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This paper published in Health Policy and Planning, examines changes in several indicators of access to health care across communities in during the period of 1989 to 1997. During this period there was rapid economic development and reforms including reductions in central government funding of health services, greater reliance on user fees as the main cost-recovery mechanism, and a loosening of restrictions on health care workers’ location and remuneration. The indicators of access to health care that the paper considers are: distance to closest health facility, service price, time spent waiting to be treated, staff qualifications and drug availability.

The paper finds evidence of relatively uneven changes in access to health care: monthly charges for routine services increased consistently, though this trend was less pronounced in lower-income communities. Most communities experienced reductions in travel distance to clinics but increases in distance to hospitals. There were major improvements to the quality of care in wealthier rural areas, but not in poorer villages. This result may serve as confirmation that poorer communities have been losing well-trained doctors to hospitals in high-income communities. To maintain treatment capacity, facilities in the future may have to rely more heavily on village doctors or health workers.

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