Abstract

Health care access is a challenge in rural areas in Africa. On the demand side, rural people are often poor, and transport connectivity is typically bad in rural and remote areas. Because of limited transport connectivity, the quality of health care services provided is also often compromised. In Madagascar, the poor condition of the road network has long hampered the sustainability of the medical supply chain in rural areas. The paper shows that people's demand for health care services is affected not only by local transport connectivity, but also availability of medical supplies at the health facility level, which is also determined by primary and secondary road network connectivity. This in turn further suppresses people's demand in rural areas. The results also indicate that it is important to ensure financial affordability among the poor, which is found to be one of the most crucial constraints.

Highlights

  • Health care access is an important challenge in rural areas, in developing countries

  • For Equation (1), local connectivity is measured by two variables: (i) weighted average distance between a fokontany and the nearest basic health center, and (ii) rural access index (RAI), which is available at the district level

  • Rural people tend to be poorer than urban residents for whatever reason

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Summary

Introduction

Health care access is an important challenge in rural areas, in developing countries. Limited transport connectivity reduces people’s accessibility, and compromises the quality of health care services provided. Because of the lack of proper insurance, rural residents are less likely to use emergency medical services (Fan et al, 2011) This is a important concern in Africa where poverty is concentrated in rural areas. This paper casts light on the nexus of transport connectivity, medical supply sustainability and people’s health care service access. As discussed, these factors are interdependent on one another.

Methodology and data
Main estimation results
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