This paper assesses the ex-post performance of two popular targeting mechanisms, Proxy Means Testing (PMT) and Community-Based Targeting (CBT), in a pilot cash transfer program in Cameroon. CBT is found to perform poorly in terms of selecting households with low per capita consumption when compared to PMT. CBT appears to select households with low physical and human capital, regardless of actual consumption level and shows more variability in the selection decision than PMT. The results suggest caution is needed in employing CBT methods to select households with low per capita consumption in an environment with high poverty rates and limited administrative capacity.

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Can insurance cost-effectively mitigate the increasingly deleterious impacts of climate risk on poverty and food insecurity? The theory reviewed in this chapter suggests an affirmative answer if well-designed insurance contracts can be implemented and priced at a reasonable level despite the uncertainties that attend climate change. Evidence from the IBLI index insurance project in the pastoral regions in East Africa suggest that these practical difficulties can be overcome and that insurance can have the impacts that underlay the positive theoretical evaluation. At the same time, continuing analysis of the IBLI experience suggests that much remains to be done if quality index insurance contracts are to be scaled up and sustained. We conclude that insurance is not an easy, off-the-shelf solution to the problem of climate risk and food insecurity. Creativity in the technical and institutional design of contracts is still required, as are efforts to forge the more effective publicprivate partnerships needed to price insurance at levels that will allow insurance to fulfill its potential as part of an integrated approach to social protection and food security in an era of climate change.There is ample evidence that climate shocks create and sustain poverty and food insecurity in rural regions of the developing world. There is also ample evidence that climate change is increasing the frequency and severity of climate shocks.

The Policy Research Working Paper Series disseminates the findings of work in progress to encourage the exchange of ideas about development issues. An objective of the series is to get the findings out quickly, even if the presentations are less than fully polished. The papers carry the names of the authors and should be cited accordingly. The findings, interpretations, and conclusions expressed in this paper are entirely those of the authors. They do not necessarily represent the views of the International Bank for Reconstruction and Development/World Bank and its affiliated organizations, or those of the Executive Directors of the World Bank or the governments they represent.

BackgroundIn Africa, health research on indigent people has focused on how to target them for services, but little research has been conducted to identify the social groups that compose indigence. Our aim was to identify what makes someone indigent beyond being recognised by the community as needing a card for free healthcare.MethodsWe used data from a survey conducted to evaluate a state-led intervention for performance-based financing of health services in two districts of Burkina Faso. In 2015, we analysed data of 1783 non-indigents and 829 people defined as indigents by their community in 21 villages following community-based targeting processes. Using a classification tree, we built a model to select socioeconomic and health characteristics that were likely to distinguish between non-indigents and indigents. We described the screening performance of the tree using data from specific nodes.ResultsWidow(er)s under 45 years of age, unmarried people aged 45 years and over, and married women aged 60 years and over were more likely to be identified as indigents by their community. Simple rules based on age, marital status and gender detected indigents with sensitivity of 75.6% and specificity of 55% among those 45 years and over; among those under 45, sensitivity was 85.5% and specificity 92.2%. For both tests combined, sensitivity was 78% and specificity 81%.ConclusionIn moving towards universal health coverage, Burkina Faso should extend free access to priority healthcare services to widow(er)s under 45, unmarried people aged 45 years and over, and married women aged 60 years and over, and services should be adapted to their health needs.Ethics considerationsThe collection, storage and release of data for research purposes were authorised by a government ethics committee in Burkina Faso (Decision No. 2013-7-066). Respondent consent was obtained verbally.