Constraints on Improving Access to Essential Health Interventions, by Level| Level of constraint | Types of constraints |
| Community and household | Lack of demand for effective interventionsSFTRETBarriers to the use of effective interventions (physical, financial, social) |
| Health services delivery | Shortages and inadequate distribution of appropriately qualified staffSFTRETWeak technical guidance, program management, and supervision Inadequate drugs and medical suppliesSFTRETLack of equipment and infrastructure, including poor accessibility of health services |
| Health sector policy and strategic management | Weak and overly centralized planning and management systems SFTRETWeak drug policies and drug supply system SFTRETInadequate regulation of pharmaceutical and private sectors and improper industry practicesSFTRETLack of intersectoral action and partnership for health between government and civil society SFTRETWeak incentives to use inputs efficiently and to respond to users' needs and preferences SFTRETReliance on aid agency funding, which reduces flexibility and ownership SFTRETAid agency practices that overload country management capacity |
| Public policies cutting across sectors | Government bureaucracy (civil service rules and remuneration, centralized management system) SFTRETPoor availability of communications and transportation infrastructure |
| Environmental and contextual characteristics | Governance and overall policy framework: -
Corruption, weak government, weak rule of law, weak enforceability of contracts -
Political instability and insecurity -
Low priority attached to social sectors -
Weak structures for public accountability -
Lack of a free press
|
| Physical environment: |
Source: Hanson and others 2003.
