Disparities in access to health services in low- and middle-income countries (LMICs) are reviewed using a framework incorporating quality, geographic accessibility, availability, financial accessibility, and acceptability of services. Background data on the the numbers of doctors, nurses and beds per populations in various parts of the world is provided. "Different approaches are shown to improve access to the poor, using targeted or universal approaches, engaging government, nongovernmental, or commercial organizations, and pursuing a wide variety of strategies to finance and organize services. Key ingredients of success include concerted efforts to reach the poor, engaging communities and disadvantaged people, encouraging local adaptation, and careful monitoring of effects on the poor. Yet governments in LMICs rarely focus on the poor in their policies or the implementation or monitoring of health service strategies. There are also new innovations in financing, delivery, and regulation of health services that hold promise for improving access to the poor, such as the use of health equity funds, conditional cash transfers, and coproduction and regulation of health services. The challenge remains to find ways to ensure that vulnerable populations have a say in how strategies are developed, implemented, and accounted for in ways that demonstrate improvements in access by the poor"
Ann N Y Acad Sci. 2008;1136:161-7