Challenges in identifying the poor: an assessment of household eligibility for Health Equity Fund after four years of pre-identification in Oddar Meanchey, Cambodia

In developing countries, waivers and exemptions of user fees often fail to preserve equitable access to health services. In Cambodia, Health Equity Funds (HEFs) have been successful in addressing the failure of waivers to improve access to government health services for the poor. In this study, household eligibility for HEF in Oddar Meanchey was evaluated, based on data collected from a household survey conducted four years after preidentification. Three tools were used to assess the level of HEF eligibility for each household: a scoring tool that replicated the one used at preidentification, an assessment by interviewers and a SES index, constructed through principal components analysis. In Oddar Meanchey, the targeting errors that resulted from all the tested tools were high. It seems that the HEF entitlement status of households as it was granted through pre-identification four years earlier does not reflect the real current poverty situation of households anymore. We outline several reasons for this phenomenon and recommend ways to minimize targeting error in the future. Regular updates of pre-identification in combination with post-identification should be considered.