Abstract
BackgroundIn conflict settings, data to guide humanitarian and development responses are often scarce. Although geospatial analyses have been used to estimate health-care access in many countries, such techniques have not been widely applied to inform real-time operations in protracted health emergencies. Doing so could provide a more robust approach for identifying and prioritising populations in need, targeting assistance, and assessing impact. We aimed to use geospatial analyses to overcome such data gaps in Yemen, the site of one of the world's worst ongoing humanitarian crises.MethodsWe derived geospatial coordinates, functionality, and service availability data for Yemen health facilities from the Health Resources and Services Availability Monitoring System assessment done by WHO and the Yemen Ministry of Public Health and Population. We modelled population spatial distribution using high-resolution satellite imagery, UN population estimates, and census data. A road network grid was built from OpenStreetMap and satellite data and modified using UN Yemen Logistics Cluster data and other datasets to account for lines of conflict and road accessibility. Using this information, we created a geospatial network model to deduce the travel time of Yemeni people to their nearest health-care facilities.FindingsIn 2018, we estimated that nearly 8·8 million (30·6%) of the total estimated Yemeni population of 28·7 million people lived more than 30-min travel time from the nearest fully or partially functional public primary health-care facility, and more than 12·1 million (42·4%) Yemeni people lived more than 1 h from the nearest fully or partially functional public hospital, assuming access to motorised transport. We found that access varied widely by district and type of health service, with almost 40% of the population living more than 2 h from comprehensive emergency obstetric and surgical care. We identified and ranked districts according to the number of people living beyond acceptable travel times to facilities and services. We found substantial variability in access and that many front-line districts were among those with the poorest access.InterpretationThese findings provide the most comprehensive estimates of geographical access to health care in Yemen since the outbreak of the current conflict, and they provide proof of concept for how geospatial techniques can be used to address data gaps and rigorously inform health programming. Such information is of crucial importance for humanitarian and development organisations seeking to improve effectiveness and accountability.FundingGlobal Financing Facility for Women, Children, and Adolescents Trust Fund; Development and Data Science grant; and the Yemen Emergency Health and Nutrition Project, a partnership between the World Bank, UNICEF, and WHO.
Highlights
Since 2015, Yemen has faced one of the world’s most devastating armed conflicts
A road network grid was built from OpenStreetMap and satellite data and modified using UN Yemen Logistics Cluster data and other datasets to account for lines of conflict and road accessibility
Geospatial analytics have been used to estimate access to care and inform policy making in many countries, these techniques have not been widely applied in conflict settings to inform humanitarian and development responses
Summary
Since 2015, Yemen has faced one of the world’s most devastating armed conflicts. More than 100 000 people have been killed, 3·6 million internally displaced, and nearly 80% of the country’s almost 30 million people requires humanitarian assistance.[1,2] In 2018, the conflict in Yemen was named the world’s worst humanitarian crisis, with nearly half of the country’s population on the brink of famine and hundreds of thousands affected by cholera.[3,4] The ongoing conflict has severely affected the country’s health-care system: barely half of public health facilities are fully functional; salaries for health-care workers went unpaid from October, 2016, to early 2019; and essential medications and equipm ent are in short supply or absent.[5]As humanitarian and development agencies seek to support health-care delivery in Yemen, timely and www.thelancet.com/lancetgh Vol 8 November 2020 e1435 e1436Research in contextEvidence before this study Timely and accurate data are crucial for guiding humanitarian and development assistance in protracted conflict settings, yet such data are often lacking. The conflict in Yemen, in its 6th year, has severely impacted the country’s health system, but data on access to health care remain scarce. Geospatial analytics have been used to estimate access to care and inform policy making in many countries, these techniques have not been widely applied in conflict settings to inform humanitarian and development responses. We searched PubMed, Google Scholar, and grey literature in the Humanitarian Data Exchange repository for articles in English related to the use of geospatial analyses in humanitarian health emergencies and conflict settings between Jan 1, 2006, and Dec 1, 2019. We searched more broadly for examples of geospatial analyses used for health policy and planning from non-conflict settings focusing on the measurement of access to care.
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