abstract: 'There is growing concern that health policies and programmes may be

  contributing to disparities in health and wealth between and within

  households in low-income settings. However, there is disagreement

  concerning which combination of health and non-health sector

  interventions might best protect the poor. Potentially promising

  interventions include those that build on the social resources that have

  been found to be particularly critical for the poor in preventing and

  coping with illness costs. In this paper we present data on the role of

  one form of social resourcecommunity-based organizations (CBOs) - in

  household ability to pay for health care on the Kenyan coast. Data were

  gathered from a rural and an urban setting using individual interviews

  (n = 24), focus group discussions (n = 18 in each setting) and

  cross-sectional surveys (n = 294 rural and n = 576 urban households). We

  describe the complex hierarchy of CBOs operating at the strategic,

  intermediate and local level in both settings, and comment on the

  potential of working through these organizations to reach and protect

  the poor. We highlight the challenges around several interventions that

  are of particular international interest at present: community-based

  health insurance schemes; micro-finance initiatives; and the removal of

  primary care user fees. We argue the importance of identifying and

  building upon organizations with a strong trust base in efforts to

  assist households to meet treatment costs, and emphasize the necessity

  of reducing the costs of services themselves for the poorest households.'
affiliation: 'Molyneux, C (Corresponding Author), Ctr Geog Med Res, Wellcome Trust
  Collaborat Res Programme, KEMRI, POB 230, Kilifi, Kenya.

  Ctr Geog Med Res, Wellcome Trust Collaborat Res Programme, KEMRI, Kilifi, Kenya.

  Med San Frontieres Holland, NL-1001 EA Amsterdam, Netherlands.

  Univ Witwatersrand, Ctr Hlth Policy, Johannesburg, South Africa.

  Univ London London Sch Hyg \& Trop Med, London WC1E 7HT, England.'
author: Molyneux, Catherine and Hutchison, Beryl and Chuma, Jane and Gilson, Lucy
author-email: SMolyneux@kilifi.kemri-wellcome.org
author_list:
- family: Molyneux
  given: Catherine
- family: Hutchison
  given: Beryl
- family: Chuma
  given: Jane
- family: Gilson
  given: Lucy
da: '2023-09-28'
doi: 10.1093/heapol/czm031
files: []
issn: 0268-1080
journal: HEALTH POLICY AND PLANNING
keywords: 'illness; ability to pay; social relations; community-based

  organizations; community financing; user fees; micro-finance; trust'
keywords-plus: 'SUB-SAHARAN AFRICA; PRIVATE-SECTOR; LOW-INCOME; INSURANCE; EXPERIENCE;

  VIEWPOINT; COUNTRIES; DELIVERY; SERVICES; POVERTY'
language: English
month: NOV
number: '6'
number-of-cited-references: '50'
orcid-numbers: 'Gilson, Lucy/0000-0002-2775-7703

  Molyneux, Catherine/0000-0001-9522-416X'
pages: 381-392
papis_id: 3c1e3ea9b209b80cba1087a98d8e535a
ref: Molyneux2007rolecommunitybased
researcherid-numbers: 'Gilson, Lucy/R-8846-2019

  Molyneux, Catherine/HGB-8464-2022'
times-cited: '29'
title: The role of community-based organizations in household ability to pay for health
  care in Kilifi District, Kenya
type: Article
unique-id: WOS:000251036200004
usage-count-last-180-days: '0'
usage-count-since-2013: '11'
volume: '22'
web-of-science-categories: Health Care Sciences \& Services; Health Policy \& Services
year: '2007'