Disease Control Priorities Network

Access, Bottlenecks, Costs, and Equity (ABCE)

Initiated in 2011, the Access, Bottlenecks, Costs, and Equity (ABCE) project aims to collect and generate the evidence base for improving the cost effectiveness and equity of health systems. ABCE takes place in several countries and utilizes a multipronged approach to support the decision‐making needs of policymakers and stakeholders in achieving improved and more equitable population health outcomes.

The ABCE project focuses on health system service delivery and four components that contribute to the optimal delivery of health services: 

  • Access: the factors that improve or hinder contact with health facilities.
  • Bottlenecks: the supply-side limitations that can prevent receipt of proper care upon arriving at a health facility.
  • Costs: a range of financial measures across levels of the health system, from what a patient pays for care to what facilities pay to provide services.
  • Equity: the ways in which factors affect the access to and use of health services for different populations in different places.

To assess health service delivery in countries, the ABCE team brings together existing data sources and conducts primary data collection at health facilities as needed. This work includes in‐depth facility surveys and facility inventories across a range of service delivery platforms. For countries with a high HIV/AIDS burden, supplementary data collection, which is known as ABCE+, includes patient exit interviews and chart extractions to learn more about antiretroviral therapy (ART) costs and patient outcomes. With these data, facility‐level analyses on the costs of care and the bottlenecks that impede service are conducted.

Aug 2013
Data collection starts in Madhya Pradesh, India, for the ABCE project
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Project update
Jul 2013
IHME researchers present findings from DCPN research at the International Health Economics Association (iHEA) conference
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Project update
Jun 2013
Access, Bottlenecks, Costs, and Equity (ABCE) project meetings take place in Seattle
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Project update
Jun 2013
ABCE and ABCE+ findings are presented at the second Global Health Metrics & Evaluation conference in Seattle
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Project update
May 2013
Data collection begins in Rajasthan, India
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Project update
May 2013
Hanlon presents preliminary results from ABCE and ABCE+ projects to the UNAIDS/World Bank Economic Reference Group
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Project update
Apr 2013
IHME Assistant Professor Mike Hanlon presented preliminary findings at the Ghana Health Summit
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Project update
Apr 2013
ABCE and ABCE+ data collection starts in Andhra Pradesh, India
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Project update
Apr 2013
ABCE collaborators from India meet in Seattle
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Project update
Mar 2013
ABCE collaborators from Ghana advise on dissemination efforts
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Project update
Sep 2013
Travel time to maternity care and its effect on utilization in rural Ghana: a multilevel analysis
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Research Article
Apr 2013
ABCE in Ghana Policy Brief
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Research Article
Nov 2012
Exploring the relationship between population density and maternal health coverage
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Research Article
Apr 2012
Does distance matter for institutional delivery in rural India: an instrumental variable approach
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Research Article
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