Overcoming barriers to health service access and influencing the demand side through purchasing

This study, from the Health, Nutrition and Population family of the World Bank, reviews literature on demand barriers to accessing health services and surveys studies that report and evaluate methods for overcoming these barriers. Evidence suggests that distance, education, opportunity cost, and cultural and social barriers are often at least as important in determining access to services as the quality, volume and price of health services. However, the authors find that relatively little work has been done on how to overcome these barriers. Obstetric care and family planning stood out as the main areas where demand-side initiatives have been tried and evaluated.

From the limited evidence available, the paper finds that while demand-side barriers are important, interventions are likely to work only if services have already reached an adequate standard. The importance of consulting extensively with communities both on the barriers that prevent use of services and the types of interventions that might be acceptable is also stressed. The study calls for a research agenda to stimulate the evaluation of methods to minimize demand-side barriers and incorporate a poverty focus into future work [adapted from author].