education, water, power, food or whatever intended to promote equity and benefit the poor are largely captured by the non-poor , especially by the middle class. Provision of free university education provides a classic example of this. Because of this difficulty there have been many experiments in targeting by geographical area or by individual but the results have often been disappointing. Targeting by disease has merit for some diseases. For example, a tuberculosis control programme that everyone can access (a rare phenomenon) will be pro-poor and pro-equity because it is the poor who suffer disproportionately from tuberculosis. Commonly, however, the poor, and especially the very poor and socially marginalized, do not enjoy equal access to the programme concerned, which therefore