Designing community financing schemes in two developing countries

Abstract

This article describes the application of operations research (OR) to the design of community financing strategies in two primary health care (PHC) projects, one in Bolivia and the other in Liberia, during the period 1984–1986. It highlights the use of preference-based heuristics to select appropriate financing schemes, and illustrates how such heuristics can accomodate the preferences, judgments, and knowledge of community members and health professionals alike in arriving at program decisions which have a reasonable probability of being both feasible and acceptable to those most concerned. The paper begins with a description of the Bolivian community financing study. It follows the decision heuristic step-by-step through the identification and initial scoring of alternative strategies, the selection of the most promising of these, and the resulting decision to undertake a field trial in eight villages. Turning to the Liberian study, the paper reviews a considerably less complex preference-based heuristic used in three remote rural communities to select a community financing strategy. That heuristic led to the implementation of a strategy combining four different modes of community support. The results of a 12-month field test of that strategy are described. Although the heuristic decision processes followed in the Bolivian and Liberian cases differ in detail and complexity, the approach used to design a community financing strategy was based on the same principle: the systematic ranking of alternative financing schemes according to the preferences of the relevant decision-makers in order to select that strategy which appears most likely to solve the financing problem in a given community. Officials of both projects conclude that the basic approach affords an effective way to enlist community support in financing a portion of PHC costs from local resources.