Access to basic services

Access to services (including health) is a topical issue in international policy circles. The World Development Report in 2004 looked at how services often fail poor people in terms of access, quantity and quality. It is recognised that barriers to access are an important obstacle to meeting the Millennium Development Goals, especially Goal 4 to reduce the under-5 mortality rate by two-thirds.

The services available to a community, such as electricity, clean water and sanitation, health services, education and transport, are not only an indicator of the resources available within that community – and thus a factor in all multi-dimensional measurement of poverty – but they also have a direct impact on poverty levels and child well-being. Clean water improves child nutrition and health outcomes. Access to transport and roads opens up more and better income opportunities.

Analysis of Round 1 Young Lives data demonstrated marked disparities in the use of health services according to socio-economic indicators, such as wealth and rural/urban location. There were also differences between the Older Cohort families, who appeared to be ‘better-off’ than Younger Cohort families, perhaps due to the maturity of the family unit.

Evidence in Round 2 showed a relatively fast spread of improved sanitation and water. This improved coverage is impressive, but as with education, is only part of the story – usage is the key indicator. Our data show an average improvement in all of our study countries, but unpicking this further demonstrates ongoing differences, particularly between rural and urban areas and between the better-off and poorer families.

One of the clearest positive achievements associated with the MDGs has been around access to school. The most often quoted target is, of course, universal primary enrolment, although alongside this there are related targets around completing a course of primary-level education and subsequent literacy. We see clear evidence of gains in the first of these targets, but less clear evidence on the third. Our work around access to education is presented in the Theme area on Learning, time-use and life transitions.