Handbook for conducting assessments of barriers to effective coverage with health services

Book excerpt: According to the most recent data available , 4.5 billion people were not fully covered by essential health services in their countries in 2021. Likewise, in 2019, the total population experiencing financial hardship was estimated to be 2 billion people. To scale up action to leave no one behind, WHO’s Fourteenth General Programme of Work, 2025-2028 (GPW 14) has an explicit and strong commitment to equity. In support of this, WHO has released a handbook with methods for the identification of barriers to effective coverage with health services. The 8-module handbook applies mixed method research approaches -- grounded in the Tanahashi framework for effective coverage -- to focus on barriers experienced by potential users and non-users of health services. The handbook facilitates the capturing of evidence on the interface between the population and the services. The handbook has four objectives. 1.To orient national authorities and partners on key concepts, definitions, frameworks and principles relevant to barriers assessments. 2.To build the capacity of national authorities and partners to design a research plan and apply diverse methods (e.g. informant interviews, literature reviews, quantitative analysis and focus groups) in barriers assessments. 3.To provide guidance for reporting on barrier assessment findings in a clear and actionable manner and convening key stakeholders to deliberate next steps. 4.To adapt the methods for humanitarian contexts, accounting for the need for differentiated approaches.