|
 |
|||||||||||||||||||
|
|||||||||||||||||||
|
|||||||||||||||||||
 |
 |
|
|
Ann. N.Y. Acad. Sci., Annals PrePrint, published online ahead of print October 22, 2007 doi: 10.1196/annals.1425.011 Copyright © 2007 by the New York Academy of Sciences description
1 International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, Maryland, 21205, United States 2 International Health, Johns Hopkins Bloomber School of Public Health, 615 N. Wolfe St, Baltimroe, Maryland, 21205, United States 3 Knowledge, Technology, & Society, Institute of Development Studies, at the University of Sussex, Brighton, Sussex, BN1 9RE,, United Kingdom
* To whom correspondence should be addressed. E-mail: dpeters{at}jhsph.edu. PrePrint 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 paper 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, non-governmental 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 services 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 co-production 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. Key Words:
access, poverty, health services, developing countries, equity, utilization
|
 |
 |
