Publication: Improving the Accessibility of Frontline Services: For Quality Care Amidst Infrastructure and Resource Constraints
Loading...
Published
2018-10
ISSN
Date
2019-06-13
Author(s)
Editor(s)
Abstract
In low, and middle-income countries, distance and cost can keep people in rural communities from seeking and receiving care, even from the frontline health system. Even where public health facilities exist, these barriers, paired with (often justified) perceptions that the care available is low quality, can lead to extremely low use of available services, despite high need. Together, these forces create systemic gaps in essential health service coverage. To effectively engage rural communities in essential primary care, frontline health systems must develop innovative, locally-appropriate, and cost-effective approaches to staffing, logistics, and financing that overcome entrenched barriers to care.
Link to Data Set
Citation
“World Bank Group. 2018. Improving the Accessibility of Frontline Services: For Quality Care Amidst Infrastructure and Resource Constraints. FLF Evidence Brief Series;. © World Bank. http://hdl.handle.net/10986/31848 License: CC BY 3.0 IGO.”
Digital Object Identifier
Associated URLs
Associated content
Other publications in this report series
Journal
Journal Volume
Journal Issue
Collections
Related items
Showing items related by metadata.
Publication Soft Skills or Hard Cash?(World Bank, Washington, DC, 2012)Jordan faces extremely high levels of youth unemployment: 19 percent of male and 48 percent of female youth between the ages of 19 to 24 years old want to work but can't find jobs. For men, the transition from school to work is slow (on average 15 months), but for women the school to work transition often never takes place. In this context of high female unemployment and low female labor force participation, the Jordanian government, requested the World Bank's support to develop an employment pilot targeting female community college graduates in 2009. This pilot is part of a broader technical assistance program supporting the reform of the public community college system in Jordan. The objective of the Jordan New work Opportunities for Women (NOW) pilot was to increase female labor force participation and help women gain real world job experience. In particular, the hope was to improve information between firms and potential workers, create an opportunity to change negative stereotypes from firms and young women about women's role in the labor market, and improve soft skills and communication. Overall, the objectives of the Jordan NOW pilot were to increase labor force participation and to give young female graduates a chance to accrue some work experience.Publication Strengthening Governance of Social Safety Nets in ASEAN(World Bank, Washington, DC, 2013)Several Association of Southeast Asian Nation (ASEAN) member states, in the aftermath of the global financial crisis, are expanding their social safety net programs. In many cases, existing delivery mechanisms for social assistance in the region tend to be basic, in line with the small size of programs. This paper is an analytical framework to systematically consider and include governance aspects in the design and analysis of modern social assistance programs. The underlying conceptual model is simple. Programs face a set of supply-side challenges that have to do with their institutional structure and the ways in which accountability and incentive relationships are shaped. However, both in the region and elsewhere in the world there are a number of experiences with diverse governance tools that countries can draw upon as they think how best to design and implement more sophisticated and comprehensive social safety net programs. Finally, administrative capacity is likely to represent a constraint as governments seek to deliver increasingly complex programs to a growing number of beneficiaries over a wide geographically dispersed area. While large investments in administrative capacity are unlikely, it is possible to think about context appropriate solutions that can contribute to reduce governance risk. This report is the first attempt to systematically apply a governance lens to Social Safety Net (SSN) programs in the region. An analytical framework and diagnostic resource to review governance dimensions of SSN programs in ASEAN, the report intends to document existing efforts and challenges and provide guidance to World Bank staff, donors and policy makers interested in strengthening program administration and mitigating potential governance risks within social assistance programs in the region.Publication Review of Program Design and Beneficiary Profiles of Social Welfare Programs in Mongolia(World Bank, Washington, DC, 2015)The report begins with a summary of programs reviewed, a description of the PMT targeting system, and the profile of individuals in the database. It then presents key findings from the review of budgets and the analysis of SW Admin/PMT data on program coverage and distributional equity of program benefits. The report concludes with a discussion of policy implications and recommendations that emerged from the key findings and the process of data gathering and analysis. The Annexes include program descriptions based on the corresponding laws; the estimated benefit levels per individual; government expenditure and budget trends for each program since 2010; and information on social welfare program beneficiaries, by program grouping.Publication Ethiopia : Improving Health Service Delivery(World Bank, Washington, DC, 2009-08)This case study aims to identify how Ethiopia has adopted and implemented strategies to improve health services, including the factors that enabled and inhibited success across a meaningful range of health services for the period 1996-2006. Particular emphasis has been given to the impact of utilized strategies on the poor. This case study reviewed one 'primary strategy', decentralization in the form of devolution of authority to the regional level in 1996 and to the district (woreda) level in 2002, and seven 'corollary strategies' in the context of decentralization implemented at the subnational level. The study concludes that decentralization in the health sector is likely to be more effective when it is implemented as part of a broader government decentralization policy across sectors. Sequencing in implementing Ethiopia's decentralization strategy made decentralization more manageable, although decentralization was rolled out prematurely. Moreover, the effectiveness of implementation was found to be driven largely by the institutional and management capacity at the subnational level. At the subnational level, decentralization was found to be more effective in those regions that increasingly strengthened their management and institutional capacity and where regional governments set priorities and adapted the strategies to local needs. However, decentralization was often influenced by the 'clientelistic' center, region power relationship, a problem compounded by the lack of community voice, making the available resources at risk of political capture by the local elite. Overall, the key lesson for implementing improvements in health service delivery (HSD) is that the lack of any critical inputs (facilities, health workers, and drugs) inevitably limits the overall impact of the strategy, and that the implementation of such key inputs should be carefully coordinated and properly synchronized.Publication Improving the Accessibility of Frontline Services(World Bank, Washington, DC, 2018-10)Even in mature health systems, universal access to frontline health services remains largely aspirational. Most countries in the Organization for Economic Co-operation and Development (OECD) have few general practitioners relative to specialists, and many systems suffer from long wait times for primary care or limited options outside standard office hours. Those living in disadvantaged communities or on the margins of society, including rural, poor, minority, mobility constrained, and immigrant patients, can also face entrenched physical, social, and financial barriers to accessing health services, even in countries with universal health coverage. Universal coverage of accessible frontline services will require creative solutions to encourage physician entry into primary care (see Brief 15c); task shifting to emerging cadres of workers (see Brief 7c); creating flexible, nontraditional care models that make it easier to access care; and reaching populations excluded under the status quo.
