Community-Based versus Statistical Targeting of Anti-Poverty Programs: Evidence from Burkina Faso

2019 ◽  
Vol 29 (3) ◽  
pp. 271-305
Author(s):  
Michael Hillebrecht ◽  
Stefan Klonner ◽  
Noraogo A Pacere ◽  
Aurélia Souares
Keyword(s):  
Burkina Faso ◽  
Low Income ◽  
Urban Areas ◽  
Household Survey ◽  
Cost Effective ◽  
Original Data ◽  
Low Income Countries ◽  
Community Based ◽  
Household Level ◽  
Poor Households

Abstract Targeting of governmental welfare programmes in low-income countries commonly relies on statistical procedures involving household-level data, while smaller-scale programmes often employ community-based targeting, where village communities themselves identify beneficiaries. Combining original data from community-based targeting exercises in Burkina Faso with a household survey we compare the targeting accuracy of community-based targeting with four common statistical targeting methods when the objective is to target consumption-poor households. We find that community-based targeting is substantially less accurate than statistical targeting in villages, while it is as accurate as the much more costly statistical methods in semi-urban areas. We show that this difference is due to differences in poverty concepts held by rural and urban communities. Its large cost advantage makes community-based targeting far more cost-effective than statistical targeting for common amounts of welfare programme benefits.

scholarly journals Epidemiology of multimorbidity in conditions of extreme poverty: a population-based study of older adults in rural Burkina Faso

2020 ◽  
Vol 5 (3) ◽  
pp. e002096
Author(s):  
Maria Lisa Odland ◽  
Collin Payne ◽  
Miles D Witham ◽  
Mark J Siedner ◽  
Till Bärnighausen ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Burkina Faso ◽  
Physical Performance ◽  
Low Income ◽  
Household Survey ◽  
Population Based ◽  
Low Income Countries ◽  
Cross Sectional ◽  
Management Interventions

IntroductionMultimorbidity is a health issue of increasing importance worldwide, and is likely to become particularly problematic in low-income countries (LICs) as they undergo economic, demographic and epidemiological transitions. Knowledge of the burden and consequences of multimorbidity in LICs is needed to inform appropriate interventions.MethodsA cross-sectional household survey collected data on morbidities and frailty, disability, quality of life and physical performance on individuals aged over 40 years of age living in the Nouna Health and Demographic Surveillance System area in northwestern Burkina Faso. We defined multimorbidity as the occurrence of two or more conditions, and evaluated the prevalence of and whether this was concordant (conditions in the same morbidity domain of communicable, non-communicable diseases (NCDs) or mental health (MH)) or discordant (conditions in different morbidity domains) multimorbidity. Finally, we fitted multivariable regression models to determine associated factors and consequences of multimorbidity.ResultsMultimorbidity was present in 22.8 (95% CI, 21.4 to 24.2) of the study population; it was more common in females, those who are older, single, more educated, and wealthier. We found a similar prevalence of discordant 11.1 (95% CI, 10.1 to 12.2) and concordant multimorbidity 11.7 (95% CI, 10.6 to 12.8). After controlling for age, sex, marital status, education, and wealth, an increasing number of conditions was strongly associated with frailty, disability, low quality of life, and poor physical performance. We found no difference in the association between concordant and discordant multimorbidity and outcomes, however people who were multimorbid with NCDs alone had better outcomes than those with multimorbidity with NCDs and MH disorders or MH multimorbidity alone.ConclusionsMultimorbidity is prevalent in this poor, rural population and is associated with markers of decreased physical performance and quality of life. Preventative and management interventions are needed to ensure that health systems can deal with increasing multimorbidity and its downstream consequences.

scholarly journals Vulnerability, Resilience and Transformation of Urban Areas in the Coastal Megacity Lagos: Findings of Local Assessments and a Household Survey in Highly Exposed Areas

2016 ◽  
Vol 03 (03) ◽  
pp. 1650019 ◽  
Author(s):  
Joern Birkmann ◽  
Julius I. Agboola ◽  
Torsten Welle ◽  
Michael Ahove ◽  
Shakirudeen Odunuga ◽  
...  
Keyword(s):  
At Risk ◽  
Risk Management ◽  
Extreme Events ◽  
Low Income ◽  
Urban Areas ◽  
Household Survey ◽  
Transformative Change ◽  
Household Level ◽  
Different Characteristics ◽  
Coastal Megacity

