Targeting the Poorest in a Performance-Based Financing Program in Northern Cameroon

Performance-Based Financing (PBF) is a promising approach to improve health system performance in developing countries, but there are concerns that it may inadequately address inequalities in access to care. Incentives for reaching the poor may prove beneficial, but evidence remains limited. The authors of this article evaluated a system of targeting the poorest of society (‘indigents’) in a PBF programme in Cameroon, examining (under)coverage, leakage and perceived positive and negative effects. They also conducted a documentation review, 59 key informant interviews and 33 focus group discussions with community members (poor and vulnerable people—registered as indigents and those not registered as such). They found that community health workers were able to identify very poor and vulnerable people with a minimal chance of leakage to non-poor people.