Quick count to five around the room
Imagine that all people here are with a sick child and need a health service provider for your child
Those who stay at the table, will get the service
Now – everyone who is a 1, you can step away from the table, because you live in a remote rural settlement and there is no service provider nearby
Now – everyone who is a 2, you can step away from the table, because there is a fee for seeing the provider, and you cannot afford it
Now – everyone who is a 3, you can step away, because the service provider does not speak the language you do, and you are also afraid of discrimination
Now – everyone who is a 4, you actually contact the service…great, but the provider suggests referaral for your child (that is either too far away, or unaffordable) and so the treatment is not completed.
Availability coverage: The ratio between availability of resources – such as human power, facilities, drugs – and the size of the target population gives the measurement of availability coverage (Tanahashi, 1978). Availability coverage considers the resources available for delivering an intervention and their sufficiency, namely the number or density of health facilities and personnel or the availability of necessary inputs (e.g., drugs, equipment). Availability coverage measures the capacity of a health system in relation to the size of the target population or ideally for the population in need.
Accessibility coverage: According to the definition by Tanahashi, even if the service is available, it must be located within reasonable reach of the people who should benefit from it. The capacity of the service is limited by the number of people who can reach and use it and thereby access it (Tanahashi, 1978). There are two main dimensions of accessibility: physical access and financial accessibility. These are described below.
Physical access. Distance from a health service provider is a strong accessibility factor. Another factor closely related to distance and transport is time. The travel time to a health facility to access services and the waiting time to see a health professional are associated with the patients’ perception of accessibility of services. However, the value of time (the opportunity cost of time) is different for different groups of people and consequently its impact as an access barrier will also vary.
Financial accessibility. User fees and transport costs have been shown to negatively impact access to health services, rendering health services less accessible to poor and vulnerable households. Uncertainty of costs and expectations of high out-of-pocket costs (formal or informal) can also obstruct access. See “effective coverage” for issues related to financial protection.
Availability coverage: The ratio between availability of resources – such as human power, facilities, drugs – and the size of the target population gives the measurement of availability coverage (Tanahashi, 1978). Availability coverage considers the resources available for delivering an intervention and their sufficiency, namely the number or density of health facilities and personnel or the availability of necessary inputs (e.g., drugs, equipment). Availability coverage measures the capacity of a health system in relation to the size of the target population or ideally for the population in need.
Accessibility coverage: According to the definition by Tanahashi, even if the service is available, it must be located within reasonable reach of the people who should benefit from it. The capacity of the service is limited by the number of people who can reach and use it and thereby access it (Tanahashi, 1978). There are two main dimensions of accessibility: physical access and financial accessibility. These are described below.
Physical access. Distance from a health service provider is a strong accessibility factor. Another factor closely related to distance and transport is time. The travel time to a health facility to access services and the waiting time to see a health professional are associated with the patients’ perception of accessibility of services. However, the value of time (the opportunity cost of time) is different for different groups of people and consequently its impact as an access barrier will also vary.
Financial accessibility. User fees and transport costs have been shown to negatively impact access to health services, rendering health services less accessible to poor and vulnerable households. Uncertainty of costs and expectations of high out-of-pocket costs (formal or informal) can also obstruct access. See “effective coverage” for issues related to financial protection.
Contact coverage: Contact coverage is the actual contact between the service provider and the user. The number of people who have contacted the service is a measurement of service output (Tanahashi , 1978). It is similar to ‘use of services’.
Effective coverage: The Tanahashi framework defines effective coverage as the proportion of the population in need of an intervention who has received an effective intervention (Tanahashi, 1978). For health interventions that require a one-time action, contact coverage may be virtually equivalent to effective coverage. For other interventions, such as chronic disease treatment, effectiveness can require diagnostic accuracy, provider compliance for evidence-based treatment, ‘continuity’ of access by the patient, effectiveness of referrals, and adherence to prescribed treatment and rehabilitation (WHO, 2010b). As this study focuses on universal health coverage (see next definition), effective coverage also entails financial protection. Out-of-pocket health expenditure as a percentage of total health expenditure and the percentage of the population suffering from catastrophic health expenditures can be used as indicators to measure financial protection.
Travel time may be more relevant than distance, as lack of all-weather roads in some forested, tribal areas can lead to difficulties in access during monsoon and rains. Mountainous terrain can also prolong travel times, hence creating an access barrier.
Contact coverage: Contact coverage is the actual contact between the service provider and the user. The number of people who have contacted the service is a measurement of service output (Tanahashi , 1978). It is similar to ‘use of services’.
Effective coverage: The Tanahashi framework defines effective coverage as the proportion of the population in need of an intervention who has received an effective intervention (Tanahashi, 1978). For health interventions that require a one-time action, contact coverage may be virtually equivalent to effective coverage. For other interventions, such as chronic disease treatment, effectiveness can require diagnostic accuracy, provider compliance for evidence-based treatment, ‘continuity’ of access by the patient, effectiveness of referrals, and adherence to prescribed treatment and rehabilitation (WHO, 2010b). As this study focuses on universal health coverage (see next definition), effective coverage also entails financial protection. Out-of-pocket health expenditure as a percentage of total health expenditure and the percentage of the population suffering from catastrophic health expenditures can be used as indicators to measure financial protection.
Travel time may be more relevant than distance, as lack of all-weather roads in some forested, tribal areas can lead to difficulties in access during monsoon and rains. Mountainous terrain can also prolong travel times, hence creating an access barrier.
