title: A community-based approach to indigent selection is difficult to organize in a formal neighbourhood in Ouagadougou, Burkina Faso: a mixed methods exploratory study.
abstract: BACKGROUND
  In most African countries, indigents treated at public health centres are supposed to be exempted from user fees. In Africa, most of the available knowledge has to do with targeting processes in rural areas, and little is known about how to select the worst-off in an urban area. In rural communities of Burkina Faso, trials of participatory community-based selection of indigents have been effective. However, the process for selecting indigents in urban areas is not yet clear.
  
  
  METHODS
  This study evaluates a community-funded participatory indigent selection process in both a formal (loti) and an informal (non-loti) neighbourhood in the urban setting of Burkina Faso's capital. This was an exploratory study to evaluate the processes and effectiveness of participatory targeting. We conducted individual interviews (n = 26) and analyzed secondary qualitative data (eight focus groups, 16 individual interviews). We also used the results of a socioeconomic survey (carried out by the Ouaga HDSS in 2011) of all the households established in the areas, including those of selected indigents.
  
  
  RESULTS
  The coverage of indigent targeting was very low: 0.33% (loti) and 0.22% (non loti). In the non loti neighbourhood, the level of poverty among people selected was higher than the mean level of the poor who were not selected. Some indigents selected in the loti neighbourhood were not among the worst-off. The process was difficult to organize in the loti neighbourhood; people knew each other less well and were not very available, and there were cases of collusion. The process worked well in the non loti neighbourhood.
  
  
  CONCLUSIONS
  This intervention research provides new evidence about the feasibility of a community-based selection process in an urban setting in Africa by comparing two different urban settings. The participatory community-based selection process appeared to be suitable for the non loti neighbourhood, but other targeting strategies need to be found for loti areas. Specific budgets need to be allocated to increase the coverage of indigent targeting.
authors.affiliation: University of Montreal School of Public Health (ESPUM), Montreal, Canada. valery.ridde@umontreal.ca.
authors.forename: Valéry
authors.initials: V
authors.lastname: Ridde
authors.forename: Clémentine
authors.initials: C
authors.lastname: Rossier
authors.forename: Abdramane B
authors.initials: AB
authors.lastname: Soura
authors.forename: Fiacre
authors.initials: F
authors.lastname: Bazié
authors.forename: Kadidiatou
authors.initials: K
authors.lastname: Kadio
mesh_terms: D000328:Adult; D002050:Burkina Faso; D002947:Cities; D003625:Data Collection; D004608:Eligibility Determination / Q000379:methods*; D005191:Family Characteristics; D005249:Fees and Charges; D005260:Female; D017144:Focus Groups; D006296:Health Services / Q000191:economics; D006297:Health Services Accessibility / Q000191:economics*; D054625:Healthcare Disparities / Q000191:economics*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D011203:Poverty; D011634:Public Health; D012111:Residence Characteristics; D014505:Urban Population
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