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Methods to evaluate the effectiveness of a
community-based selection of indigents
N Atchessi, V Ridde, E Bonnet, K Kadio, M-V
Zunzunégui
CRCHUM, Health Research Axis
Ecohealth 2014, August, 12th 2014
Session: Nuts & bolts of EcoHealth research: sharing data integration strategies for Ecohealth studies
Introduction
• Burkina Faso, West Africa
• Community-based selection of
indigents in 2010
• Step 1: CSV selection
• Step 2: CoGes Selection
• Indigents retained are those
selected by CoGes.
• Is this an effective selection
method?
• Objective: describe two
methods used to evaluate the
effectiveness of a community-
based selection of indigents
Session: Nuts & bolts of EcoHealth research: sharing data integration strategies for Ecohealth studies
Method
• Method 1: Spatial analysis
• Hypothesis 1: The entities
representing the communities (CSV
and CoGes) tended to select indigents
who were physically nearer to them.
• Method 2: Analysis of characteristics
• Hypothesis 2: Indigents selected by
CoGes are the more socially and
economically vulnerable
• Strategy: Compare two groups of
indigents selected by 2 types of
community organization
According to your context
Session: Nuts & bolts of EcoHealth research: sharing data integration strategies for Ecohealth studies
Method
Why these methods?
• Both methods use objective criteria to measure a
selection method based on the judgment and will
of selection committee members
• Determinants of health care access are used to
assess the effectiveness of the indigent selection
According to your context
Session: Nuts & bolts of EcoHealth research: sharing data integration strategies for Ecohealth studies
Method
• Spatial analysis
 Socially and spatially representative sample of indigents in the
two groups
 Variables: village location, indigents location (GPS), road, trails
network, hydrographic network, administrative boundaries
 Analysis: geographic distribution of indigents
• Analysis of characteristics
 Variables: (Andersen and Newman model)
 predisposing factors;
 facilitating factors;
 needs.
 Logistic regression: Factors associated with possession of
indigent card
According to your context
Session: Nuts & bolts of EcoHealth research: sharing data integration strategies for Ecohealth studies
Method
Challenges and limitations
• Spatial analysis
 Not enough to assess
effectiveness of selection
when used alone
 Scarcity of geographic data
• Analysis of characteristics
 Age over/under-estimated
 Self-reported variables
Strengths and opportunities
• Spatial analysis
 Assessment of effectiveness of
selection with geographic
determinants of health
 Indicators based on distance
• Analysis of characteristics
 Cross-sectional design
 Multivariate analysis
 Andersen and Newman model:
a comprehensive model
Session: Nuts & bolts of EcoHealth research: sharing data integration strategies for Ecohealth studies
Results
Analysis of characteristics
Including an example
Session: Nuts & bolts of EcoHealth research: sharing data integration strategies for Ecohealth studies
Spatial analysis:
 CSV had no particular pattern of
selection
 CoGes tended to select Indigents
who were geographically nearest
to health centers
Variables OR CI
95%
Predisposing
factors
Sex ns
Age ns
Widowed
vs. not widowed
1.40
*
[1.10-
1.78]
Facilitatingfactors
Instrumental assistance ns
Lack of financial assistance
vs. financial assistance
1.58
*
[1.26-
1.97]
Living alone
Living with spouse
vs. Living with children
1.28
*
2.00
*
[1.01-
1.63]
[1.35-
2.96]
Needs
Chronic illness ns
Vision impairment
vs. no vision impairment
1.45
*
[1.14-
1.84]
[1.28-
References
Thank you!
1-Andersen R, Newman JF: Societal and individual determinants of medical care utilization in the United
States. Milbank Memorial Fund Quarterly. Health and Society 1973. 51(1): 95-124.
3-Nagi SZ: An epidemiology of disability among adults in the United States. Milbank Memorial Fund
Quarterly. Health and Society 1976. 54(4): 439-467.
4-Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG, Scherr PA, Wallace RB: A
short physical performance battery assessing lower extremity function: association with self-reported
disability and prediction of mortality and nursing home admission. Journal of Gerontology 1994. 49(2):
M85-94.
5-Arnaud M., Emery X. (2000), Estimation et interpolation spatiale, Paris, Hermes Science Publications.
6-Banos A., Huguenin-Richard F. (2000), « Spatial distribution of road accidents in the vicinity of point
sources : application to child pedestrian accidents », in Flahault A., Toubiana L. (eds), Geography and
Medicine, Elsevier, pp. 54-64.
http://www.equitesante.org/home/
Session: Nuts & bolts of EcoHealth research: sharing data integration strategies for Ecohealth studies

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Methods to evaluate the effectiveness of a community-based selection of indigents

