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

According to the most recent data available1, 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 primary target audience is technical staff in national and subnational authorities with a remit to plan, manage, monitor and evaluate health services. This handbook also targets: research institutes and universities; multilateral system organizations/entities working at country level; nongovernmental and civil society organizations; and patients’ associations.

This handbook is part of a wider set of WHO tools for supporting equity-oriented, rights-based and gender-responsive planning and programming by the health sector. It also complements the equity focus of other WHO and partner guidance on PHC, integrated people-centred health services, health financing, social determinants of health, and human resources for health, among other areas. 

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[1] See the WHO and World Bank 2023 Universal Health Coverage (UHC) Global Monitoring Report.

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