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Review
. 2007 Oct;4(10):1584-8.
doi: 10.1371/journal.pmed.0040308.

Access to health care in contexts of livelihood insecurity: a framework for analysis and action

Brigit Obrist  1 , Nelly Iteba, Christian Lengeler, Ahmed Makemba, Christopher Mshana, Rose Nathan, Sandra Alba, Angel Dillip, Manuel W Hetzel, Iddy Mayumana, Alexander Schulze, Hassan Mshinda
Affiliations
Review

Access to health care in contexts of livelihood insecurity: a framework for analysis and action

Brigit Obrist et al. PLoS Med. 2007 Oct.

Abstract

The authors present a framework for analysis and action to explore and improve access to health care in resource-poor countries, especially in Africa.

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Conflict of interest statement

Competing Interests: AS works for the Novartis Foundation for Sustainable Development, which is fully funded by the pharmaceutical company Novartis. The Foundation works independently from the company's business and supports not-for-profit health programs in developing countries.

Figures

Figure 1
Figure 1. The Health Access Livelihood Framework
Once people recognize an illness and decide to initiate treatment, access becomes a critical issue. Five dimensions of access influence the course of the health-seeking process: Availability, Accessibility, Affordability, Adequacy, and Acceptability. What degree of access is reached along the five dimensions depends on the interplay between (a) the health care services and the broader policies, institutions, organizations, and processes that govern the services, and (b) the livelihood assets people can mobilize in particular vulnerability contexts. However, improved access and health care utilization have to be combined with high quality of care to reach positive outcomes. The outcomes can be measured in terms of health status (as evaluated by patients or by experts), patient satisfaction, and equity.
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