Overcoming Barriers to Health Service Access: Influencing the Demand Side

International Programme, Centre for Health Economics, University of York, York, UK.
Health Policy and Planning (Impact Factor: 3.47). 04/2004; 19(2):69-79. DOI: 10.1093/heapol/czh009
Source: PubMed

ABSTRACT Evidence suggests that demand-side barriers may be as important as supply factors in deterring patients from obtaining treatment. Yet relatively little attention is given, either by policy makers or researchers, to ways of minimizing their effect. These barriers are likely to be more important for the poor and other vulnerable groups, where the costs of access, lack of information and cultural barriers impede them from benefiting from public spending. Demand barriers present in low- and middle-income countries and evidence on the effectiveness of interventions to overcome these obstacles are reviewed. Demand barriers are also shown to be important in richer countries, particularly among vulnerable groups. This suggests that while barriers are plentiful, there is a dearth of evidence on ways to reduce them. Where evidence does exist, the data and methodology for evaluating effectiveness and cost-effectiveness is insufficient. An increased focus on obtaining robust evidence on effective interventions could yield high returns. The likely nature of the interventions means that pragmatic policy routes that go beyond the traditional boundaries of the public health sector are required for implementing the findings.

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Available from: Tim Ensor, Sep 27, 2015
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    • "The third factor, geographical accessibility refers to the physical location of the health facility with respect to the location of the users. Examining these factors is essential because literature suggests that they influence population's health-seeking behaviour and impact health outcomes (Ensor and Cooper, 2004; Kerber et al., 2007;Peters et al.,2008; Arthur, 2012). For instance, Kerber et al. (2007) argue that long distances, financial constraints, poor transport, and poor quality care in health facilities are serious barriers limiting access to care for those who need it most. "
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    ABSTRACT: This paper examines the historical development of health policy in Ghana within the framework of financial, geographical accessibility and the availability of health care. We find that historically, health policy has been urban biased, and largely focused on financial accessibility. Even Nkrumah's free health care policy could not adequately address the problem of inadequate health professionals and facilities in the rural areas.The study also established that poverty is also largely a rural phenomenon.The poor benefit less from the National Health Insurance Scheme (NHIS).This situation makes the NHIS lacksocial equity, the very reason for its being. We recommend thatgovernment should expand health facilities in the rural areas, and introduce attractive incentive packages to attract and retain health professionals in such areas. And, there is an urgent need for rigorous criteria to be developed by the NHIS to identify the very poor for health insurance premium exemptions. Introduction This paper examines the history of health policy development and health care provisionfrom the colonial days to the present, with a special focus onthe poor in Ghana. Examining the history of health policy development and health care provision is predicated on the recognition that access to health care is a key strategy for poverty reduction. This examination is based on an interaction of both demand and supply side factors that may determine an individual or household's access to health care. These factors include:financial accessibility,geographical accessibility and the availability of health care. Financial accessibility speaks to the ability and
    • "Ensuring reliable transportation also helped provide greater access to the program . Transportation has been demonstrated to be a barrier both in low and high income countries ( Ensor & Cooper , 2004 ) and research in a Canadian urban centre has demonstrated that individuals from higher socioeconomic backgrounds have better access to services than those with lower socioeconomic status ( Steele , Glazier , & Lin , 2006 ) . Since attendance was an on - going issue in the first year of programing , the program leaders were able to organize the Boys and Girls Club bus to pick up participants . "
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    • "To increase the use of skilled birth attendance it is important that interventions target both the demand and the supply of services [12]. The demand side involves the need to utilize healthcare services by individuals, household or the community [13], whereas the supply side involves provision of services by the healthcare system. The health system’s intrinsic goals are to improve the health of the population, to enhance the responsiveness to legitimate expectations of the population, and to create fair financing and financial risk protection [14]. "
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    ABSTRACT: Maternal mortality remains high in sub-Saharan Africa. Health facility intra-partum strategies with skilled birth attendance have been shown to be most effective to address maternal mortality. In Zambia, the health policy for pregnant women is to have facility childbirth, but less than half of the women utilize the facilities for delivery. ‘Born before arrival’ (BBA) describes childbirth that occurs outside health facility. With the aim to increase our understanding of trust in facility birth care we explored how users and providers perceived the low utilization of health facilities during childbirth. A qualitative study was conducted in Kapiri Mposhi, Zambia. Focus group discussions with antenatal clinic and outpatient department attendees were conducted in 2008 as part of the Response to Accountable priority setting and Trust in health systems project, (REACT). In-depth interviews conducted with women who delivered at home, their husbands, community leaders, traditional birth attendants, and midwives were added in 2011. Information was collected on perceptions and experiences of home and health facility childbirth, and reasons for not utilizing a facility at delivery. Data were analysed by inductive content analysis. Perspectives of users and providers were grouped under themes that included experiences related to promotion of facility childbirth, responsiveness of health care providers, and giving birth at home. Trust and quality of care were important when individuals seek facility childbirth. Safety, privacy and confidentiality encouraged facility childbirth. Poor attitudes of health providers, long distances and lack of transport to facilities, costs to buy delivery kits, and cultural ideals that local herbs speed up labour and women should exhibit endurance at childbirth discouraged facility childbirth. Trust and perceived quality of care were important and influenced health care seeking at childbirth. Interventions that include both the demand and supply sides of services with prioritizing needs of the community could substantially improve trust and utilization of facilities at childbirth, and accelerate efforts to achieve MDG5.
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