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


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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    • "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
    Full-text · Article · Dec 2014
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    • "). Lower proportions of reported chronic conditions in the African surveys may reflect higher barriers to accessing care and differences in the structure and efficiency of health care delivery systems (Ensor and Cooper 2004; Sachs 2012). In addition, chronic diseases were more likely to be reported in women than men in the three surveys from low-income countries, an observation consistent with previous reports suggesting that in resource-constrained settings, women may carry an advantage in accessing care by the nature of their reproductive health needs and their predominant caregiver role in the family (Wagner et al. 2013; Rilkoff et al. 2013). "
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    ABSTRACT: The 2011 United Nations (UN) General Assembly Political Declaration on Prevention and Control of Non-Communicable Diseases (NCDs) brought NCDs to the global health agenda. Essential medicines are central to treating chronic diseases such as hypertension and diabetes. Our study aimed to quantify access to essential medicines for people with chronic conditions in five low- and middle-income countries and to evaluate how household socioeconomic status and perceptions about medicines availability and affordability influence access. We analysed data for 1867 individuals with chronic diseases from national surveys (Ghana, Jordan, Kenya, Philippines and Uganda) conducted in 2007-10 using a standard World Health Organization (WHO) methodology to measure medicines access and use. We defined individuals as having access to medicines if they reported regularly taking medicine for a diagnosed chronic disease and data collectors found a medicine indicated for that disease in their homes. We used logistic regression models accounting for the clustered survey design to investigate determinants of keeping medicines at home and predictors of access to medicines for chronic diseases. Less than half of individuals previously diagnosed with a chronic disease had access to medicines for their condition in every country, from 16% in Uganda to 49% in Jordan. Other than reporting a chronic disease, higher household socioeconomic level was the most significant predictor of having any medicines available at home. The likelihood of having access to medicines for chronic diseases was higher for those with medicines insurance coverage [highest adjusted odds ratio (OR) 3.12 (95% confidence intervals (CI): 1.38, 7.07)] and lower for those with past history of borrowing money to pay for medicines [lowest adjusted OR 0.56 (95% CI: 0.34, 0.92)]. Our study documents poor access to essential medicines for chronic conditions in five resource-constrained settings. It highlights the importance of financial risk protection and consumer education about generic medicines in global efforts towards improving treatment of chronic diseases.
    Preview · Article · Sep 2014 · Health Policy and Planning
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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.
    Full-text · Article · Sep 2014 · BMC Pregnancy and Childbirth
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