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The Effect
of Poverty and Access to Healthcare
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
healthcare 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.
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