<i>Poverty and Access to Health Care in Developing Countries</i>

TLDR

People in low‑ and middle‑income countries have less access to health services, but innovations such as health equity funds, conditional cash transfers, and coproduction offer promise to improve access. The article aims to document disparities in access using a comprehensive framework and to explore how to involve vulnerable populations in shaping and evaluating strategies. The authors employ a framework covering quality, geographic, availability, financial, and acceptability dimensions, and review targeted or universal approaches that engage governments, NGOs, and commercial actors to finance and organize services. Disparities persist across all access dimensions, yet success hinges on concerted outreach, community engagement, local adaptation, and monitoring, while governments rarely prioritize the poor in policy implementation.

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.