title: Using a community-based definition of poverty for targeting poor households for premium subsidies in the context of a community health insurance in Burkina Faso.
abstract: BACKGROUND
  One of the biggest challenges in subsidizing premiums of poor households for community health insurance is the identification and selection of these households. Generally, poverty assessments in developing countries are based on monetary terms. The household is regarded as poor if its income or consumption is lower than a predefined poverty cut-off. These measures fail to recognize the multi-dimensional character of poverty, ignoring community members' perception and understanding of poverty, leaving them voiceless and powerless in the identification process. Realizing this, the steering committee of Nouna's health insurance devised a method to involve community members to better define 'perceived' poverty, using this as a key element for the poor selection. The community-identified poor were then used to effectively target premium subsidies for the insurance scheme.
  
  
  METHODS
  The study was conducted in the Nouna's Health District located in northwest Burkina Faso. Participants in each village were selected to take part in focus-group discussions (FGD) organized in 41 villages and 7 sectors of Nouna's town to discuss criteria and perceptions of poverty. The discussions were audio recorded, transcribed and analyzed in French using the software NVivo 9.
  
  
  RESULTS
  From the FGD on poverty and the subjective definitions and perceptions of the community members, we found that poverty was mainly seen as scarcity of basic needs, vulnerability, deprivation of capacities, powerlessness, voicelessness, indecent living conditions, and absence of social capital and community networks for support in times of need. Criteria and poverty groups as described by community members can be used to identify poor who can then be targeted for subsidies.
  
  
  CONCLUSIONS
  Policies targeting the poorest require the establishment of effective selection strategies. These policies are well-conditioned by proper identification of the poor people. Community perceptions and criteria of poverty are grounded in reality, to better appreciate the issue. It is crucial to take these perceptions into account in undertaking community development actions which target the poor. For most community-based health insurance schemes with limited financial resources, using a community-based definition of poverty in the targeting of the poorest might be a less costly alternative.
authors.affiliation: Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso. germain_savadogo@hotmail.com.|Institute of Public Health, University of Heidelberg, INF 324 69120, Heidelberg, Germany. germain_savadogo@hotmail.com.
authors.forename: Germain
authors.initials: G
authors.lastname: Savadogo
authors.affiliation: Institute of Public Health, University of Heidelberg, INF 324 69120, Heidelberg, Germany. souares@uni-heidelberg.de.
authors.forename: Aurelia
authors.initials: A
authors.lastname: Souarès
authors.affiliation: Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso. alisie.crsn@fasonet.bf.
authors.forename: Ali
authors.initials: A
authors.lastname: Sié
authors.affiliation: School of Health Sciences, City University, London, UK. Divya.Parmar@city.ac.uk.
authors.forename: Divya
authors.initials: D
authors.lastname: Parmar
authors.affiliation: Department of Anthropology, University of Montreal, Montreal, Canada. gilles.bibeau2@sympatico.ca.
authors.forename: Gilles
authors.initials: G
authors.lastname: Bibeau
authors.affiliation: Institute of Public Health, University of Heidelberg, INF 324 69120, Heidelberg, Germany. rainer.sauerborn@urz.uni-heidelberg.de.
authors.forename: Rainer
authors.initials: R
authors.lastname: Sauerborn
mesh_terms: D002050:Burkina Faso; D003906:Developing Countries / Q000191:economics; D004608:Eligibility Determination / Q000379:methods*; D005260:Female; D017144:Focus Groups; D006801:Humans; D007182:Income / Q000706:statistics & numerical data*; D007348:Insurance, Health / Q000706:statistics & numerical data*; D011203:Poverty / Q000706:statistics & numerical data*; D011634:Public Health / Q000191:economics; D012111:Residence Characteristics / Q000706:statistics & numerical data