Medical Help

Medical Help

People in poor countries tend to have less access to health services than those in better-off countries, and within countries, the poor have less access to health services. This article documents disparities in access to health services in low- and middle-income countries (LMICs), using a framework incorporating quality, geographic accessibility, availability, financial accessibility, and acceptability of services. Whereas the poor in LMICs are consistently at a disadvantage in each of the dimensions of access and their determinants, this need not be the case. Many different
approaches are shown to improve access to the poor, using targeted or universal approaches, engaging government, nongovernmental, or commercial organisations, and pursuing a wide variety
of strategies to finance and organise services. Key ingredients of success include concerted efforts to reach the poor, engaging communities and disadvantaged people, encouraging local adaptation,
and careful monitoring of effects on the poor. Yet governments in LMICs rarely focus on the poor in their policies or the implementation or monitoring of health service strategies. There are also
new innovations in financing, delivery, and regulation of health services that hold promise for improving access to the poor, such as the use of health equity funds, conditional cash transfers, and
coproduction and regulation of health services. The challenge remains to find ways to ensure that vulnerable populations have a say in how strategies are developed, implemented, and accounted
for in ways that demonstrate improvements in access by the poor.

There are also many definitions of access to health services, with most researchers recognizing that access is related to the timely use of services according to need.17 Although some researchers distinguish between the supply and opportunity for use of services and the actual using of health services,18 most view access to health services as including realized need.19 Here we use a conceptual framework that builds on longstanding descriptions of access to health services that includes actual use (FIG. 1).20–23 In this framework, four main dimensions of access are described, each having a supply-and-demand element, and include the
following:
1. Geographic accessibility—the physical distance or travel time from service delivery point to the user
2. Availability—having the right type of care available to those who need it, such as hours of operation and waiting times that meet demands of those who would use care, as well as having the appropriate type of service providers and materials
3. Financial accessibility—the relationship between the price of services (in part affected by their costs) and the willingness and ability of users to pay for those services, as well as be protected from the economic consequences of health costs 4. Acceptability—the match between how responsive health service providers are to the social and cultural expectations of individual users and communities

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