Access

WHO Definitions Related to Access

WHO Health Systems Strengthening Glossary

Access (to health services): the perceptions and experiences of people as to their ease in reaching health services or health facilities in terms of location, time, and ease of approach. [1]

WHO Ageing Glossary [2]

Access: The ability of an individual or a defined population to obtain or receive appropriate health care. This involves the availability of programmes, services,facilities and records. Access can be influenced by such factors as finances (insufficient monetary resources); geography (distance to providers); education (lack of knowledge of services available); appropriateness and acceptability of service to individuals and the population; and sociological factors (discrimination, language or cultural barriers).

Human rights and health fact sheet

Requires that health facilities, goods, and services must be accessible to everyone. Accessibility has four overlapping dimensions:

• non-discrimination
• physical accessibility
• economical accessibility (affordability)
• information accessibility.

Assessing accessibility may require analysis of barriers – physical financial or otherwise – that exist, and how they may affect the most vulnerable, and call for the establishment or application of clear norms and standards in both law and policy to address these barriers, as well as robust monitoring systems of health-related information and whether this information is reaching all populations.

Other Definitions of Access

Individually-focused

PubMed Medical Subject Headings (MeSH)

Health Services Availability: The degree to which individuals are inhibited or facilitated in their ability to gain entry to and to receive care and services from the health care system. Factors influencing this ability include geographic, architectural, transportational, and financial considerations, among others.

Year introduced: 1978

RAND website

Access to health care refers to the ease with which an individual can obtain needed medical services.

Saurman (2016) [3]

“Access is defined as the degree of fit between the user and the service; the better the fit, the better the access… access is optimized by accounting for the different dimensions of access: accessibility; availability; acceptability; affordability; and adequacy in service design, implementation and evaluation.”

McIntyre et al. (2009) [4]

"We present a conceptual framework that defines access to health care as the empowerment of an individual to use health care…[access has’ three dimensions: availability, affordability, and acceptability""

Structurally-focused

Brookings website

Urban access: “Ask each stakeholder to define what they mean by access, however, and the range of conflicting and confusing answers is akin to the “Tower of Babel” phenomenon, underscoring a deeper gap in defining, measuring, and ultimately creating policy to address transport needs across the global urban landscape...[three definitions]: Quality of mobility; access to transport; access to opportunities."

W.K. Kellogg Foundation [5]

Access to care” “Some health delivery system administrators might define access to health care as whether or not a person in X community could see X provider. But Community Voices projects consider a range of issues with bearing on access to appropriate and timely health care – financial barriers (adequate coverage for services or for the purchase of medications), geographic barriers (distance, lack of transportation, travel time), and cultural barriers (language, understanding, acceptance of health care professionals or treatment)."" -p.21.

World Resources Institute [6]

Access: ""Access to information, public participation, and access to justice; these principles strengthen the right to a healthy or safe environment and are in turn strengthened by an established, enforceable right to a healthy or safe environment."" -Box 1, p.2

Product- or service-focused

Example 1: Makay-Barasa et al. (2020) [7]

Kenya's cancer policy to improve testing and screening

Example 2: Eldis [8]

""Having access to health services - the provision of vaccinations/immunisation, basic emergency surgery and public health information etcetera - can be life-saving.""

Note: Other case studies on access include:

• Access to medicines in LMICs (Health Research Policy and Systems; Health Affairs; Health Policy and Planning)
• Medical innovations (WHO Bulletin)
• Adult hearing aids (WHO Bulletin)
• Food (World Medical & Health Policy)
• Contraceptives (Human Rights Quarterly)
• Health care among asylum seekers in the EU (European Journal of Public Health)"

[1]Starfield B. Basic concepts in population health and health care. Journal of Epidemiology and Community Health, 2001;55:452‐454.

[2] WHO Centre for Health Development (‎‎‎Kobe, Japan)‎‎‎. (‎2004)‎. A glossary of terms for community health care and services for older persons. Kobe, Japan : WHO Centre for Health Development. https://apps.who.int/iris/handle/10665/68896

[3] Saurman E. Improving access: modifying Penchansky and Thomas’s theory of access. Journal of health services research & policy. 2016 Jan;21(1):36-9.

[4] McIntyre DL, Thiede M, Birch S. Access as a policy-relevant concept in low- and middle-income countries. Health Economics, Policy and Law, 2009; 4(2): 179-93.

[5] More Than A Market: Making Sense of Health Care Systems (Lessons from Community Voices: healthcare for the Underserved). 2002. Battle Creek, MI: W.K. Kellogg Foundation.

[6] Foti J. A seat at the table: Including the poor in decisions for development and environment. 2010. Washington, D.C.: World Resources Institute.

[7] Makau-Barasa, L., Greene, S., Othieno-Abinya, N., Wheeler, S. B., Skinner, A., & Bennett, A. V. (2020). A review of Kenya’s cancer policies to improve access to cancer testing and treatment in the country. Health Research Policy and Systems, 18, 1-10.

[8] https://www.eldis.org/keyissues/inequality-access-health-services"