Abstract
BackgroundLong distances to facilities, topographical constraints, inadequate service capacity of institutions and insufficient/ rudimentary road & transportation network culminate into unprecedented barriers to access. These barriers gets exacerbated in presence of external factors like conflict and political disruptions. Thus, this study was conducted in rural, remote and fragile region in India measuring geographical accessibility and modelling spatial coverage of public healthcare network.MethodsVector and raster based approaches were used to discern accessibility for various packages of service delivery. Alternative scenarios derived from local experiences were modelled using health facility, population and ancillary data. Based on that, a raster surface of travel time between facilities and population was developed by incorporating terrain, physical barriers, topography and travelling modes and speeds through various land-cover classes. Concomitantly, spatial coverage was modelled to delineate catchment areas. Further, underserved population and zonal statistics were assessed in an interactive modelling approach to ascertain spatial relationship between population, travel time and zonal boundaries. Finally, raster surface of travel time was re-modelled for the conflict situation in villages vulnerable to obstruction of access due to disturbed security scenario.ResultsEuclidean buffers revealed 11% villages without ambulatory & immunization care within 2 km radius. Similarly, for 5 km radius, 11% and 12% villages were bereft of delivery and inpatient care. Travel time accessibility analysis divulged walking scenario exhibiting lowest level of accessibility. Enabling motorized travel improved accessibility measures, with highest degree of accessibility for privately owned vehicle (motorcycle and cars). Differential results were found between packages of services where ambulatory & immunization care was relatively accessible by walking; whereas, delivery and inpatient care had a staggering average of three hours walking time. Even with best scenario, around 2/3rd population remained unserved for all package of services. Moreover, 90% villages in conflict zone grapples with inaccessibility when the scenario of heightened border tensions was considered.ConclusionsOur study demonstrated the application of GIS technique to facilitate evidence backed planning at granular level. Regardless of the scenario, the analysis divulged inaccessibility to delivery and inpatient care to be most pronounced and majority of population to be unserved. It was suggested to have concerted efforts to bolster already existing facilities and adapt systems approach to exploit synergies of inter-sectoral development.
Highlights
Universal Health Coverage(UHC) has become the focal point of health policy discourse as the world has made transition from Millennium Development Goals(MDG s) to Sustainable Development Goals (Goal 3.8: “Achieve UHC, including financial risk protection, access to quality essential healthcare services and access to safe, effective, quality and affordable essential medicines and vaccines for all”)
Differential results were found between packages of services where ambulatory & immunization care was relatively accessible by walking; whereas, delivery and inpatient care had a staggering average of three hours walking time
Our study demonstrated the application of GIS technique to facilitate evidence backed planning at granular level
Summary
Universal Health Coverage(UHC) has become the focal point of health policy discourse as the world has made transition from Millennium Development Goals(MDG s) to Sustainable Development Goals (Goal 3.8: “Achieve UHC, including financial risk protection, access to quality essential healthcare services and access to safe, effective, quality and affordable essential medicines and vaccines for all”). The framework of effective coverage propounded by Tanahashi encompasses the domain of accessibility (spatial and non-spatial) as a component in ascertaining barriers to Universal Health Coverage [1]. Spatial accessibility measuring travel impedance (distance or time) between patient location and service points impacts the progression from potential to realized access. Topographical constraints, inadequate service capacity of institutions and insufficient/ rudimentary road & transportation network culminate into unprecedented barriers to access. These barriers gets exacerbated in presence of external factors like conflict and political disruptions. This study was conducted in rural, remote and fragile region in India measuring geographical accessibility and modelling spatial coverage of public healthcare network
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