For our research, understanding the barriers that prevent equitable access to healthcare is crucial. A recent study, conducted as part of our collaborative research consortium, sheds light on the challenges faced by the poorest communities in Khyber Pakhtunkhwa (KP), Pakistan, especially regarding primary healthcare access. In October 2024, the study was published in the International Journal of Equity in Health, a renowned and peer-reviewed public health journal. 

In the study, we followed a triangulation mixed-methods approach, combining insights from qualitative and quantitative data analyses. We analysed data from a quantitative household survey of 744 households, 17 focus group discussions with household members and, 11 interviews with healthcare providers. 

We used Leveque’s Framework of Patient-centred Access to Healthcare to examine the unmet primary healthcare needs and the reasons behind them for the poorest people in four districts of KP province in Pakistan. We find that despite using available services, many people’s healthcare needs remain unmet or are met with difficulties, primarily due to prohibitively high costs at each stage of access. 

Figure: Levesque Framework

Some of the key challenges identified: 

• High costs: Financial barriers discourage many from accessing appropriate healthcare services.
• Accessibility and Availability: Limited outreach and communication efforts, along with inconsistent availability of medicines and diagnostics at healthcare facilities, compound these challenges. 
• System Navigation and Engagement: Patients often find the healthcare system difficult to navigate, and adherence to prescribed care can be challenging when costs are unmanageable.

Potential pathways for improvement: 

• Enhancing communication and outreach to increase awareness and accessibility.
• Improving infrastructure and ensuring consistent quality of care to meet patient needs.
• Implementing targeted social health protection policies, focusing on specific demographic disparities, such as age and gender.

Our findings emphasise that while social health protection is key to advancing Universal Health Coverage, it must be complemented by improved healthcare service quality and accessibility. For this, it is important to understand and bridge the gaps on both the supply and demand sides of healthcare access. 

The full article can be assessed here: Un/met: a mixed-methods study on primary healthcare needs of the poorest population in Khyber Pakhtunkhwa province, Pakistan