Household survey data, time allocation data, and qualitative interviews were used to examine whether households allocate their resources for health care differently between age and gender groups. Households allocated significantly fewer resources to the health care of sick children compared to that of sick adults. In contrast there were no such differences with regard to gender. The underlying household rationale is to concentrate its resources spent for health care on productive members rather than to spread them equitably among all its sick members. While children are not productive, women were shown to contribute as much to household production as men, hence their health is valued equally with that of men. Unless we understand intra-household biases in resource allocation, policies will be undermined. Further research is needed to test the hypothesis for the households' preference of production maintenance over health maximization.
PIP: This study compares household allocation of resources in time and money for child care versus adult care and boys versus girls in Burkina Faso. Analysis is based on data and information from a household interview survey, a time allocation study, and qualitative in-depth interviews. Findings from interviews suggest that children were perceived as "unproductive" and health care was an investment. The household valued provision of health care to productive adults. Health care was underused by the elderly because it was perceived to be ineffective and it was deemed useless to interfere with disease at such a late stage in one's life. The support for an age bias in health care use and expenditure was consistent with multivariate findings of Nougtara et al. (1989) and Sauerborn et al. (1989). Findings suggest that households aimed to maintain production and income. Households gave priority to health care expenditures which stabilize and secure production and income. Households worked very hard to find the money for treatment of an ill but productive household member, whereas little effort was expended for treatment of illness among the very young or the old. Findings did not support gender discrimination in use of health care. Productivity among Burkina Faso women was as high as among men. Four other theories that might explain allocation of household resources to health care were dismissed as unsupported or unlikely. These theories include hypotheses about 1) the lack of information about the availability and effectiveness of health services for children; 2) cultural influences that interfere with modern medical care (Caldwell); 3) child fostering (Bledsoe, Ewbank, and Isiugo-Abanihe); and 4) maternal employment (Basu). Findings suggest that government health strategies might focus on reducing household costs of health care for children and/or adults or on insurance benefits. A better understanding of household priorities might yield better policies.