Poverty and Access to Health Care in Developing Countries

Abstract

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 organizations, and pursuing a wide variety of strategies to finance and organize 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.

Barriers to access for severe acute malnutrition treatment services in Pakistan and Ethiopia: a comparative qualitative analysis

“…Evidence shows that reducing the distance barrier, through treatment of SAM directly at the household via community health workers, positively affects beneficiary acceptance of and compliance with services, with implications for early presentation and effective recovery of cases of SAM (13) . Programme uptake is strongly influenced by household opportunity costs across the spectrum of public health services (5,6) . Findings from both Pakistan and Ethiopia indicate that caregivers have competing priorities for their time and must balance decisions affecting their child's health with their household's welfare and survival.…”

Distance to health services affects local-level vaccine efficacy for pneumococcal conjugate vaccine (PCV) among rural Filipino children

“…Although we have not yet replicated these analyses in other regions, it is possible that limited access to health services may lead to similar patterns in other geographic regions. Evidence suggests that barriers to access related to travel time, distance, and cost are ubiquitous in developing countries (15,16). However, there are also other factors, such as care-seeking behaviors, socioeconomic status, and population density, which determine which subpopulations are at higher risk for disease (17).…”

Disability and Poverty in Developing Countries: A Snapshot from the World Health Survey

“…Poverty may lead to health conditions through various pathways and much evidence is available on this link in the literature on the social determinants of health (WHO 2009). Pathways include malnutrition (Susser et al 2008), housing and environmental exposures (Rauh et al 2008), and a lack of access to health services (Peters et al 2008). Some diseases such as malaria, measles, lower respiratory infections, and diarrheal diseases are so strongly associated with poverty that they have been labeled "diseases of poverty" (Kaler 2008).…”