Guide for Identifying Obstacles to Achieving Comprehensive Healthcare Coverage

The most recent data available shows that 4.5 billion people were not fully covered by essential health services in their countries in 2021. Additionally, in 2019, an estimated 2 billion people experienced financial hardship. To address these issues and ensure that no one is left behind, the World Health Organization (WHO) has made a strong commitment to equity in their Fourteenth General Programme of Work, 2025-2028 (GPW 14).

In line with this commitment, WHO has released a handbook outlining methods for identifying barriers to effective coverage with health services. This 8-module handbook utilizes mixed method research approaches based on the Tanahashi framework for effective coverage. The focus is on understanding the barriers experienced by both potential users and non-users of health services, in order to capture evidence on the interface between the population and the services.

The primary audience for this handbook is technical staff in national and subnational authorities responsible for planning, managing, monitoring, and evaluating health services. However, it also targets research institutes, universities, multilateral organizations working at the country level, non-governmental organizations, civil society organizations, and patient associations.

This handbook is part of a larger set of tools provided by WHO to support equity-oriented, rights-based, and gender-responsive planning and programming by the health sector. It is meant to complement other WHO and partner guidance on primary health care, integrated people-centered health services, health financing, social determinants of health, and human resources for health, among other areas.