Users also downloaded
Showing related downloaded files
Publication Comoros Country Climate and Development Report(Washington, DC: World Bank, 2025-06-18)The Union of the Comoros (The Comoros) has significant vulnerability to climate change-related risks but has considerable opportunities to strengthen preparedness and resilience against these challenges. According to the Notre Dame Global Adaptation Index, the Comoros is the 29th-most vulnerable country to climate change and the 163rd most ready to adapt (out of 191). The Comoros archipelago is exposed to many natural hazards that adversely affect the country’s natural capital, people, and physical infrastructure. In 2014, the economic cost of climate-related disasters was estimated at 5.7 million dollars annually, equivalent to 9.2 percent of Gross Domestic Product (GDP). Between 2018 and 2023, as many as 11 tropical depressions or cyclones impacted the country, with Cyclone Kenneth causing the greatest damage, equivalent to 14 percent of GDP, resulting in total economic growth falling from 3.6 percent in 2018 to 1.9 percent in 2019. More than 345,000 people (40 percent of the population) were affected by the cyclone, with 185,000 people experiencing severe impacts and 12,000 people displaced. However, there is an opportunity for the country to grow more robust and shock-responsive, and to establish pre-positioned funding mechanisms to enhance future crisis response efforts. For the Comoros, adaptation and climate-resilient development are the key climate change focus areas, with the country projected to face 836 million dollars 2050 in additional costs due to climate-related impacts. Current plans to adapt to the impacts of climate change in the Comoros include efforts to improve water management, strengthen coastal protection, and develop climate-smart agriculture practices. Given the country’s reliance on its natural resource base for economic growth and mobility, protection of these resources from climate change will be essential for promoting resilient growth and development. In addition to growing the adaptive capacity of the country’s natural resource sectors, strategic economic diversification will be important to help minimize future climate impacts, and development activities will need to be undertaken in such a way as to attract low-carbon co-benefits. The Union of the Comoros is committed to addressing climate change through its Nationally Determined Contribution (NDC) and national priorities. The country’s NDC (which was revised in 2021 for a ten-year horizon) sets ambitious targets, with a goal of reducing greenhouse gas emissions by 23 percent by 2030. The country also plans to significantly increase the share of renewable energy in its energy portfolio, reaching 33 MW by 2030. This will not only promote low-carbon development but also reduce the country’s dependency on imported oil and coal, which currently make up 95 percent of the energy mix. Additionally, the Comoros has declared its intention to increase CO2 removals by 47 percent by 2030, compared to BAU.Publication Guinea-Bissau Country Climate and Development Report(Washington, DC: World Bank, 2024-10-23)Guinea-Bissau is endowed with a wealth of natural resources, with the highest natural capital per capita in West Africa (US3,874 dollars per capita), which could be leveraged for sustainable and resilient growth. However, Guinea-Bissau faces significant development hurdles, such as high poverty rates, political instability, and economic challenges, including an over-reliance on cashew nuts. Rural poverty has increased, and the nation's infrastructure, education, and health care systems are underdeveloped. Climate change poses a severe threat, potentially impacting agriculture, fisheries, and infrastructure. Without adaptation, it could lead to a significant cut in real GDP per capita (minus 7.3 percent by 2050) and increase in poverty (with up to over 200,000 additional poor by 2050, that is, 5 percent of the expected population, in the worst scenario). The country's low greenhouse gas emissions are expected to rise, mainly due to agriculture and land-use changes, with deforestation being a major contributing factor. Although Guinea-Bissau is a low emitter, it has high mitigation ambitions, targeting a 30 percent reduction in greenhouse gas emissions by 2030. The Nationally Determined Contribution outlines significant climate actions, with initiatives focused on forest conservation, sustainable agriculture, and community development. However, the country's political instability, institutional weaknesses, and limited financial resources pose challenges to implementing these climate commitments, which depend heavily on external funding. The financial sector's underdevelopment and vulnerability to external shocks limit its ability to support green investments, though reforms could enhance resilience. Guinea-Bissau must consider its climate financing as development financing and vice-versa, engage the private sector, and integrate climate goals with national development plans to ensure a sustainable future. Concessional climate financing is vital due to the underdeveloped financial sector and the government’s limited borrowing capacity. Addressing Guinea-Bissau's vulnerability to climate change and its structural issues requires a cohesive approach that integrates development and climate strategies. This could involve improving governance, diversifying the economy, protecting natural capital, developing human capital, and investing in sustainable agriculture and infrastructure. The transition to a more sustainable and inclusive development pathway