• Costs of targeting the poorest

Costs of targeting the poorest

This paper, published by the World Bank, examines attempts to focus health sector development programmes on the poor. Drawing particularly on a series of case studies undertaken in Latin America in the late 1980s and early 1990s, it notes that although none of the programmes studied were perfect, the more carefully targeted ones were much more successful in reaching the poor than the less carefully targeted ones. The administrative costs of targeting were below 10 per cent of total programme costs. However, other studies describe the failure of many targeting programmes, particularly in Africa, leaving a mixed picture overall.

The paper suggests that it is worth the time and trouble to explore carefully the targeting options available in any particular setting, but that more than targeting will be required for the development of highly progressive, pro-poor initiatives. Targeting individuals through methods such as means testing can work well, but has failed when it was tried “on the cheap” – with minimal administrative effort and without additional resources to cover the costs of the services provided. Targeting by age and by disease should also be considered, and using several targeting mechanisms at once appears more effective than reliance on a single mechanism.

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