Targeting the very poor

A large evidence base highlights the fact that there are widespread inequities in access to public sector health services. Health services provide more and better quality care to wealthier people. Individuals and households suffering chronic poverty often benefit the least from scaled up national health programmes, even if they have special health-related needs. Inequities may be apparent based on where an individual lives, their social group, socio-economic status, gender, age or other aspects of difference.

A number of studies have looked at who benefits from public sector funding of health services. A major contribution in this field is the set of multicountry analyses of Demographic and Health Surveys done by Gwatkin et al.. In Making health systems more equitable, Gwatkin states that although inequities are likely to continue they should not be accepted as inevitable. The paper identifies different measures and techniques that have been effective in reaching the poor and empowering patients. These include the establishment of health policy goals that specifically address coverage of the poor, cash transfer programmes, targeting to provide subsidised health insurance, and contracting NGOs to operate services.

These “reaching the poor” measures do not all include a targeting component. A key area of debate today concerns the respective benefits of non-targeted strategies, such as provision of universal free health care services versus specific, targeted strategies for reaching the very poor.