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or lack of purchasing power – especially if services are offered by the private, for-profit sector. Also,
facilities accessed by the poor are often overcrowded and understaffed.
The poverty-health cycle leads to poor health outcome such as increased mortality and morbidity or
malnutrition. The lack of access to health service for the poor results in lack of utilization of health
services, and lack of knowledge of good practices, which is a direct cause of poor health. In turn, poor
health leads to lack of productivity and decreased income which risk causing some people to either fall
into poverty or to further reinforce their poverty status. This explains why access to health is more
than just a service and is a basic component of one’s wellbeing.
A recently published article explains that access to healthcare is embedded in a complex interaction
between financial capability, individual knowledge and preferences and one’s human and power
interrelationship, a pathway triggered by making the decision of seeking care. Considering the
marginal status, poverty restricts all these socio-personal agency resources and thereby limits access
to required healthcare (Saini et al. 2017Considering any form of surgery as healthcare, globally 3.7
billion people are at risk of financial catastrophe and about 81 million are experiencing financial
catastrophe. Among those who are incurring catastrophic expenditure, 32·8 million is from surgery
related cost and 48·5 million is from non-medical but related cost (Shrime et al. 2015).
2.2 Concepts, dimensions and measurements related to access to health
Access to healthcare plays a key role in understanding health equity1 because restricted access can
result in varying levels of health outcomes among various social groups. From the health system
perspective, considering opportunity to avail and actual use of health services as the basis for access,
Peters et al. (2008) has presented a popular conceptual framework to understand the level of access
to healthcare in a community (see . According to the framework, there are certain
characteristics of healthcare provision which help us to understand the level of access to health. These
are:
a) availability (e.g. formal vs. informal, urban biased distribution of health workforce etc.),
b) cost (financial affordability),
c) geographical accessibility, and
d) acceptability of health services.
1 "Health equity or equity in health implies that ideally everyone should have a fair opportunity to attain
their full health potential and that no one should be disadvantaged from achieving this potential”
).