There are often barriers to the delivery of health services, and research on these constraints is important from a policy standpoint. Once we better understand the main constraints to service delivery in a country or region, policymakers can more accurately target them with policy interventions. Effective interventions should relax specific constraints and increase utilization while scaling up coverage in the most cost-effective manner.
The Health Service Delivery Constraints research team attempts to recognize, understand, and quantify the constraints to effective coverage and utilization of health interventions.
We seek to understand the complex multidimensional relationships between patients and health facilities and their impact on utilization of health services.
In our research, we divide constraints of service delivery into two groups – supply side and demand side. Supply side constraints include access to facilities, the extent to which different types of services are offered at each facility, and the extent to which they have appropriate and effective medications. The second group is the demand side of utilization, which is driven by patient constraints to care, such as financial access or distance.
Key Activities
- Develop a conceptual framework and gather data to analyze
Service delivery constraints are an understudied research area, and IHME researchers are attempting to fill a gap in the knowledge about what affects health intervention utilization and subsequent coverage. Much of our early research has been focused on understanding the complex multidimensional levels of constraints to health service delivery.
We have reviewed various sources and created what we believe to be a comprehensive framework, which encompasses all the main factors that affect health service utilization and coverage.
As part of our research, we have exhaustively searched for datasets that allow us to directly link households with the facilities that provide their health care. Many facility data sources have been evaluated, but most lack corresponding household surveys in order to evaluate the direct effect of constraints. We have drawn information from the RAND Indonesia Family Life Survey, and the MACRO Demographic and Health Surveys for households and the MACRO Service Provision Assessment for facilities show some promise for future studies.
In addition, we are leveraging the Access, Bottlenecks, Costs, and Equity project, which is being carried out in conjunction with UNICEF, to collect information on a select set of constraints at the facility level in approximately 15 countries. This data collection is being undertaken through implementation of a survey instrument designed by IHME and adapted to the various national contexts in which it is being implemented.
Impact
In the future, the Health Service Delivery Constraints research team’s work will focus on quantifying the relationships between supply and demand constraints and effective coverage. Ideally, this work will be done through in-depth analysis of multiple surveys and with the use of geographic information systems. Our research can help illuminate constraints within a country’s health care delivery system. With this knowledge, policymakers within a country will be able to increase effective coverage of essential health interventions through the creation of targeted programs focused on eliminating constraints.
