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Access to healthcare and related equity are sometimes proxied by utilization of healthcare. People with
equal need may display different utilization rates of healthcare due to socio-cultural issues. For
example, high use of surgical services among the higher income groups compared to the lower income
groups with the same needs may be due to financial ability. Such differences in use of healthcare among
people with equal need due to social or economic barriers are indicative of inequity. Sometimes, out-
reach schemes are required to cater services to the people living in the periphery or to provide
religiously acceptable methods for family planning for a religious community etc. (Ghosh, 2014; Oliver
& Mossialos, 2004).
It is also important to discuss access to healthcare is the changing context of the country and health
system with the rapid growth technology. Technology has appeared to be a major innovation in the
development domain. As a result, globally policy makers and other stakeholders are showing much
interest in technology to address prevailing political, financial and technical barriers to access to
resources and services (Gomez Quiñonez, Walthouwer, Schulz, & de Vries, 2016; Gutierrez, Moreno, &
Rebelo, 2017; Kampmeijer, Pavlova, Tambor, Golinowska, & Groot, 2016; Lewis, Synowiec,
Lagomarsinoa, & Schweitzera, 2012). A growing number of studies suggests that everyday newmodels
and techniques are being invented and tested by governments and private actors of both developed
and developing countries; i.e. M-pesa or Tigo Kilimo.2. This has changed the conventional
understanding of health markets by redefining service providers, consumers and the mode of delivery.
Because of these innovations and the use of technology, seeking digital health information and services
is becoming an integral part of health care seeking. As the health market is shifting towards a health
knowledge economy, access to and use of technology for health is becoming a decisive factor in
accessing health services. As a result, the concept of social exclusion and vulnerability is also changing.
Groups with greater access to technology is becoming somewhat information rich and the rest are
becoming information poor. Often, socio-economically poor groups have limited access to technology,
and are thus further disadvantaged in their access to health services (Bloom, Berdou, Standing, Guo, &
Labrique, 2017; Bloom, Henson, & Peters, 2014; Bloom, Standing, & Lloyd, 2008; Khatun et al., 2014).
Considering the discussion on access to health, Evans, Hsu, & Boerma (2013) has presented a more
indicator-based simplistic framework; including a) physical accessibility (good services are within
reasonable reach of everybody), b) financial affordability (people’s ability to pay without financial
hardship) and c) acceptability (people’s willingness to seek services). Considering the discussion on
changing context and growth of technology, d) information accessibility was later added to this
framework. It is the right of the people to seek, receive and contribute health related information
(WHO, 2015). However, the right to information too needs to be contextualised by incorporating
people’s experience with illness, health and health care seeking.
To understand access to health by the poor, the conceptual framework should reflect the dimension of
access as well as demand of healthcare by the poor which is reflected by their care seeking. Considering
this, merging the access dimension and care seeking is a contextual way to understand the level of
access to health by the poor (figure 4). The demand of healthcare can be explored in light of current
health status of the population by using different SDG and other widely used and agreed upon
indicators. An examination of access dimensions over various stages of care seeking by different social
groups (e.g. by income groups or wealth asset quintiles) would then help identify barriers that affect
all groups equally and those that are specific to the poor. To understand right to information, the
demand of health information should be viewed by various stages of healthcare seeking with a special
2 Examples include Tigo Kilimo by Tigo in Tanzania (launched in 2013) (GSMA Intelligence, 2015), Airtel
Green SIM in India (launched in 2007) etc. (GSMA, 2015, 2018) for eAgriculture, TradeNet in Ghana (De
Wulf, 2004), bKash in Bangladesh (bKash, 2017; Kamal Quadir, 2015) for eCommerce and mCommerce as
mobile wallet. M-pesa by Vodafone is one of the largest mobile based financial services in the world, used
by millions across Africa, Europe and Asia (Aker & Mbiti, 2010; Camner, Pulver, & Sjöblom, 2009; Vodafone
Group, 2015).