Tool 2: The “Access to Service” Guide

If you’ve read previous essays in this “Social Change Cookbook” series, you may have noticed that we are “de-branding“ some classic theoretical articles.

We mean no disrespect to the creators of the various tools and models featured thus far, we are simply seeking to synthesize and de-complicate longer articles, using the titles to highlight a key feature of each model and/or tool.

For this “Access to Service” Guide, we (re)introduce people to the key ideas presented by T. Tanahashi in his article on “Service Coverage” appearing in a 1978 World Health Organization Bulletin.

An alternative introduction to this essay could have been: “We read the long versions so you won’t have to.”

Let’s now look at the key points in Tanahashi’s essay, and how these help us create a Service Coverage Guide.

Tanahashi (1978) Health coverage diagram

The key components in Tanahashi’s model for increasing health service coverage are:

• Availability of service
• Accessibility of service
• Acceptability of service
• Contact at service-point
• Effectiveness of the service

To summarize the above, we can say that if people want to access a health-related service, or any service, one needs to first think about two things: 1) how many people can be served (the capacity) and 2) how many people are able to access the service. For this latter part, the idea of “underserved” communities comes into play. (Recently, a colleague of ours suggested that we use the term “underserved” when referring to communities and we stop saying “hard-to-reach,” as it is often the service that is “hard to reach.”)

Any Robert Chambers fans reading this essay might be thinking right now about his classic books: “Rural Development: Putting the Last First,” where he urged all of us to go beyond the areas accessible by paved roads, to do what is less comfortable but potentially more important and equitable. [PDF of full book here, see p. 13 to learn about “Spatial” biases]

To continue with Tanahashi’s Service Coverage Model, after determining the capacity to deliver a service and the number of people who can actually access that service, it is important to consider one additional service-side component, which is the quality of the service. Is the service good? Are people willing to use the service? Do they feel welcomed? Are service-side actors friendly and knowledgable?

People working in Design, Marketing, Branding or Sales might find these questions obvious: “Of COURSE a service should be of high quality!”

The commercial sector aims to ensure that clients do not encounter “pain points,” “hassle factors,” or “friction moments” when trying to purchase a product or access a service.

In the social sector, the ideas of “making things easy and attractive” are rarely discussed in our experience.

Having covered the key points of Tanahashi’s essay, we can now present an extremely short guide to increasing Service Coverage:

1. First step: Ensure you have enough capacity to serve a given community. (People crying “vaccine hesitancy!” we’re looking at YOU.) Are there enough supplies? Is the service open when it should be open? Do staff regularly show up for work? If not, you would do well to address these first before you promote your service;
2. Step two: Do everything you can to help people access your service. Consider “mobile services” (outreach vans, motorcycles, bicycles, etc.). If you can’t bring your service to the people, help the people get to the service. Consider a shuttle service. Consider opening earlier, for those who have to go to their farms, or get to work early. Consider staying open late.
3. Step three: Build client satisfaction into your service model. Regularly ask service users: “How did we do?” Create accountability mechanisms for poor service. Use a “Net Promoter Score” or other one-question exit survey to see what clients thought of their experience. Alight, formerly American Refugee Committee, successfully built real-time customer feedback and improvement into refugee camp service model. Let their wise investment and experience inspire us.
4. Step four: Don’t blame community members if they don’t want your product or don’t access your service.

That’s it. That is the “Access to Service” Guide in four short steps.

One motivation for writing this essay is our strong desire to reduce the amount of blame placed on communities themselves by public health professionals who bemoan “low coverage,” “low uptake” and the “hesitancy” of community members to use services.

If you work in the commercial sector you would never blame your clients for not purchasing your product, or not coming to your restaurant. So why do we, in the social sector, think it is okay to blame communities for low vaccination rates? Or for low birth-registration rates?

Those laggard community members, when will they learn to accept and access our mediocre, hard-to-reach services? (We’re snark-laughing here, but also slightly crying, and hoping for changes and and end to this “blame the community mindset.”).

Thank you for reading this essay. Suggestions and comments welcome. A word of thanks to Kier Olsen DeVries from The Communication Initiative, whose kind email motivated me to keep writing, one “four minute essay” at a time. kgreiner-at-gmail-dot-com. Twitter: @kpgreiner