Coastal urban regions in low-lying areas in developing countries are often hotspots of climate change related risks and therefore the analysis of different characteristics of vulnerability, resilience and transformation is an important prerequisite for planning and decision making. Even though the concepts of resilience and transformation have been discussed for some time, they often remain still very abstract. Against this background the following paper aims to illustrate how different characteristics of vulnerability: susceptibility, exposure and adaptation from resilience to transformative change can be assessed in practice at the level of individual households and different city districts. The household survey was conducted in four low-income, at risk areas in the coastal megacity of Lagos. It reveals important differences between the case study locations in terms of perceived capacities and actual responses of households to extreme events and creeping hazards. The analysis of behavioral changes undertaken after extreme events underscores that experience of loss and damage is an important stimulus for people to change their behavior. Moreover perception of actual and future risk management capacities and the performance of government institutions influences risk management regimes at the household level. It was found that at risk populations experienced both, inaction from government and individual households. This is a corrective to the majority literature that focuses on proactive local or government action. In fact, these examples of success may be quite rare and were not found in the four settlements studied in this research. The survey is part of a larger international project regarding the Transformation and Resilience of Urban Coasts (TRUC (2016). Transformation fo urban coasts Available at www.bel_truc.org ) funded by the Belmont Forum and the DFG in particular in terms of the research in Lagos.

scholarly journals Expanding safe fecal sludge management in Kisumu, Kenya: an experimental comparison of latrine pit-emptying services

2020 ◽  
Vol 10 (4) ◽  
pp. 744-755 ◽  
Author(s):  
Rachel Peletz ◽  
Andy Feng ◽  
Clara MacLeod ◽  
Dianne Vernon ◽  
Tim Wang ◽  
...  
Keyword(s):  
Low Income ◽  
Cost Effective ◽  
Experimental Comparison ◽  
Community Based ◽  
Sludge Management ◽  
Septic Tanks ◽  
Poor Households ◽  
Fecal Sludge ◽  
The City ◽  
Safety Procedures

Abstract Most residents of Kisumu, Kenya, use latrines constructed over basic pits or attached to more durable concrete vaults and septic tanks. Only one-third of fecal sludge generated in the city, however, is safely collected and treated. Programs for improving fecal sludge management among poor households include the development of formal manual emptying organizations that are recognized by local authorities, employ safety procedures, and transport fecal sludge to a treatment site. In this study, we compared the financial structures of these organizations with those of vacuum trucks that primarily serve wealthier households. We also employed an incentives-based strategy to promote the expansion of safe pit-emptying services in a low-income area and compared the performance of three managing groups to coordinate these services: (1) The Association of Wastewater Managers (The Association); (2) a formal manual emptying organization; and (3) a community-based water supplier interested in coordinating emptying services. Vacuum trucks were more cost-effective than the formal manual emptying organization, and The Association was most efficient in servicing poor households. The Association also demonstrated the ability to service low-income areas comprehensively by delegating a fraction of jobs (11%) to formal manual emptiers in locations not serviceable by VTOs, and overall showed the highest potential to achieve pro-poor service delivery at scale.

scholarly journals Aptamer-Based Diagnostic Systems for the Rapid Screening of TB at the Point-of-Care

Diagnostics ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. 1352
Author(s):  
Darius Riziki Martin ◽  
Nicole Remaliah Sibuyi ◽  
Phumuzile Dube ◽  
Adewale Oluwaseun Fadaka ◽  
Ruben Cloete ◽  
...  
Keyword(s):  
Low Income ◽  
Point Of Care ◽  
Health Care Systems ◽  
Cost Effective ◽  
Rapid Screening ◽  
Low Income Countries ◽  
Sputum Smear ◽  
Diagnostic Systems ◽  
Molecular Tests ◽  
Rapid Tests

The transmission of Tuberculosis (TB) is very rapid and the burden it places on health care systems is felt globally. The effective management and prevention of this disease requires that it is detected early. Current TB diagnostic approaches, such as the culture, sputum smear, skin tuberculin, and molecular tests are time-consuming, and some are unaffordable for low-income countries. Rapid tests for disease biomarker detection are mostly based on immunological assays that use antibodies which are costly to produce, have low sensitivity and stability. Aptamers can replace antibodies in these diagnostic tests for the development of new rapid tests that are more cost effective; more stable at high temperatures and therefore have a better shelf life; do not have batch-to-batch variations, and thus more consistently bind to a specific target with similar or higher specificity and selectivity and are therefore more reliable. Advancements in TB research, in particular the application of proteomics to identify TB specific biomarkers, led to the identification of a number of biomarker proteins, that can be used to develop aptamer-based diagnostic assays able to screen individuals at the point-of-care (POC) more efficiently in resource-limited settings.

User fees removal and community-based management of undernutrition in Burkina Faso: what effects on children’s nutritional status?

