Availability, Accessibility, Acceptability and Quality Framework

Introduction[edit | edit source]

The right to health (Article 12) was defined in General Comment 14 of the Committee on Economic, Social and Cultural Rights – a committee of Independent Experts, responsible for overseeing adherence to the Covenant. [1] The right to health includes the following four core components, which are often used to describe health service delivery: Availability, Accessibility, Acceptability and Quality (AAAQ) Framework. The AAAQ framework is often used to describe health service delivery and we will use this model to look at rehabilitation in health systems[2][3][4].[5]

Availability[edit | edit source]

Availability of services requires that public health and healthcare facilities are available in sufficient quantity, taking into account a country’s developmental and economic condition.

In low-resource countries, there are often little or no rehabilitation services available.  Where it is available, rehabilitation is often concentrated in urban centres or is delivered by NGOs which means the services are not integrated into the local health service system.[2][5]


Accessibility[edit | edit source]

The health system has to be accessible to all and accessibility has four overlapping dimensions:[2]

  1. Non-discrimination
    • Health facilities, goods and services must be accessible to all, especially the most vulnerable. [2]
  2. Physical Accessibility
    • Health facilities, goods and services must be within safe physical reach of all parts of the population.[2]
  3. Economic Accessibility (Affordability)
    • Health services must be affordable for all. Access can be limited by expense, the need to pay out-of-pocket or long wait times.[5][5] 
  4. Information Accessibility
    • ccessibility includes the right to seek, receive, and impart information concerning health issues. For example, governments must ensure that young people have access to sexual and reproductive health education and information presented in an unbiased manner.[2]

Acceptability[edit | edit source]

Acceptability requires that health services are ethically and culturally appropriate, i.e. respectful of individuals, minorities, peoples, and communities, and sensitive to gender and life-cycle requirements. Rehabilitation services must be ethically and culturally appropriate to the populations they serve.[5][5]  Data of more than 280,000 service users over a 30 year period found that fewer women and girls attended rehabilitation across all health conditions.  Further research is indicated to understand the exclusion of women and girls from rehabilitation services as it affects their potential and has a negative impact on their families and greater communities.[5][2][6]

Quality[edit | edit source]

Quality requires that health services must be scientifically and medically appropriate and of the highest quality. Underpinning the quality of rehabilitation services is evidenced-based practice.  Unfortunately, there is a mismatch between where rehabilitation research is conducted, with relatively little being done in low-resource contexts.[5][5] [2] A 2020 systematic review of interventions for persons with stroke from low- and middle-income countries found only 62 studies, 44 of which were conducted in India.[5][5][7] This exemplifies the lack of rehabilitation research carried out in low- and middle-income contexts.  Another factor limiting the quality of rehabilitation is the inability to access meaningful research. This may be due to a lack of relevancy to the context, articles/research may be blocked by a paywall or there may be a language barrier in terms of reading the research and translating knowledge.[5][2][5]

Resources[edit | edit source]

References[edit | edit source]

  1. Şaramet O. The right to protection to health or the right to health?–constitutional approaches. Jus et Civitas-A Journal of Social and Legal Studies (former Buletinul Universității Petrol Gaze din Ploiești, Seria Științe Socio-Umane și Juridice). 2020;71(1):29-40.
  2. 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 2.9 Peters DH, Garg A, Bloom G, Walker DG, Brieger WR, Hafizur Rahman M. Poverty and access to health care in developing countries. Annals of the new York Academy of Sciences. 2008 Jun;1136(1):161-71.
  3. Office of the United Nations High Commissioner for Human Rights. CESCR General Comment No. 14: The Right to the Highest Attainable Standard of Health (Art. 12). 2000
  4. World Health Organization. Rehabilitation in health systems: guide for action. 2021
  5. 5.00 5.01 5.02 5.03 5.04 5.05 5.06 5.07 5.08 5.09 5.10 5.11 5.12 United Nations. Universal Declaration of Human Rights. Available from: https://www.un.org/en/universal-declaration-human-rights/(accessed 22 June 2021).
  6. Barth CA, Wladis, A, Blake C, Bhandarkar P, O’Sullivan C, (2020) Users of rehabilitation services in 14 countries and territories affected by conflict, 1988-2018. Bulletin of the World Health Organisation. 2020 September 98:599-614
  7. Dee M, Lennon O, O’Sullivan C (2020) A Systematic Review of Physical Rehabilitation Interventions for Stroke in Low- and Middle-Income Countries. Disability and Rehabilitation. 42:4, 473-501.