Since the 1980s, most developing countries have adopted a policy of user fees for health care services. Such
policies, however, reduce access to services for those unable to pay. A variety of options have been explored to
mitigate this negative effect, and these are the subject of three policy briefs that complement this one. One option
is to eliminate this type of policy by abolishing health services user fees altogether. Other options consist of leaving
user fees in place but developing mechanisms to shelter the poor from their negative effects: exempting the poorest
from user fees (with or without health equity funds); developing health insurance that includes special measures for
the poor. In this case, it becomes necessary to identify the poor who are eligible for such initiatives.
However, in a context of widespread poverty, determining who really is poor can be a challenge. Numerous exemption
experiences have had ambivalent results in terms of access to services for the poorest. Many evaluations of these
experiences have noted a lack of clarity in the criteria and processes used to identify the poor.
What is the best way to operationalise identification of the poor? This information brief describes how identification
processes were carried out in several developing countries, focusing on four aspects: processes for defining
identification criteria; the identification criteria used; processes for identifying the poor; and the effectiveness of the
identification, i.e., the capacity to actually distinguish the poor from the others.