A Systematic Literature Review on Building Accessible and Quality-Driven Healthcare

Abstract

Background: Health systems worldwide have widened nominal coverage faster than they have secured the quality, safety and fairness of the care people actually receive. Access and quality are still studied largely in separate literatures, which leaves policymakers with fragmentary guidance. Objective: To synthesise how accessibility and quality have been conceptualised, measured and operationalised across clinical, digital, workforce, legal and environmental domains, and to audit where the evidence is thin, concentrated or contradictory. Methods: The review was reported against the PRISMA 2020 guideline, adapted for a bounded corpus. Two evidence streams were combined: a screened corpus of 117 records, of which 62 met the eligibility criteria, and a purposive benchmark set of 69 landmark syntheses, conceptual frameworks and primary studies. Findings were integrated through narrative and thematic synthesis. Results: Eligible corpus records clustered in clinical-system topics (n = 19), determinants and governance (n = 14), integrative health (n = 14), quality-assurance analogues (n = 9) and methodological or research-integrity guidance (n = 6). Only three records signalled a systematic or meta-analytic design, 60 of 62 shared a common author, and 51.6% appeared in a single journal. Benchmark evidence showed that poor-quality care, rather than non-use alone, accounts for a large share of avoidable mortality in low- and middle-income countries; that digital and algorithmic tools can narrow or widen inequity depending on design; and that workforce wellbeing, facility design and legal accountability are under-integrated in access policy. Conclusions: An integrated Accessibility–Quality–Equity (AQE) framework with six domains and seven testable propositions is proposed. The principal conclusion is that accessibility without verified quality is incomplete coverage, and that the present evidence base needs independent replication, standardised outcome measurement and transparent reporting before it can safely guide system redesign.