that supports economic growth is possible, but requires focusing on key strategic sectors, enhancing institutional capacity, and creating the conditions to mobilize finance. As a highly vulnerable country, there are myriad needs in the different sectors; however, to be more efficient and effective, Guinea-Bissau should prioritize actions in a few sectors, especially actions on biodiversity, agriculture, and social protection. Low carbon development, especially in energy and forestry sectors, could provide cost-efficient solutions and attract climate finance, including from the private sector, which will support the overall development agenda.Publication Kyrgyz Republic Country Climate and Development Report(Washington, DC: World Bank, 2025-11-03)This Country Climate and Development Report (CCDR) on the Kyrgyz Republic aims to support the country’s development goals amid a changing climate. The CCDR considers two policy scenarios up to 2050: the business-as-usual (BAU) and high-growth scenarios. As it quantifies the likely impacts of climate change on the Kyrgyz economy between now and 2050, the report highlights key government actions to best prepare for and adapt to climate impacts (referred to as “with adaptation” measures), with a particular focus on the time horizon up to 2030. The CCDR also outlines a path to net zero emissions by 2050 (referred to as “with mitigation” measures, “decarbonization,” or, simply, “net zero 2050”), highlighting associated development co-benefits.Publication Jobs in a Changing Climate: Insights from World Bank Group Country Climate and Development Reports Covering 93 Economies(Washington, DC: World Bank, 2025-11-05)The World Bank Group’s Country Climate and Development Reports (CCDRs) provide a crosscutting look at how countries’ development prospects, and the job opportunities they offer to their people, can be threatened by climate impacts and supported by climate policies. Climate change and policies affect jobs through impacts on productivity, energy and material efficiency, and physical, human, and natural capital. They can also transform employment opportunities, especially through complementary measures that help workers and firms adapt to and benefit from new technologies and production practices. Prepared by the World Bank, the International Finance Corporation (IFC), and the Multilateral Investment Guarantee Agency (MIGA), CCDRs integrate country perspectives, climate science and economic modeling, private sector information, and policy analysis to assess how countries can successfully grow and develop their economies and create jobs despite increasing climate risks and while achieving their climate objectives and commitments. Each CCDR starts from the country’s development priorities, opportunities, and challenges, and is developed in close consultation with governments, businesses, and civil society, ensuring the recommendations reflect national priorities. By combining evidence on adaptation, resilience, and emissions pathways, CCDRs highlight where climate action can reinforce development and job creation, and where targeted policies are needed to manage risks and smooth labor market transitions. Taken together, these elements can help create local jobs, ensure economic transitions are just and inclusive, and equip workers and firms to navigate the disruptions and opportunities of a changing climate and changing technologies.Publication Mongolia Country Climate and Development Report(Washington, DC: World Bank, 2024-10-22)Mongolia’s development prospects are uniquely challenged by both the impacts of climate change and the global shift toward a low-carbon economy. The country’s efforts toward decarbonization pose significant challenges given the structurally high-emission intensity of its economy. While challenging, climate action also presents Mongolia with opportunities to achieve important development benefits. The effects of climate risks and the shift away from coal will have diverse impacts across different regions, communities, and socioeconomic levels. The report assesses the critical interconnections between Mongolia’s development ambitions and climate change action and identifies ways to transition to a more economically diversified, inclusive, and resilient development path. It highlights key climate and transition risks affecting Mongolia’s future development and presents a pathway to enhance climate mitigation and adaptation. The report also makes a case for strengthening policies to enhance resilience to climate change and ensure a just transition, particularly for the most vulnerable. The report is structured as follows: section 1 gives introduction. Section 2 delves into the linkages between development and climate in Mongolia and presents model-based findings on the economic and poverty impacts of climate change under different scenarios. Section 3 covers four in-depth sectoral analyses. The first two mainly focus on adaptation to climate change in the agriculture and water sectors. The third considers prospects for the extraction sector, while the fourth sectoral analysis focuses on decarbonizing power and heat generation. Section 4 shifts the focus to how the government can boost resilience for climate-vulnerable populations. Section 5 outlines options for mobilizing private and public financing and private investments to support the green transition. Section 6 examines the existing institutional and governance structure for climate action and presents recommendations to improve its effectiveness, and section 7 concludes with a framework for prioritizing the policy actions outlined in this report.