This function exhibited an intermediate performance for the Region, with a median of 0.55. The following performance profile is quite heterogeneous, with some groups of countries exhibiting different levels of development for this function:
Although some countries revealed lower performance, it is important to note that a considerable number of countries performed at a level of 70% or higher, which reflects the emphasis placed on this health objective. The lowest level of performance was by indicator 1, evaluation of access to health services. All other indicators exhibited intermediate performance, including institutional capacity for developing strategies to improve access (indicator 2), advocacy and actions to improve access (indicator 3), and NHA support to the sub-national level (indicator 4).
With respect to the variability of the results, indicator 7.3 exhibited a better overall performance and a smaller dispersion, which confirms the general view that this is a strong area for the Region. All other indicators exhibited high dispersion, which implies that a grouping of countries performed better while other countries still need improvement in these critical areas.
The primary factors determining this function’s performance are:
• In general, the evaluations of access to collective public health services are better than those for individual services (especially due to the lack of information from the private sector or social security). Fifty-seven percent of the countries asserted that they have the indicators to objectively evaluate access to health services. A common critical area for the Region was the failure to identify and disseminate those practices aimed at eliminating barriers to access. In general, few countries use the results of these evaluations to implement strategies aimed at reducing access barriers.
• A small percentage of countries identified access barriers related to ethnicity, culture, religion, and/or sexual orientation. Forty-six percent of the countries indicated that gender was a criterion in these analyses.
• One major weakness in the implementation of strategies and actions aimed to improve access to health services is related to the knowledge and experience of health personnel in guiding users through the system when linguistic barriers exist. Other weaknesses include the design of actions aimed at improving access to services for vulnerable populations and the lack of systematic evaluation of efforts to reduce access barriers. Conversely, most countries possess the institutional capacity to develop early detection programs and implement innovative methods to improve access (through mobile clinics, fairs, etc.)
• Countries performed well in the development of laws and standards that improve access for the neediest. They also showed strong performance with respect to carrying out actions to reduce access barriers for vulnerable groups. Half of the countries included information on access barriers in human resources training programs, and informed the decision makers about findings regarding access barriers. In general, the more prominent weaknesses of the NHA were seen in the development of actions to encourage other health services providers (private organizations and social security entities) to reduce access barriers.
• All countries demonstrated strengths in their capacity to inform the population about accessing health services.
• Major weaknesses were observed in the development of incentive systems for service providers (public and private) aimed at reducing access barriers. Forty-six percent of the countries indicated that they have local measures to encourage the development of actions to promote more equitable access to health services.
• All countries advise their sub-national levels on the basic package of individual and collective services that should be available to the entire population. However, countries do not regularly monitor compliance in this matter, especially when vulnerable or underserved populations are involved.