While World Health Organization member countries embraced the concept of universal coverage as early as 2005, few low-income countries have yet achieved the objective. This is mainly due to numerous barriers that hamper access to needed health services.
Although we acknowledge that there is no universally accepted definition of access to health services (Oliver and Mossialos 2004), we use the definition by Peters et al. (2008) which implies ‘the timely use of service according to need’.
A range of preventive and curative interventions can be implemented by non-professional health workers, through so-called community-based interventions which tackle issues related to service location, transport-associated costs and means (geographical accessibility), costs of service (affordability) and treatment availability.
Geographic accessibility
Service location
Indirect costs to household (transport cost)
Household location
Means of transport available
Availability
Unqualified Health workers, drugs, equipment
Waiting time
Demand for services
Wages and quality of staff
Price and quality of drugs and other consumables
Information on health care choice/providers
Education
Affordability
Costs and prices of services
Direct price of service, including informal fees
Household resources and willingness to pay
Opportunity costs
Acceptability
Characteristics of the health services
Management/staff efficiency
User’s attitudes and expectations
Technology
Household expectations
Community and cultural preferences, attitudes and norms (D)