  • 1. Methods to evaluate the effectiveness of a community-based selection of indigents N Atchessi, V Ridde, E Bonnet, K Kadio, M-V Zunzunégui CRCHUM, Health Research Axis Ecohealth 2014, August, 12th 2014 Session: Nuts & bolts of EcoHealth research: sharing data integration strategies for Ecohealth studies
  • 2. Introduction • Burkina Faso, West Africa • Community-based selection of indigents in 2010 • Step 1: CSV selection • Step 2: CoGes Selection • Indigents retained are those selected by CoGes. • Is this an effective selection method? • Objective: describe two methods used to evaluate the effectiveness of a community- based selection of indigents Session: Nuts & bolts of EcoHealth research: sharing data integration strategies for Ecohealth studies
  • 3. Method • Method 1: Spatial analysis • Hypothesis 1: The entities representing the communities (CSV and CoGes) tended to select indigents who were physically nearer to them. • Method 2: Analysis of characteristics • Hypothesis 2: Indigents selected by CoGes are the more socially and economically vulnerable • Strategy: Compare two groups of indigents selected by 2 types of community organization According to your context Session: Nuts & bolts of EcoHealth research: sharing data integration strategies for Ecohealth studies
  • 4. Method Why these methods? • Both methods use objective criteria to measure a selection method based on the judgment and will of selection committee members • Determinants of health care access are used to assess the effectiveness of the indigent selection According to your context Session: Nuts & bolts of EcoHealth research: sharing data integration strategies for Ecohealth studies
  • 5. Method • Spatial analysis  Socially and spatially representative sample of indigents in the two groups  Variables: village location, indigents location (GPS), road, trails network, hydrographic network, administrative boundaries  Analysis: geographic distribution of indigents • Analysis of characteristics  Variables: (Andersen and Newman model)  predisposing factors;  facilitating factors;  needs.  Logistic regression: Factors associated with possession of indigent card According to your context Session: Nuts & bolts of EcoHealth research: sharing data integration strategies for Ecohealth studies
  • 6. Method Challenges and limitations • Spatial analysis  Not enough to assess effectiveness of selection when used alone  Scarcity of geographic data • Analysis of characteristics  Age over/under-estimated  Self-reported variables Strengths and opportunities • Spatial analysis  Assessment of effectiveness of selection with geographic determinants of health  Indicators based on distance • Analysis of characteristics  Cross-sectional design  Multivariate analysis  Andersen and Newman model: a comprehensive model Session: Nuts & bolts of EcoHealth research: sharing data integration strategies for Ecohealth studies
  • 7. Results Analysis of characteristics Including an example Session: Nuts & bolts of EcoHealth research: sharing data integration strategies for Ecohealth studies Spatial analysis:  CSV had no particular pattern of selection  CoGes tended to select Indigents who were geographically nearest to health centers Variables OR CI 95% Predisposing factors Sex ns Age ns Widowed vs. not widowed 1.40 * [1.10- 1.78] Facilitatingfactors Instrumental assistance ns Lack of financial assistance vs. financial assistance 1.58 * [1.26- 1.97] Living alone Living with spouse vs. Living with children 1.28 * 2.00 * [1.01- 1.63] [1.35- 2.96] Needs Chronic illness ns Vision impairment vs. no vision impairment 1.45 * [1.14- 1.84] [1.28-
  • 8. References Thank you! 1-Andersen R, Newman JF: Societal and individual determinants of medical care utilization in the United States. Milbank Memorial Fund Quarterly. Health and Society 1973. 51(1): 95-124. 3-Nagi SZ: An epidemiology of disability among adults in the United States. Milbank Memorial Fund Quarterly. Health and Society 1976. 54(4): 439-467. 4-Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG, Scherr PA, Wallace RB: A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. Journal of Gerontology 1994. 49(2): M85-94. 5-Arnaud M., Emery X. (2000), Estimation et interpolation spatiale, Paris, Hermes Science Publications. 6-Banos A., Huguenin-Richard F. (2000), « Spatial distribution of road accidents in the vicinity of point sources : application to child pedestrian accidents », in Flahault A., Toubiana L. (eds), Geography and Medicine, Elsevier, pp. 54-64. http://www.equitesante.org/home/ Session: Nuts & bolts of EcoHealth research: sharing data integration strategies for Ecohealth studies

Editor's Notes

  1. The study took place in Burkina Faso, where indigent selection is a challenge. The aim of the process is to select indigents so that the poorest and most vulnerable people in the population can benefit from health programs, such as user fees exemptions. A community-based selection process was carried out in a centre-east region of Burkina Faso in 2010. This was an inexpensive method designed for rural areas. First, each of the village health committees (CVS, or comité villageois de santé) selected the people in their village that they considered to be indigent, using their best judgment. Then, the health centre management committees took the lists of indigents selected by the CVSs and chose the people they considered to be the poorest and most vulnerable. Research question: Is this an effective selection method? Were the people who were finally selected actually the poorest and most vulnerable?
  2. We used two methods to analyze the effectiveness of the indigent selection processes: Method 1: spatial analysis Method 2: analysis of characteristics
  3. Spatial analysis: According to the results of this analysis: - the CVSs indiscriminately selected indigents who were both near and far from health centres - the CoGes tended to select indigents who lived nearest to the health centres   Explanation: - The CVSs are local committees who have a better knowledge of the villagers they represent. - The CoGes know the villagers less well. - The demographic composition of the CoGes is not representative of all the villages.