Designing Health and Population Program to Research the poor

Abstract

Nearly everywhere in the developing world health services benefit the well-off more than the poor. Even in programs designed and funded expressly to address the health needs of the poor--such as family planning maternity care and child nutrition--better-off groups usually capture more of the benefits by using the services more than disadvantaged groups. The poor receive less care for a variety of reasons including lack of knowledge lack of power inaccessibility of facilities that provide decent care unresponsive health providers and the cost of some services. Successful programs in a variety of settings in developing countries have worked to overcome these barriers to give the neediest a greater share of program benefits. Some national health programs provide universal health coverage to ensure the poor are included; others focus directly on poor communities and families while others pursue a combination of both. Some programs are reorganized in ways that bring health providers closer to communities or give community members a greater say in program design and implementation. However any approach can have unintended results and no single approach is likely to work for all health services in all settings. Whatever strategy is pursued careful attention to program design monitoring and evaluation is needed to ensure that health benefits are reaching the poor. Policymakers and program managers will want to study the approaches tried in other settings adapt them to local circumstances measure their impact and refine those that work while abandoning those that do not. The tools to determine whether a program reaches the poorest groups are readily available. While using them may take more effort than program managers normally devote to evaluation the tools are not especially difficult to apply. Part 4 and the Appendix describe some of these tools and show where program planners and evaluators can obtain more information about them. Applying these tools is an important first step to tackling the failure of many health programs to serve the poor effectively. (excerpt)