Table 2 Constraints to improving access to priority health interventions, by level (from [4])
Level of constraint | Types of constraint |
|---|---|
I. Community and household level | • Lack of demand for effective interventions |
|  | • Barriers to the use of effective interventions (physical, financial, social) |
II. Health services delivery level | • Shortage and distribution of appropriately qualified staff |
|  | • Weak technical guidance, programme management and supervision |
|  | • Inadequate drugs and medical supplies |
|  | • Lack of equipment and infrastructure, including poor accessibility of health services |
III. Health sector policy and strategic management level | • Weak and overly-centralised systems for planning and management |
|  | • Weak drug policies and supply system |
|  | • Inadequate regulation of pharmaceutical and private sectors and improper industry practices |
|  | • Lack of inter-sectoral action and partnership for health between government and civil society |
|  | • Weak incentives to use inputs efficiently and respond to user needs and preferences |
|  | • Reliance on donor funding that reduces flexibility and ownership |
|  | • Donor practices that damage country policies |
IV. Public policies cutting across sectors | • Government bureaucracy (civil service rules and remuneration, centralised management systems, civil service reforms) |
|  | • Poor availability of communication and transport infrastructure |
V. Environmental and contextual characteristics | • Governance and overall policy framework |
|  |    - Corruption, weak government, weak rule of law and |
|  |    - enforceability of contracts |
|  |    - Political instability and insecurity |
|  |    - Low priority attached to social sectors |
|  |    - Weak structures for public accountability |
|  |    - Lack of free press |
|  | • Physical environment |
|  |    - Climatic and geographic predisposition to disease |
|  |    - Physical environment unfavourable to service delivery |