Targeting services towards the poor: a review of targeting mechanisms and their effectiveness

This chapter analyses the alternative approaches to targeting the poor that have been used in healthcare delivery and draws together evidence from a range of countries about their effectiveness. The authors emphasise the importance of programme design and implementation issues and argue that successful programmes will need to identify these issues and devote adequate resources to overcoming them.

The authors propose a conceptual framework for understanding the key elements of targeting policies. These elements are: who is targeted; what is the targeted benefit; what is the targeting method; and what evaluation criteria are used to measure the impact. The paper then uses this framework to assess six different targeting mechanisms that have been applied in the health sector in a range of contexts. These approaches are: resource allocation formulae, contracting Non-governmental Organisations (NGOs), user fee exemptions, cash transfers, vouchers and market segmentation strategies using self-selection. A critical issue identified in the chapter is the availability of good information for programme design and evaluation. Most evaluations in this area have focused on the main targeting outcomes (coverage, under-coverage and leakage) and have neglected the other issues of concern to policymakers such as cost and sustainability. Future research in this area needs to consider a broader range of outcomes, and more systematically compare the costs and consequences of alternative methods of directing resources towards those most in need.