Addressing access barriers to health services: an analytical framework for selecting appropriate interventions in low-income Asian countries

Abstract

While World Health Organization member countries embraced the concept of universal coverage as early as 2005, few low-income countries have yet achieved the objective. This is mainly due to numerous barriers that hamper access to needed health services. In this paper we provide an overview of the various dimensions of barriers to access to health care in low-income countries (geographical access, availability, affordability and acceptability) and outline existing interventions designed to overcome these barriers. These barriers and consequent interventions are arranged in an analytical framework, which is then applied to two case studies from Cambodia. The aim is to illustrate the use of the framework in identifying the dimensions of access barriers that have been tackled by the interventions. The findings suggest that a combination of interventions is required to tackle specific access barriers but that their effectiveness can be influenced by contextual factors. It is also necessary to address demand-side and supply-side barriers concurrently. The framework can be used both to identify interventions that effectively address particular access barriers and to analyse why certain interventions fail to tackle specific barriers.

Assessing geographical inequity in availability of hospital services under the state-funded universal health insurance scheme in Chhattisgarh state, India, using a composite vulnerability index

“…Those who have discussed the inherent limitations of insurance-like, demand-side interventions argue that there is a need to focus on and strengthen the supply side of health service provision if all aspects of access and equity are to be addressed [24,73,74], failing which, Universal Health Coverage would be ‘nominal’ rather than ‘effective’ ([28], pp. 26–27).…”

Cervical cancer screening: barriers to access and potential solutions for Nigeria

“…The various mechanisms that could be used have been categorized into financial and non-financial interventions and discussed under along the dimensions of access. The financial schemes address the dimensions of affordability and geographical access, which tend to be related, while the non-financial schemes address awareness and acceptability barriers 37 .…”

“…They are different from health equity funds, which are third-party mechanisms that Table 3: Demand-and Supply-Side Barriers to Access. Adapted from Jacob et al 37 . reimburse selected health care providers for services delivered to eligible poor.…”

“…Conditional cash transfers are monetary transfers made to households over a certain time period when complying with certain health behaviour 40 . Thus they can make money available for transport while cash transfers make money available for transport (geographic accessibility), often deal with low education (availability), address household resources and cash flow within society (affordability), specifically deal with health awareness, and can tackle low self-esteem, cultural preferences, and stigma (acceptability) 37 .…”

“…The non-financial interventions which would be useful for cervical cancer screening include raising awareness, community participation, and community-based interventions 37,42 . Raising awareness would involve the use of counselling and provision of consumer information on service.…”