 per ultra-poor person identified. The financial costs of almost USD 6 represents 21% of the per capita government expenditure on health.

Suggested Citation

  • Yvonne Beaugé & Jean-Louis Koulidiati & Valéry Ridde & Paul Jacob Robyn & Manuela De Allegri, 2018. "How much does community-based targeting of the ultra-poor in the health sector cost? Novel evidence from Burkina Faso," Health Economics Review, Springer, vol. 8(1), pages 1-11, December.
    • Handle: RePEc:spr:hecrev:v:8:y:2018:i:1:d:10.1186_s13561-018-0205-7
    DOI: 10.1186/s13561-018-0205-7
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    References listed on IDEAS

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    1. David Coady & Margaret Grosh & John Hoddinott, 2004. "Targeting of Transfers in Developing Countries : Review of Lessons and Experience," World Bank Publications - Books, The World Bank Group, number 14902, December.
    2. Drummond, Michael F. & Sculpher, Mark J. & Torrance, George W. & O'Brien, Bernie J. & Stoddart, Greg L., 2005. "Methods for the Economic Evaluation of Health Care Programmes," OUP Catalogue, Oxford University Press, edition 3, number 9780198529453.
    3. World Bank, 2016. "Identification for Development," World Bank Publications - Reports 26439, The World Bank Group.
    4. Mcintyre, Di & Meheus, Filip & Røttingen, John-Arne, 2017. "What level of domestic government health expenditure should we aspire to for universal health coverage?," Health Economics, Policy and Law, Cambridge University Press, vol. 12(2), pages 125-137, April.
    5. Conning, Jonathan & Kevane, Michael, 2002. "Community-Based Targeting Mechanisms for Social Safety Nets: A Critical Review," World Development, Elsevier, vol. 30(3), pages 375-394, March.
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    Cited by:

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    2. Yvonne Beaugé & Manuela De Allegri & Samiratou Ouédraogo & Emmanuel Bonnet & Naasegnibe Kuunibe & Valéry Ridde, 2020. "Do Targeted User Fee Exemptions Reach the Ultra-Poor and Increase their Healthcare Utilisation? A Panel Study from Burkina Faso," IJERPH, MDPI, vol. 17(18), pages 1-21, September.

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