Healthcare access for the elderly in the Middle East and North Africa Region: A scoping review based on Levesque framework

This research project is a scoping review that aims to systematically map and synthesize existing evidence on healthcare access among older adults in the Middle East and North Africa (MENA) region. The study focuses on identifying the key barriers and facilitators influencing access to healthcare services for individuals aged 60 years and above, as well as examining the dimensions of access most frequently reported in the literature. Purpose of the Study The MENA region is experiencing a gradual demographic transition characterized by a growing ageing population. Older adults typically have higher healthcare needs due to the increased prevalence of chronic diseases, functional limitations, and multimorbidity. Despite these growing needs, evidence on healthcare access for this population in the MENA region remains fragmented, often limited to specific diseases, individual countries, or healthcare utilization indicators without a comprehensive analysis of the underlying determinants. The primary purpose of this project is to provide a structured and comprehensive synthesis of the available research in order to: Identify and map the key barriers and facilitators affecting healthcare access for older adults in the MENA region. Examine healthcare access across the five dimensions proposed by Penchansky and Thomas: availability, accessibility, affordability, acceptability, and accommodation. Analyze the determinants of healthcare utilization using the Aday and Andersen behavioral model, which categorizes factors into predisposing, enabling, and need-related domains. Identify gaps in the current literature and highlight underexplored areas requiring further research. Research Approach A scoping review methodology was adopted to capture the breadth and diversity of evidence across multiple countries and healthcare contexts. The review followed the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines to ensure methodological rigor and transparency. A comprehensive search of multiple databases was conducted through the Saudi Digital Library, covering studies published between 2014 and 2025. Eligible studies included those conducted within MENA countries that examined healthcare access or utilization among older adults. Both quantitative and qualitative studies were included to allow for a broad understanding of structural, socioeconomic, cultural, and health system factors influencing access. The included studies were analyzed and synthesized using a framework-based approach. Findings were categorized according to the five dimensions of access, while determinants were mapped into predisposing, enabling, and need factors. This dual-framework approach enabled the study to examine both the nature of access challenges and the underlying mechanisms influencing healthcare-seeking behavior. Expected Outcomes The expected outcomes of this project include: A comprehensive evidence map outlining the major barriers and facilitators to healthcare access for older adults across MENA countries. Identification of the most critical access challenges, particularly those related to geographic accessibility, service availability, financial barriers, transportation, insurance coverage, and sociocultural factors affecting healthcare utilization. Recognition of under-researched areas, such as the accommodation dimension (e.g., system responsiveness, appointment systems, and age-friendly service design) and the role of digital health accessibility among older populations. Policy-relevant insights to support health system planning, including recommendations for improving service distribution, strengthening financial protection mechanisms, enhancing transport and outreach services, and developing culturally sensitive and age-friendly healthcare environments. A research agenda highlighting priority areas for future studies, including the need for multi-country research, mixed-methods approaches, and evaluation of interventions aimed at improving equitable healthcare access for ageing populations. Significance of the Project By synthesizing evidence across diverse healthcare systems and socioeconomic contexts, this study provides a regional perspective on the complex and multidimensional nature of healthcare access for older adults in MENA. The findings are expected to support policymakers, healthcare planners, and researchers in designing targeted strategies to reduce inequities and improve healthcare accessibility for an increasingly vulnerable and growing segment of the population.