The project seeks to use the unique position of the INDEPTH platform of health and demographic surveillance systems (HDSSs) in Africa and Asia to understand the impact of various health sector reforms on the population particularly the poor and vulnerable in society. The project will develop a simple tool that will be used by the HDSSs to capture information on need, access to health care and utilisation pattern of health care at the district level. Embedding the activities in the visits to households by the participating HDSSs in Ghana and Vietnam in a pilot, the project will document households’ needs, access and utilisation of health care services as a critical aspect in ensuring that the poor are identified for effective targeting of health care services. The project will enhance the knowledge of policy-makers in designing policies that will address health needs, access and utilisation of health care challenges.