Objectives: To examine the frequency of street food consumption of people living in low-income settlements in Nairobi and the role of street foods in their daily diet and to reveal why people consume street foods rather than home-prepared foods. Setting, subjects and methods: A cross-sectional descriptive study was done with 1011 households and in-depth interviews with a subsample of 73 households in two selected areas in Nairobi: Korogocho, a low-income slum area and Dandora, a low ± middle-income area. Results: The frequency of street food consumption was higher in Korogocho than in Dandora (3.6 vs 2.0 days per week; P`0.001). Street food consumption did not differ between different types of households, with the exception of household size. Employment status of the household head and street food consumption were related (P`0.001): consumption frequency of 3.7 days per week when irregularly or unemployed, 2.9 daysaweek when self-employed and 2.1 daysaweek when regularly employed. Furthermore, where an adult woman with primarily a domestic role was present, street food consumption was less (2.55 days per week when present vs 2.95 when not present; P`0.05). Conclusions: Street foods play an important role in the diet of poor households in Nairobi, in particular for breakfast and snacks, because they are cheap and convenient. The frequency of street food consumption is determined by a combination of at least four factors: level of household income; regularity of income; household size; and time available to prepare meals. Sponsorship: The project is ®nanced by the Netherlands Foundation for the Advancement of Tropical Research (WOTRO), ®lenumber WV 96-153.

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Performance-Based Financing (PBF) is a promising approach to improve health system performance in developing countries, but there are concerns that it may inadequately address inequalities in access to care. Incentives for reaching the poor may prove beneficial, but evidence remains limited. We evaluated a system of targeting the poorest of society (‘indigents’) in a PBF programme in Cameroon, examining (under)coverage, leakage and perceived positive and negative effects. We conducted a documentation review, 59 key informant interviews and 33 focus group discussions with community members (poor and vulnerable people—registered as indigents and those not registered as such). We found that community health workers were able to identify very poor and vulnerable people with a minimal chance of leakage to non-poor people. Nevertheless, the targeting system only reached a tiny proportion (≤1%) of the catchment population, and other poor and vulnerable people were missed. Low a priori set objectives and implementation problems—including a focus on easily identifiable groups (elderly, orphans), unclarity about pre-defined criteria, lack of transport for identification and insufficient motivation of community health workers—are likely to explain the low coverage. Registered indigents perceived improvements in access, quality and promptness of care, and improvements in economic status and less financial worries. However, lack of transport and insufficient knowledge about the targeting benefits, remained barriers for health care use. Negative effects of the system as experienced by indigents included negative reactions (e.g. jealousy) of community members. In conclusion, a system of targeting the poorest of society in PBF programmes may help reduce inequalities in health care use, but only when design and implementation problems leading to substantial under-coverage are addressed. Furthermore, remaining barriers to health care use (e.g. transport) and negative reactions of other community members towards indigents deserve attention.