Abstract: Despite increased investment in healthcare infrastructure and outreach services, including humanitarian assistance in complex emergencies, many low- and middle-income countries (LMICs) continue to experience critical failures in healthcare service utilization. Traditional access models, such as Andersen’s Behavioral Model, inadequately explain why resources, despite being technically available, fail to reach intended beneficiaries or translate into improved outcomes. This study introduces and empirically validates Bull’s Resource-to-Access Conversion Theory (B-RACT), a systems-level theoretical framework that explains the persistent gap between resource availability and actual healthcare access in fragile, corrupt, or poorly governed contexts. Central to B-RACT is the novel construct of the Resource-to-Access Conversion Gap (RACG), which captures both structural and perceptual barriers, including corruption, lack of accountability, service opacity, and institutional distrust that obstruct the effective utilization of resources. Using a 35-item instrument derived from the model and tested in a LMIC sample (N = 300), the study confirms B-RACT’s core propositions through correlation, multiple regression, and structural equation modeling. The model explained 52.7% of the variance in self-reported health outcomes, with healthcare utilization (β = .501, p < .001) and trust in the health system (β = .213, p < .01) emerging as significant predictors. RACG negatively predicted trust (β = –.472), while governance accountability positively predicted trust and mitigated RACG. Importantly, effect size analysis revealed that healthcare utilization had a large effect (f² = 0.61), trust in the health system a medium effect (f² = 0.23), and RACG a large effect (f² = 0.59) in predicting health outcomes and mediating system trust. These results further reinforce the explanatory power of B-RACT in diagnosing systemic inefficiencies and access failures. Beyond LMICs, B-RACT has broad application in complex emergencies, refugee settings, and disaster response, where the breakdown of accountability mechanisms impedes access. By shifting the analytic lens from resource inputs to the integrity of conversion mechanisms—emphasizing trust, governance, and legitimacy, B-RACT provides a powerful tool for global health policy reform, humanitarian health programming, and implementation science.
Keywords: B-RACT, Resource-to-Access Conversion Gap (RACG), health systems, service utilization, LMICs, governance accountability, humanitarian access, effect sizes.
Title: Resource-to-Access Conversion Theory (B-RACT): A New Model for Understanding Service Utilization Failures and Resource Conversion Gaps in Healthcare Delivery in Third World Countries
Author: Dr. David Augustine Bull
International Journal of Interdisciplinary Research and Innovations
ISSN 2348-1218 (print), ISSN 2348-1226 (online)
Vol. 13, Issue 4, October 2025 - December 2025
Page No: 56-97
Research Publish Journals
Website: www.researchpublish.com
Published Date: 05-November-2025
