Exploring the dimensions of access

Equity in health care is often defined in terms of access to health services. Yet, in the literature and in policy, the extent to which the concept of access has been taken beyond the realms of principle is limited. This chapter explores the multifaceted concept of access to health services and indicates how it can be operationalized to address health system inequities. Access is interpreted as the freedom to use health services. Whilst health policy efforts to improve equity in access to services have been guided by a focus on the health system, we propose that household or individual aspects of access deserve more attention than they have received to date. The quality of interaction between an individual and the health system's attributes in terms of delivery and financing lies at the core of access. It is argued that, with a view to health policy, these interactions can be meaningfully and comprehensively presented in three dimensions: availability, affordability and acceptability. Each of these captures distinct interactions between the health system and individuals. There is a set of factors that describes each dimension and that can be represented by a set of clearly defined and measurable variables. Within and across the access dimensions, information is an important determinant of the quality of health system and individual interaction. This approach makes it possible to measure and to map access. Using a Ghanaian case study, this chapter illustrates the health policy relevance of this conceptual approach.