Protecting the poor in Africa : impact of means testing on equity in the health sector in Burkina Faso, Niger, and Senegal

To date, however, there has been no evidence documented to prove the success or failure of such systems. This Technical Note provides evidence from household surveys in Burkina Faso, Niger, and Senegal to show that informal means testing practices do provide financial protection for at least some of the poor during the public sector"s official shift to cost recovery. However, current fee waiver policies also provide a substantial portion of fee waivers to the non-poor, either because of other eligibility criteria in place (e.g., for civil servants, students, military, handicapped) or because of inaccuracies in identifying the poor and "leakages" of waiver benefits. Also, data from Senegal suggest that some private providers, especially church mission health providers, have developed more effective means testing and fee waiver practices than have public providers (they granted twice the percentage of fee waivers to the poor as did MOH facilities). The report concludes that achieving the twin and at times opposed goals of cost recovery and equity will require African MOHs to improve both fee collection and exemption practices.