2021 ◽  
pp. 1-12
Author(s):  
David Y Zombré ◽  
Manuela De Allegri ◽  
Valéry Ridde ◽  
Kate Zinszer
Keyword(s):  
Burkina Faso ◽  
Household Survey ◽  
Community Level ◽  
User Fees ◽  
Nutrition Status ◽  
Control Group ◽  
Community Based ◽  
Sahel Region ◽  
Intervention District ◽  
Children Under 5

Abstract Objective: To examine the effect of an intervention combining user fees removal with community-based management of undernutrition on the nutrition status in children under 5 years of age in Burkina Faso. Design: The study was a non-equivalent control group post-test-only design based on household survey data collected 4 years after the intervention onset in the intervention and comparison districts. Additionally, we used propensity score weighting to achieve balance on covariates between the two districts, followed by logistic multilevel modelling. Setting: Two health districts in the Sahel region. Participants: Totally, 1116 children under 5 years of age residing in 41 intervention communities and 1305 from 51 control communities. Results: When comparing children living in the intervention district to children living in a non-intervention district, we determined no differences in terms of stunting (OR = 1·13; 95 % CI 0·83, 1·54) and wasting (OR = 1·21; 95 % CI 0·90, 1·64), nor in severely wasted (OR = 1·27; 95 % CI 0·79, 2·04) and severely stunted (OR = 0·99; 95 % CI 0·76, 1·26). However, we determined that 3 % of the variance of wasting (95 % CI 1·25, 10·42) and 9·4 % of the variance of stunting (95 % CI 6·45, 13·38) were due to systematic differences between communities of residence. The presence of the intervention in the communities explained 2 % of the community-level variance of stunting and 3 % of the community-level variance of wasting. Conclusions: With the scaling-up of the national free health policy in Africa, we stress the need for rigorous evaluations and the means to measure expected changes in order to better inform health interventions.

scholarly journals Adapting the Community-based Health Planning and Services (CHPS) to engage poor urban communities in Ghana: protocol for a participatory action research study

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e049564
Author(s):  
Mary Abboah-Offei ◽  
Akosua Gyasi Darkwa ◽  
Andrews Ayim ◽  
Adelaide Maria Ansah-Ofei ◽  
Delanyo Dovlo ◽  
...  
Keyword(s):  
Action Research ◽  
Participatory Action Research ◽  
Urban Communities ◽  
Low Income ◽  
Urban Areas ◽  
Health Planning ◽  
Phase 1 ◽  
Participatory Action ◽  
Community Based ◽  
Key Stakeholders

IntroductionWith rapid urbanisation in low-income and middle-income countries, health systems are struggling to meet the needs of their growing populations. Community-based Health Planning and Services (CHPS) in Ghana have been effective in improving maternal and child health in rural areas; however, implementation in urban areas has proven challenging. This study aims to engage key stakeholders in urban communities to understand how the CHPS model can be adapted to reach poor urban communities.Methods and analysisA Participatory Action Research (PAR) will be used to develop an urban CHPS model with stakeholders in three selected CHPS zones: (a) Old Fadama (Yam and Onion Market community), (b) Adedenkpo and (c) Adotrom 2, representing three categories of poor urban neighbourhoods in Accra, Ghana. Two phases will be implemented: phase 1 (‘reconnaissance phase) will engage and establish PAR research groups in the selected zones, conduct focus groups and individual interviews with urban residents, households vulnerable to ill-health and CHPS staff and key stakeholders. A desk review of preceding efforts to implement CHPS will be conducted to understand what worked (or not), how and why. Findings from phase 1 will be used to inform and co-create an urban CHPS model in phase 2, where PAR groups will be involved in multiple recurrent stages (cycles) of community-based planning, observation, action and reflection to develop and refine the urban CHPS model. Data will be managed using NVivo software and coded using the domains of community engagement as a framework to understand community assets and potential for engagement.Ethics and disseminationThis study has been approved by the University of York’s Health Sciences Research Governance Committee and the Ghana Health Service Ethics Review Committee. The results of this study will guide the scale-up of CHPS across urban areas in Ghana, which will be disseminated through journal publications, community and government stakeholder workshops, policy briefs and social media content. This study is also funded by the Medical Research Council, UK.

scholarly journals P.028 Global surgery for pediatric hydrocephalus in the developing world: a review of the history, challenges, and future directions

2017 ◽  
Vol 44 (S2) ◽  
pp. S20-S20
Author(s):  
S Wang ◽  
RT Muir ◽  
BC Warf
Keyword(s):  
Low Income ◽  
Developing World ◽  
Pediatric Neurosurgery ◽  
Cost Effective ◽  
Global Surgery ◽  
Low Income Countries ◽  
Global Burden ◽  
Pediatric Hydrocephalus ◽  
Cost Effective Treatment ◽  
Education Gaps

