The key issues

At community level, people’s decision-making on using basic services will be affected by a range of different factors including:

Cultural practices and attitudes, which may, for example, discourage women from using formal health services during their pregnancy or regard formal schooling as irrelevant in children’s education.
Gender attitudes, which often discriminate against women and girls or overload them with domestic duties, including water collection, that limit their time for schooling.
Knowledge gaps, which mean that people do not appreciate the benefits of improved sanitation, safe water or formal medical services.
Financial barriers, which make the direct and indirect costs of accessing essential services unaffordable.
Physical barriers, which mean that services are distant from communities or inaccessible due to the poor condition of roads.
Inappropriate or unresponsive staff, which means that people do not want the services that are available locally.

At sectoral level, policy decisions about user fees, or health priorities or road construction impact on which areas or which social groups benefit from improved service provision. Many factors, including political, ethnic or geographic exclusion, can influence these decisions, in overt or less clearly recognised ways. Policy approaches to alternative service provision, for example, the role of traditional healers in health services or the engagement of community schools with formal sector education also influence people’s access to formal services. To what extent service providers see themselves as accountable to service users is also critical to promoting or discouraging access to services. Service providers also need to recognise that additional measures need to be put in place to ensure that the very poor, most vulnerable or excluded women, men, girls and boys are also able to access services.

At national level, approaches to poverty reduction and decision making on spending priorities have a significant influence on people’s access to services. National decisions on budget allocations to basic service sectors, compared with other sectors, such as defence or public administration are influenced by a complex web of political factors, as well as donor polices and international aid agendas. It is important to recognise that some social sectors may be relatively less powerful or less experienced than other sectors in negotiating national budget resources and may need technical support to engage with planning and budgeting processes.

Responding to these different potential barriers to access to basic services involves not only working with communities but also with service providers and national planners to promote client involvement in services, service responsiveness and accountability to clients. It also calls for close collaboration with local, state and national governments to ensure policies and practices effectively promote people’s rights to access to basic services.

Recent Case Studies

Non-medical maternal and newborn health initiative in Pakistan

The Maternal and Newborn Health Research and Advocacy Fund (RAF) was recently launched in Pakistan. A five-year project with a grant fund of £18.3 million, RAF will provide quality, non-clinical research and effective advocacy in support of policy and practice reform to improve the health of mothers and their newborn babies. The aim is to overcome current obstacles to successful service delivery through an understanding of the financial, cultural and physical barriers to increased demand and uptake of these services.

ESSPIN- Education Sector Support Programme in Nigeria

It is estimated that there are between 7 to 9 million children in Nigeria who are out of school. Social Development Direct, as a core partner in the Education Sector Support Programme in Nigeria (ESSPIN), is helping to change this through technical assistance provided directly to state and federal governments. ESSPIN is one of the UK government's largest international development programmes and will support quality basic education reform over a six-year period.