Designing resilient public health systems centered around the needs and realities of health seekers


At least half of the world’s population cannot obtain essential health services and a large number of households are pushed into poverty each year due to out-of-pocket expenditures. For almost 100 million people these expenses are high enough to push them into extreme poverty, forcing them to survive on just $1.90 or less a day. While some progress has been made in the areas of immunizations, family planning, HIV treatment, and malaria prevention, the progress has been uneven with existence of wide gaps in the availability of services in Sub-Saharan Africa and Southern Asia. Inequalities in health services are present not just between, but also within countries: national averages often mask low levels of health service coverage in disadvantaged population groups. 

The relationship between poverty and access to health care can be seen as part of a larger cycle, where poverty leads to ill health and ill health maintains poverty. Low- and middle-income countries (LMICs) account for 90% of the global burden of disease but for only 12% of global spending on health. On average, more than 60% of the meager spending in low-income countries is from out-of-pocket payments, compared with about 20% in high-income countries. Out-of-pocket payments for health care are usually the most inequitable type of financing because they tend to hit the poor the hardest by being a barrier to health care or by denying individuals financial protection from catastrophic illness.

COVID-19 brought to light, and in some cases deepened the fault lines in the health system, especially in case of developing countries. While the statistics on number of deaths and hospitalizations have played an integral role for disease surveillance at large, there has been little comprehension of how the pandemic is changing (or has changed) the mental models and behaviors towards healthcare for the less privileged. We believe that a study of the mental models that people use to make health related decisions holds the potential to better inform design of care services; as they often don’t fit the existing narratives of global healthcare.