Abstract
BackgroundAccess to health care can be described along four dimensions: geographic accessibility, availability, financial accessibility and acceptability. Geographic accessibility measures how physically accessible resources are for the population, while availability reflects what resources are available and in what amount. Combining these two types of measure into a single index provides a measure of geographic (or spatial) coverage, which is an important measure for assessing the degree of accessibility of a health care network.ResultsThis paper describes the latest version of AccessMod, an extension to the Geographical Information System ArcView 3.×, and provides an example of application of this tool. AccessMod 3 allows one to compute geographic coverage to health care using terrain information and population distribution. Four major types of analysis are available in AccessMod: (1) modeling the coverage of catchment areas linked to an existing health facility network based on travel time, to provide a measure of physical accessibility to health care; (2) modeling geographic coverage according to the availability of services; (3) projecting the coverage of a scaling-up of an existing network; (4) providing information for cost effectiveness analysis when little information about the existing network is available. In addition to integrating travelling time, population distribution and the population coverage capacity specific to each health facility in the network, AccessMod can incorporate the influence of landscape components (e.g. topography, river and road networks, vegetation) that impact travelling time to and from facilities. Topographical constraints can be taken into account through an anisotropic analysis that considers the direction of movement. We provide an example of the application of AccessMod in the southern part of Malawi that shows the influences of the landscape constraints and of the modes of transportation on geographic coverage.ConclusionBy incorporating the demand (population) and the supply (capacities of heath care centers), AccessMod provides a unifying tool to efficiently assess the geographic coverage of a network of health care facilities. This tool should be of particular interest to developing countries that have a relatively good geographic information on population distribution, terrain, and health facility locations.
Highlights
Access to health care can be described along four dimensions: geographic accessibility, availability, financial accessibility and acceptability
We use the conceptual framework of access to health care proposed by Peters et al [4] that is derived from longstanding descriptions of access to health services [2,5,6]
This framework recognizes four dimensions of access: (1) geographic accessibility – the physical distance or travel time from service delivery point to the user; (2) availability – having the right type of care to those who need it; (3) financial accessibility – the relationship between the price of services and the willingness and ability of users to pay for those services; (4) acceptability – the match between how responsive health services providers are to the social and cultural expectations of individual users and communities
Summary
Access to health care can be described along four dimensions: geographic accessibility, availability, financial accessibility and acceptability. We use the conceptual framework of access to health care proposed by Peters et al [4] that is derived from longstanding descriptions of access to health services [2,5,6] This framework recognizes four dimensions of access: (1) geographic accessibility – the physical distance or travel time from service delivery point to the user; (2) availability – having the right type of care to those who need it; (3) financial accessibility – the relationship between the price of services and the willingness and ability of users to pay for those services; (4) acceptability – the match between how responsive health services providers are to the social and cultural expectations of individual users and communities. Central to this framework is the concept of the quality of care and each of these dimensions has a supply and demand concept
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