• Costs of targeting the poorest

Costs of targeting the poorest

This paper, published by the DFID Health Systems Resource Centre, explores the cost-effectiveness of targeted health services for the poorest by assessing marginal costs (the extra cost of providing a service to one more person, or an additional group of people). The paper reviews the empirical evidence with a focus on demand- and supply-side interventions, and user fees for primary health services. Based on this review, the author concludes that providing services for the poorest is more expensive than for the population as a whole. However, these higher costs may in some cases be offset by the greater health needs of the poorest, and hence the possibility of a higher impact.

The author recommends exploration – in the planning phase – of how new or expanded interventions can be adapted, if necessary, to reach the poorest, and how much this will cost. She also highlights the trade-off between equity and economic efficiency that does, at times, exist. Concentrating on the almost-poorest within a country, for example, may be more cost-effective and cheaper than services for the poorest, but would be less equitable. The paper concludes by asking how efficient it is to specifically target the poorest, and what political compromises may be needed between equity and acceptability. [adapted from authors]

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