Models and institutional mechanisms

A variety of institutional mechanisms can be used to target the very poor. In Designing Health & Population Programs to Reach the Poor, case studies and lessons from the World Bank’s ‘Reaching the Poor’ programmes are presented including examples from Brazil, Cambodia, Tanzania, India and Nepal. The paper concludes that it is possible to achieve better performance in reaching the poor, but there is not any one programme type or model that is more effective than others. There is also no guarantee that an approach that works in one setting will work elsewhere.

The authors recommend a process of experimentation and adaptation following the steps of:

• studying the approaches
•  adapting to local conditions
• experimenting through implementation in a few places
•  monitoring to verify how the approaches work
• adjust the approach according to findings

Policies may be implemented by government, NGOs, the private sector, research institutes or through public-private partnerships. This dossier provides several examples including: direct cash transfers by government; use of ‘Social Funds’ by communities to access government funds for locally-identified interventions; service delivery through the NGO sector; contracting out public services to the private or NGO sectors; creation of public-private partnerships for implementation of demand-side financing interventions.

Poverty and user fees for public health care in low-income countries: lessons from Uganda and Cambodia, compares policy development processes. The document addresses the strategic question of universal versus targeted solutions on access to health care for the poor (with universal free health care in Uganda and Health Equity Funds in Cambodia), and the contextual factors affected governments’ policy decisions regarding their scale and scope.


The paper proposes key technical issues that national policy makers should consider when deciding which health assistance scheme and how it should be implemented? These issues include:

• barriers to health care (poverty levels, health seeking behaviours, main barriers on access to selected health services)
• targeting (political acceptance of targeting, criteria, actors for identification)
• benefit package, resources and incentives (health problems, causes of impoverishment, absorption capacity of selected health facilities, financial resources available, appropriateness of incentives)
• process of the reform (partners and contribution, institutional and legal rooting, accompanying measures, speed, scale and scope).