This paper assesses the evidence of the human development and economic impacts of efforts to make services more inclusive. These interventions mostly involve extending access to under-served groups, but may also focus on improving utilisation or the quality of services delivered to marginalised groups.
Attribution issues hamper examination of the contribution of efforts to make service delivery more inclusive. However, many qualitative country case studies provide detailed, long-term assessments of efforts to make services more inclusive and improve progress towards the MDGs. The majority of these studies demonstrate a strong positive effect, although some highlight shortcomings. Most also acknowledge that success has been underpinned by broader improvements in governance and in social and economic development. These findings are generally supported by impact evaluations of specific programmes. Some of these evaluations, however, find that these programmes did not create broader health or economic benefits, and that lack of impact was usually the result of poor implementation.
More systematic analysis of the evidence has been conducted in the health sector. Two systematic reviews in the field of health suggest that the evidence for most mechanisms for improving access is generally of poor quality and that where the evidence is good (as in the case of conditional cash transfers (CCTs), success is often underpinned by contextual factors (such as the existence of a functioning health system).
