Abstract
BackgroundDecentralised health services form a key part of chronic care strategies in resource-limited settings by reducing the distance between patient and clinic and thereby the time and costs involved in travelling. However, few tools exist to evaluate the impact of decentralisation on patient travel time or what proportion of patients attend their nearest clinic. Here we develop methods to monitor changes in travel time, using data from the antiretroviral therapy (ART) roll-out in a rural district in North Malawi.MethodsClinic position was combined with GPS information on the home village of patients accessing ART services in Karonga District (North Malawi) between July 2005 and July 2009. Potential travel time was estimated as the travel time for an individual attending their nearest clinic, and estimated actual travel time as the time to the clinic attended. This allowed us to calculate changes in potential and actual travel time as new clinics opened and track the proportion and origin of patients not accessing their nearest clinic.ResultsThe model showed how the opening of further ART clinics in Karonga District reduced median potential travel time from 83 to 43 minutes, and median actual travel time fell from 83 to 47 minutes. The proportion of patients not attending their nearest clinic increased from 6% when two clinics were open, to 12% with four open.DiscussionIntegrating GPS information with patient data shows the impact of decentralisation on travel time and clinic choice to inform policy and research questions. In our case study, travel time decreased, accompanied by an increased uptake of services. However, the model also identified an increasing proportion of ART patients did not attend their nearest clinic.
Highlights
Poor transport infrastructure and scattered populations in low income countries force people from rural communities to spend a significant amount of their time and scarce income in travelling to meet basic needs such as healthcare [1,2], which has been shown to be a barrier to initiating care [3]
The median potential travel time to the nearest antiretroviral therapy (ART) clinic for any person living in Karonga District was almost halved
We combined geographical information on area of residence and clinic use to monitor the impact of decentralised chronic care services on estimated patient travel time, illustrated by a case study of ART roll-out in Malawi
Summary
Poor transport infrastructure and scattered populations in low income countries force people from rural communities to spend a significant amount of their time and scarce income in travelling to meet basic needs such as healthcare [1,2], which has been shown to be a barrier to initiating care [3]. Using Geographical Information Systems one can link the area of residence with the clinic accessed for their care [6,7], and assess how health service utilisation changes as clinics closer to home start providing the required care. This will help evaluate the impact of decentralised services based on one of its key metrics, the travel time. Decentralised health services form a key part of chronic care strategies in resource-limited settings by reducing the distance between patient and clinic and thereby the time and costs involved in travelling. We develop methods to monitor changes in travel time, using data from the antiretroviral therapy (ART) roll-out in a rural district in North Malawi
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
