Abstract
BackgroundEfforts to tackle the enormous burden of ill-health in low-income countries are hampered by weak health information infrastructures that do not support appropriate planning and resource allocation. For health information systems to function well, a reliable inventory of health service providers is critical. The spatial referencing of service providers to allow their representation in a geographic information system is vital if the full planning potential of such data is to be realized.MethodsA disparate series of contemporary lists of health service providers were used to update a public health facility database of Kenya last compiled in 2003. These new lists were derived primarily through the national distribution of antimalarial and antiretroviral commodities since 2006. A combination of methods, including global positioning systems, was used to map service providers. These spatially-referenced data were combined with high-resolution population maps to analyze disparity in geographic access to public health care.FindingsThe updated 2008 database contained 5,334 public health facilities (67% ministry of health; 28% mission and nongovernmental organizations; 2% local authorities; and 3% employers and other ministries). This represented an overall increase of 1,862 facilities compared to 2003. Most of the additional facilities belonged to the ministry of health (79%) and the majority were dispensaries (91%). 93% of the health facilities were spatially referenced, 38% using global positioning systems compared to 21% in 2003. 89% of the population was within 5 km Euclidean distance to a public health facility in 2008 compared to 71% in 2003. Over 80% of the population outside 5 km of public health service providers was in the sparsely settled pastoralist areas of the country.ConclusionWe have shown that, with concerted effort, a relatively complete inventory of mapped health services is possible with enormous potential for improving planning. Expansion in public health care in Kenya has resulted in significant increases in geographic access although several areas of the country need further improvements. This information is key to future planning and with this paper we have released the digital spatial database in the public domain to assist the Kenyan Government and its partners in the health sector.
Highlights
Efforts to tackle the enormous burden of ill-health in low-income countries are hampered by weak health information infrastructures that do not support appropriate planning and resource allocation
We have shown that, with concerted effort, a relatively complete inventory of mapped health services is possible with enormous potential for improving planning
Expansion in public health care in Kenya has resulted in significant increases in geographic access several areas of the country need further improvements
Summary
Efforts to tackle the enormous burden of ill-health in low-income countries are hampered by weak health information infrastructures that do not support appropriate planning and resource allocation. Efforts to tackle the enormous burden of ill-health in low-income countries are hampered by the lack of functioning health information structures to provide reliable health statistics [4,5,6,7,8,9,10]. Central to a fully operational Health Information Systems (HIS) is a basic inventory of all functioning health facilities and the services they provide Such an inventory requires a spatial dimension, allowing facilities to be linked to the populations they serve and other proximate determinants of health such as environment, poverty and education. This spatial linkage can be provided by geographic information systems (GIS). The use of GIS for health services planning is widespread in developed countries [11,12,13] but there are few examples of their development and operational use in resource poor settings in Africa [14,15,16,17]
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