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Understanding and Addressing Critical Barriers

Updated: Aug 31, 2018

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


  • 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


  • Costs and prices of services

  • Direct price of service, including informal fees

  • Household resources and willingness to pay

  • Opportunity costs


  • Characteristics of the health services

  • Management/staff efficiency

  • User’s attitudes and expectations

  • Technology

  • Household expectations

  • Community and cultural preferences, attitudes and norms (D)

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