The difficulties of access to health care for indigent living in non-poor households

Introduction: To increase the financial access to health care for indigents, an action research was conducted in Burkina Faso. Based on a community approach, village committees identified indigents who were exempt from payment of health care fees. Quantitative analysis of the food expenditure of selected households (to assess the efficacy of the community-based selection) showed that some of the indigents selected came from households with a high economic level. This research was designed to explain why these people were identified by the Village Selection Committees (VSC). Methods: This study was based on a qualitative exploratory descriptive approach, complementary and subsequent to a quantitative study. Life stories and individual interviews were conducted with stratified random sampling of 54 indigents. Thematic content analysis was performed. Results: Indigents identified by the community are usually elderly, unable to work because of old age or chronic illness. However, some of them came from households with a high level of consumption, which can be explained by the fact that they benefit from community aid for their food needs. However, they present persistent difficulties of access to health care. Discussion: The community perceives poverty in terms other simply economic aspects. The social dimension of poverty (including the inability to fully participate in community life) has a major impact on the choice of the CVS, leading to the selection of indigents from households that appear to have a high economic level. This community process which takes into account contextual factors, identified these people who do not necessarily have access to the household resources for health care.