Quantify the scale and causes of healthcare access failures in low-income and lower-middle-income countries, assess the mortality and morbidity consequences, and identify the primary system-level bottlenecks preventing service delivery.

Analysis of WHO GHED database, World Bank health spending data across 180 countries, and DHS/MICS household surveys covering 900M+ respondents. Facility readiness assessments from SARA tool across 45 countries. Cross-referenced with Lancet Global Health mortality burden studies.

3 billion people lack reliable access to essential healthcare services — not due to lack of knowledge about what works, but due to systemic delivery failures. In Sub-Saharan Africa, the median distance to the nearest facility is 40km; in rural Nepal, 60km. Only 55% of health facilities in LDCs have reliable electricity; 40% lack basic infection prevention supplies.

Maternal mortality in Chad remains 1,140 per 100,000 live births — 220x higher than in wealthy countries. The problem is not primarily financial (many countries could achieve UHC at 4-5% GDP) but organizational: fragmented supply chains, absent accountability, and health workers without supervision or support.