Economic and structural factors

Lack of political will has led to a corresponding lack of financial commitment to SRH (outside of HIV) by both international donors and national governments. Whilst HIV and AIDS has become an international priority, reflected in policy and funding programmes (PEPFAR, the Global Fund to Fight AIDS, TB & Malaria, and the World Bank’s MAP), the proportion of donor funding has been reduced in other areas of SRH, in particular family planning. In Malawi, health workers ceased to provide general SRH services in order to offer voluntary counselling and testing for HIV.

In many developing countries, governments do not have the capacity to provide universal access: there are not enough human resources (trained doctors, nurses and midwives) to provide services; supplies of drugs and contraceptives are often erratic; and there is a lack of technical expertise in some areas. Poor communications and transport infrastructure can prevent access to services in rural areas, especially in maternal health care where transport to referral services with adequate facilities is an essential component of dealing with emergencies and preventing mortality.

Poverty is a major barrier to accessing services and treatment in many countries, and the introduction or expansion of user fees (where people pay directly for services), has prevented many poor people from utilising health services. This is especially the case for family planning services which are often considered less important than treating life-threatening diseases. There is evidence in India that user fees discourage women from giving birth in formal institutions, accessing antenatal care and seeking treatment for reproductive tract infections. The cost of transport to visit regional hospitals which can be far away from rural areas also prevents many poor people from accessing the appropriate facilities.

 

 

Next: approaches for expanding access