Background: Pediatric hydrocephalus is one of the most common neurosurgical conditions and is a major contributor to the global burden of surgically treatable diseases. Methods: The authors conducted a literature review around the topic of pediatric hydrocephalus in the context of global surgery, the unique challenges to creating access to care in low-income countries, and current international efforts to address the problem. Results: Developing countries face the greatest burden of pediatric hydrocephalus due to high birth rates and greater risk of neonatal infections. This burden is related to more general global health challenges, including malnutrition, infectious diseases, maternal and perinatal risk factors, and education gaps. Unique challenges pertaining to the treatment of hydrocephalus in the developing world include a preponderance of postinfectious hydrocephalus, limited resources, and restricted access to neurosurgical care. In the 21st century, several organizations have established programs that provide hydrocephalus treatment and neurosurgical training in Africa, Central and South America, Haiti, and Southeast Asia. These international efforts have employed various models to achieve the goals of providing safe, sustainable, and cost-effective treatment. Conclusions: Broader commitment from the pediatric neurosurgery community, increased funding, public education, surgeon training, and ongoing surgical innovation will be needed to meaningfully address the global burden of untreated hydrocephalus.

scholarly journals Adaptive Capacity to Extreme Heat: Results from a Household Survey in Houston, Texas

2017 ◽  
Vol 9 (4) ◽  
pp. 787-799 ◽  
Author(s):  
Mary H. Hayden ◽  
Olga V. Wilhelmi ◽  
Deborah Banerjee ◽  
Tamara Greasby ◽  
Jamie L. Cavanaugh ◽  
...  
Keyword(s):  
Adaptive Capacity ◽  
Air Conditioning ◽  
Household Survey ◽  
The United States ◽  
Extreme Heat ◽  
Community Based ◽  
Household Level ◽  
Population Vulnerability ◽  
Heat Risk ◽  
Related Mortality

Abstract Extreme heat is the leading cause of weather-related mortality in the United States, suggesting the necessity for better understanding population vulnerability to extreme heat. The work presented here is part of a larger study examining vulnerability to extreme heat in current and future climates [System for Integrated Modeling of Metropolitan Extreme Heat Risk (SIMMER)] and was undertaken to assess Houston, Texas, residents’ adaptive capacity to extreme heat. A comprehensive, semistructured survey was conducted by telephone at 901 households in Houston in 2011. Frequency and logistic regression analyses were conducted. Results show that 20% of the survey respondents reported heat-related symptoms in the summer of 2011 despite widespread air conditioning availability throughout Houston. Of those reporting heat-related symptoms experienced in the home (n = 56), the majority could not afford to use air conditioning because of the high cost of electricity. This research highlights the efficacy of community-based surveys to better understand adaptive capacity at the household level; this survey contextualizes population vulnerability and identifies more targeted intervention strategies and adaptation actions.

scholarly journals The acceptance of covid-19 vaccines in Sub-Saharan Africa: Evidence from 6 national phone surveys

2021 ◽  
Author(s):  
Shelton Kanyanda ◽  
Yannick Markhof ◽  
Philip Wollburg ◽  
Alberto Zezza
Keyword(s):  
Side Effects ◽  
Low Income ◽  
Urban Areas ◽  
Vaccine Coverage ◽  
Sub Saharan Africa ◽  
Low Income Countries ◽  
Vaccine Hesitancy ◽  
African Countries ◽  
Representative Sampling ◽  
Sub Saharan

Introduction Recent debates surrounding the lagging covid-19 vaccination campaigns in low-income countries center around vaccine supply and financing. Yet, relatively little is known about attitudes towards covid-19 vaccines in these countries and in Africa in particular. In this paper, we provide cross-country comparable estimates of the willingness to accept a covid-19 vaccine in six Sub-Saharan African countries. Methods We use data from six national high-frequency phone surveys from countries representing 38% of the Sub-Saharan African population (Burkina Faso, Ethiopia, Malawi, Mali, Nigeria, and Uganda). Samples are drawn from large, nationally representative sampling frames providing a rich set of demographic and socio-economic characteristics by which we disaggregate our analysis. Using a set of re-calibrated survey weights, our analysis adjusts for the selection biases common in remote surveys. Results Acceptance rates in the six Sub-Saharan African countries studied are generally high, with at least four in five people willing to be vaccinated in all but one country. Vaccine acceptance ranges from nearly universal in Ethiopia (97.9%, 97.2% to 98.6%) to below what would likely be required for herd immunity in Mali (64.5%, 61.3% to 67.8%). We find little evidence for systematic differences in vaccine hesitancy by sex or age but some clusters of hesitancy in urban areas, among the better educated, and in richer households. Safety concerns about the vaccine in general and its side effects emerge as the primary reservations toward a covid-19 vaccine across countries. Conclusions Our findings suggest that limited supply, not inadequate demand, likely presents the key bottleneck to reaching high covid-19 vaccine coverage in Sub-Saharan Africa. To turn intent into effective demand, targeted communication campaigns bolstering confidence in the safety of approved vaccines and reducing concerns about side effects will be crucial to safeguard the swift progression of vaccine rollout in one of the world's poorest regions.

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