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Chapter 5: Recommendations
Globally, access to health has been a major challenge for decades. Despite the recognition of health as
human right, roughly 4 billion people lack access to essential healthcare. In 2017, 10.5 per cent of the
world population had to spend 10 per cent of their household budget for health, forcing 12.5 per cent
of them to survive on less than USD 2 per day (World Bank & WHO, 2017). Because of the ongoing
demographic and epidemiologic transition and the existing burden of infectious diseases (and related
epidemics), low- andmiddle-income countries are struggling to cope with already stretched resources.
Because of the multi-dimensionality and related complexities of access to health, no blanket approach
can address on its own the disparities of access to health. However, the lessons of the report lead us to
formulate four key recommendations for the OIC countries.
In order to expand access to health services to and increase the level of health outcomes for all
population groups, demand and supply side changes need happen simultaneously. This should involve
the reduction of direct out-of-pocket health expenditures and indirect costs for health care as the most
important barriers on demand side; and the improvement and expansion of service infrastructure and
human resources on supply side; tying in with the focus on Universal Health Coverage, conceptualized
as access to quality promotive, preventive, curative, rehabilitative and palliative health care by all
without any financial adversity (WHO, 2018). Based on the case studies and with a view on the wider
literature we recommend:
Reforms that aim at ensuring access to quality health care by the poorest populations should be
prepared carefully designed and implemented.
 Literature reviews, field visits, and consultations can be very useful tools to gain a deep
understanding of when and how poor populations (try to) access health services and which
barriers they face.
 Exchange with other countries and global health initiatives that can provide insights in what has
been tried and tested to tackle similar challenges can be helpful in identifying possible pathways
of policy design and implementation.
 Monitoring and regular evaluations will keep informed of progress made and help identify new
challenges or bottlenecks that need more/further attention.
 Political will for reforms can be sustained by careful sequencing of reforms. For example,
implementing change that addresses biggest emergencies first that benefits larger parts of the
population will buy voter support and build trust in the ability of the system to achieve change.
Community-based primary health care needs to be strengthened in order to reach poor population
groups across the countries.
 Infrastructure – both in terms of physical health infrastructures and medical supply and
technology, as well as basic infrastructure and transport – needs to be expanded and improved
to reach and connect to rural and remote areas.
 Incentives for skilled health personnel to provide services in rural and remote areas need to be
designed and implemented. Depending on context, this might need to involve
o Ensuring that sufficient numbers of medical and nursing students and other health
professions are trained and receive adequate salaries,
o Ensuring that contracting for health human resources addresses challenges within the
system, e.g. through performance incentives, location incentives, dealings with dual
practice, etc., and
o Outsourcing of health services where needed, combined with monitoring and regulation
policies.
Health insurance schemes as a way of pooling risks and expanding health service coverage need to be
designed carefully.