Poverty and access to health care in developing countries are closely linked, with the poor facing significant barriers to accessing health services. This article examines disparities in access to health services in low- and middle-income countries (LMICs), using a framework that includes quality, geographic accessibility, availability, financial accessibility, and acceptability of services. While the poor in LMICs are often at a disadvantage in these dimensions, there are many approaches that can improve access, including targeted or universal strategies involving government, non-governmental, and commercial organizations. Key factors for success include reaching the poor, engaging communities, encouraging local adaptation, and monitoring effects on the poor. However, governments in LMICs rarely focus on the poor in their policies or implementation of health service strategies. New innovations in financing, delivery, and regulation of health services, such as health equity funds, conditional cash transfers, and coproduction of health services, hold promise for improving access to the poor. The challenge remains to ensure that vulnerable populations have a say in how strategies are developed, implemented, and accounted for, with improvements in access by the poor. The relationship between poverty and health care is a common subject of research and policy, often using different definitions of poverty and health care access. Poverty is recognized as extending beyond income or material deprivation, encompassing the lack of freedom to lead a life people value. Public health and clinical services, along with food, water, sanitation, and education, are necessary for good health. Empowerment at the individual and community levels affects health choices and access. Absolute and relative assessments of poverty are considered, with the ethical perspective or specific question informing which approach is more appropriate. Access to health services is related to the timely use of services according to need. Access includes actual use, with four main dimensions: geographic accessibility, availability, financial accessibility, and acceptability. Geographic accessibility involves physical distance or travel time to health facilities. Availability includes having the right type of care available, such as hours of operation and waiting times. Financial accessibility relates to the relationship between service prices and the ability to pay. Acceptability involves the match between health service providers' responsiveness to social and cultural expectations. In LMICs, poorer countries tend to have less access to health services than wealthier ones. LMICs account for 90% of the global burden of disease but only 12% of global health spending. High-income countries spend about 100 times more on health per capita than low-income countries. The density of health workers and hospital beds is much lower in LMICs, decreasing service availability. Out-of-pocket payments for health care are often the most inequitable type of financing, as they hit the poor hardest. User fees have been a contentious source of financing in low-income countries. Studies show that user fees can lead to decreased utilization, particularly for the poor. However, the abolition of user fees has been shown to increase use of health services in some countriesPoverty and access to health care in developing countries are closely linked, with the poor facing significant barriers to accessing health services. This article examines disparities in access to health services in low- and middle-income countries (LMICs), using a framework that includes quality, geographic accessibility, availability, financial accessibility, and acceptability of services. While the poor in LMICs are often at a disadvantage in these dimensions, there are many approaches that can improve access, including targeted or universal strategies involving government, non-governmental, and commercial organizations. Key factors for success include reaching the poor, engaging communities, encouraging local adaptation, and monitoring effects on the poor. However, governments in LMICs rarely focus on the poor in their policies or implementation of health service strategies. New innovations in financing, delivery, and regulation of health services, such as health equity funds, conditional cash transfers, and coproduction of health services, hold promise for improving access to the poor. The challenge remains to ensure that vulnerable populations have a say in how strategies are developed, implemented, and accounted for, with improvements in access by the poor. The relationship between poverty and health care is a common subject of research and policy, often using different definitions of poverty and health care access. Poverty is recognized as extending beyond income or material deprivation, encompassing the lack of freedom to lead a life people value. Public health and clinical services, along with food, water, sanitation, and education, are necessary for good health. Empowerment at the individual and community levels affects health choices and access. Absolute and relative assessments of poverty are considered, with the ethical perspective or specific question informing which approach is more appropriate. Access to health services is related to the timely use of services according to need. Access includes actual use, with four main dimensions: geographic accessibility, availability, financial accessibility, and acceptability. Geographic accessibility involves physical distance or travel time to health facilities. Availability includes having the right type of care available, such as hours of operation and waiting times. Financial accessibility relates to the relationship between service prices and the ability to pay. Acceptability involves the match between health service providers' responsiveness to social and cultural expectations. In LMICs, poorer countries tend to have less access to health services than wealthier ones. LMICs account for 90% of the global burden of disease but only 12% of global health spending. High-income countries spend about 100 times more on health per capita than low-income countries. The density of health workers and hospital beds is much lower in LMICs, decreasing service availability. Out-of-pocket payments for health care are often the most inequitable type of financing, as they hit the poor hardest. User fees have been a contentious source of financing in low-income countries. Studies show that user fees can lead to decreased utilization, particularly for the poor. However, the abolition of user fees has been shown to increase use of health services in some countries