Barriers to healthcare in Middle-Income Countries

1. Barriers to Healthcare in
Middle-Income
Countries
Dr. Eduardo J. Gómez
Department of International Development
King’s College London
Eduardo.gomez@kcl.ac.uk
www.edgomez.org

2. Political and Financial
Commitment
• Most governments have not prioritized access to
universal and quality healthcare
o There are many competing needs, such as economic and national
security policies – e.g., Russia;
o Lack of sufficient federal funding;
o Healthcare issues are not covered by mainstream media – e.g., India.

3. Inequalities in Access to
Healthcare Services
• There are also ongoing inequalities in access to
quality and effective healthcare services
o Public sector providers are often underfunded, providing poor services;
most of the poor use public;
o Private sector has better quality services—used by higher income classes;
o Out-of-pocket and catastrophic expenses affect the poor more than rich,
increasing poverty levels – e.g., China, India, and Brazil

4. Human Resources
• There is also an ongoing shortage of skilled doctors
and nurses, particularly in rural areas
o Primary care workers—mobile teams needed in rural areas
- Brazil’s Family Health Program is a good example
o Skilled nurses are needed, especially for complex diseases, such as type-2
diabetes
o In response to obesity, there is also a need to involve nutritionists and
physical exercise specialists in primary care programs

5. Healthcare Infrastructure
• Governments still need to address inequalities in
access to quality hospitals and primary care clinics
between the public and private sectors
- Specialized equipment and adequate number
of beds in public hospitals;
- Access to reliable and speedy internet,
especially in rural areas – e.g., Peru

6. Decentralization
Processes
• Emerging economies have pursued healthcare
decentralization: both de-concentration and complete
devolution;
• Yet, most governments did not ensure that state and
municipal governments had sufficient funding and technical
capacity to render equitable and effective healthcare
services;
• Going forward, governments need to address resource needs
a the state-level; improve inter-governmental coordination
and cooperation; and ensure civic participation

7. Non-Communicable
Diseases
• Overweight and obesity has become a major problem
• Type-2 diabetes, cancer, and heart disease
• Ongoing challenge of malnutrition (under and over)
among the poor
- e.g., Brazil, India, and Indonesia
• Air pollution and water quality—contributes to respiratory
disease and even type-2 diabetes - e.g., India

8. Effective Receptivity to UK
and other Donor Assistance
• Government commitment to working with the UK and
other bilateral donors needs to improve – e.g. Russia;
• Bureaucratic training and transparency in how funds
are being used, especially at the local level, where
corruption is prevalent;
- which accountability mechanisms are in place?
• Overcoming new political interests and sovereignty
and self-sufficiency - e.g., India, Russia, Indonesia

9. Conclusion
• Several political, health system, and institutional
challenges to effective healthcare in emerging middle-
income countries remain;
• We continuously need to help governments make
healthcare a priority;
• UK and other nations’ assistance needs to target
ongoing health systems challenges—e.g., human
resources, infrastructure, treating complex diseases and
situations – e.g., obesity, diabetes, malnutrition;
• More assistance is also needed in strengthening health
governance, i.e., ensuring civic participation and
accountability in policymaking