Protecting the Poor in Africa: Impact of Means Testing on Equity in the HealthSector in Burkina Faso, Niger, and Senegal

摘要

Many African Ministries of Health (MOHs) have relied on informal means testing toidentify and grant income-based fee waivers to individuals unable to pay for health services. To date, however, there has been no evidence documented to prove the success or failure of such systems. This Technical Note provides evidence from household surveys in Burkina Faso, Niger, and Senegal to show that informal means testing practices do provide financial protection for at least some of the poor during the public sectors's official shift to cost recovery. However, current fee waiver policies also provide a substantial portion of fee waivers to the non-poor, either because of other eligibility criteria in place (e.g., for civil servants, students, military, handicapped) or because of inaccuracies in identifying the poor and 'leakages' of waiver benefits.