Poster presented by Kadio Kadi (Emerging Voice 2012 http://www.ev4gh.net/EV2012.html) at Second Global Symposium on Health Systems Research (HSR). http://www.hsr-symposium.org To understand why people living in high income households were considered indigents by their communities. Two hypotheses were formulated: • because they do not have access to their household’s resources; • because other criteria than economic poverty were used to identify indigent.

1. Wealth, poverty and local perceptions
of poverty in Burkina Faso
Kadio, Kadidiatou1 Results
Who are the Indigents living in
Ridde, Valéry 123
high-income households?
Samb, Oumar 3
Heads of household
1
Institut de Recherche en Science de la Santé, Burkina Faso indigents with high income
2
CRCHUM, DMSP Udem
3
Université de Montréal, Canada • Without a son or available
child to cultivate the land.
kadioka1@yahoo.fr
• Physical disability limiting
self-support due to old age or
Introduction The community defined an and chronic disabling illness.
• Since 2007, in the distict
indigent person “as “one who • However their survival Discussion
of Ouargaye (Burkina Faso),
is under extreme social and depends in part:
economic poverty, who has Unequal access to resources within the household
an action research imple- - on periodic income:
no support and is unable to
mented, the user fees they implement income-generating activities that require little • We believed that the presence of the poor in high income households
take care for themselves.”
exemption for the indigents. physical effort. was the consequence of exclusion. However, the results seem to
partially refute this hypothesis.
• By this consensus definition, the village selection committees (VSC) - or the solidarity of their social network.
proposed a list of ‘indigents. The unit of selection of the extremely • Poor have access to food in their households, but have a limited
This explains why they are situated in the higher economic strata. ability to systematically mobilize monetary resources of households
poor was the individual, not the household.
to meet their health needs.
• The efficacy of the targeting process was demonstrated (Ridde et al
“Whoever gives me to eat [....] If my mil is finished, the chief • Their low contribution to the mobilization of hous hold resources
2010), But the analysis showed that 17.6% of the indigents (i.e. 410
of Tensobtenga [village chief], takes care of me. If daughters’ explains their limited access to resources for their health needs
of the 2330) selected by VSC in 2010, live in households ranking in
husbands get millet they give me flour [..] Anyone who comes here (Behrman, 1988,Nougtara, 1989 Saauerborn, 1996)
the top quintile of poverty (Table 1); the wealthiest.
gives me 100CFA.“
IN34, 70 years Social dimension of poverty
Table 1: Distribution of households by quintiles
according to consumer spending • Community perception of poverty and indigence goes beyond
Indigents who are members of high-income households economic wealth. In all cases, selected indigents are unable to live
These indigents share common without outside support.
Indigents Average spending
Quintiles per years per person
characteristics related to vulnerability: • Village selection committees considered other dimensions than
Number percentage (FCFA*) monetary resources, such as the individual’s inability to participate
• Age: They are very old, widows/
Q 1 (inférieur) 564 24,2 42 200
fully in social life. It is the social dimension of poverty or even the lack
widowers, single (no children or who
of “capability” (Sen, 2000)
Q2 494 21,2 55 000 had only girls), with no direct link with
the household head (stepmother,
Q3 434 18,6 62 900 brother, sister, aunt, etc.). Conclusion
Q4 428 18,4 76 200
• Mental Health • Community selection, accommodates for local perceptions of poverty
Q 5 (supérieur) 410 17,6 126 000 by including a social dimension .
• Chronic illness: (example: filariasis,
TOTAL 2 330 100,0 72 500 blindness, epilepsy). • It helps to reach people that an economic analysis would have been
pushed into a ‘high-income household’ category that they do not
*500FCFA=1$USA necessarily have access to their household resources to access
“He’s my little brother, [...] He has to eat, but it is difficult [...] If I
health care in a timely fashion
look at my brother, I want to cry, it is better to die than to suffer like
Objective that and to lose his dignity. For three years, I paid for his care. This
situation has impoverished me. His choice by the committee
To understand why people living in high income households were
relieved me a little bit“
considered indigents by their communities. Two hypotheses were
Indigent householder IN9 44 years.
formulated:
• because they do not have access to their household’s resources;
They have access to their household goods, and are likely to receive
• because other criteria than economic poverty were used to the respect and consideration of other household members and the Valéry Ridde is a New Investigator of the Canadian Institute for Health Research (CIHR). The research was made possible through
identify indigent. family in general. However, access to resources for health care is funding from the International Development Research Centre (IDRC) and with support from the Global Health Research Initiative (GHRI),
a collaborative research funding partnership of the Canadian Institutes of Health Research, the Canadian International Development Agency,
not systematic. Health Canada, the International Development Research Centre, and the Public Health Agency of Canada, see http://www.vesa-tc.umontreal.ca.
References
“[....] The most difficult are the health issues. When she is sick,
Behrman, J. R. (1988). Nutrition, health, birth order and seasonality: Intrahousehold allocation among children in rural India.”
she spent lots of time before going to the clinic because money is Journal of development economics 28(1): 43.
lacking. People are more willing to sell millet or a goat to bring their Nougtara, A. (1989). Assessment of MCH services offered by professional and community health workers in the District of Solenzo, Burkina
Faso : utilization of MCH services. Journal of Tropical Pediatrics 35: 2.
children to the clinic, than an old person. That does not make them Ridde, V., Haddad, S., Nikiema, B., Ouedraogo, M., Kafando, Y., & Bicaba, A. (2010). Lowcoverage but few inclusion errors in Burkina Faso:
bad, but the lack of money often leads to prioritize” a community-based targeting approach to exempt the indigent from user fees. BMC public health, 10(1),
Chief concession of indigent IN14, 65 years. Ridde, V. (2012). L’accès aux soins de santé en Afrique de l’Ouest. Au-delà des idéologies et des idées reçues, Montréal, Presses de
l’Université de Montréal.
Sauerborn, R., Berman, P. et al. (1996). Age bias, but no gender bias, in the intra-household resource allocation for health care in rural Burkina
Faso. Health transition review 6(2): 131-145
Sen, A. (2000). Un nouveau modèle économique: développement, justice, liberté. Paris, Edition Odile Jacob.
Method
An exploratory and descriptive qualitative study was conducted in
17 health facilities. Fifty-four interviews were conducted with indigent
people selected in the wealthiest households. Data analysis were
conducted using a thematic approach (Paillé & Mucchielli, 2003).