People in poor countries have less access to health services than people in wealthy countries, and the poor have fewer access to health care inside their own countries. This article uses a paradigm that includes quality, geographic accessibility, availability, financial accessibility, and acceptability of services to document discrepancies in access to health services in low- and middle-income countries (LMICs). While the poor in LMICs are persistently disadvantaged in all aspects of access and their determinants, this does not have to be the case. Many diverse initiatives to improving access to the poor have been demonstrated, including targeted or universal approaches, including government, nongovernmental, or commercial organizations, and pursuing a variety of financing and organization options. Concerted efforts to reach the poor, engagement of communities and disadvantaged individuals, encouraging local adaptation, and thorough monitoring of effects on the poor are all essential ingredients for success. Governments in LMICs, on the other hand, rarely prioritize the poor in their policies, implementation, or monitoring of health-care plans. New innovations in health service finance, delivery, and regulation, such as the use of health equity funds, conditional cash transfers, and coproduction and control of health services, all show promise for improving access to the poor. Finding means to guarantee that vulnerable communities have a role in how initiatives are designed, executed, and reported for in ways that indicate improvements in low access remains a challenge.

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