scholarly journals Geographical perspective of modeling primary healthcare accessibility

2017 ◽  
Vol 10 (1) ◽  
pp. 56-67 ◽  
Author(s):  
Justice Surage ◽  
Richard Tawiah ◽  
Timothy Twumasi-Mensah
Keyword(s):  
Health Facility ◽  
Primary Healthcare ◽  
Rural Areas ◽  
Healthcare Facility ◽  
Access To Healthcare ◽  
Health Facilities ◽  
Spatial Accessibility ◽  
Content Type ◽  
Central District ◽  
Healthcare Accessibility

Purpose The purpose of this paper is to measure the spatial accessibility of primary healthcare facility in Ghanaian rural areas, by determining the barriers to healthcare accessibilities in the Amansie Central District. Design/methodology/approach Both network and proximity analyses were performed on the digitized data such as road networks, settlements, population, district boundary, natural resources (rivers, streams and forest) and site location (health facilities). To quantify the population who have access to healthcare the authors used the Ghana Health Service access criteria that health facility should be accessible to an estimated population within 8 km radius from the facility. Findings The overall mean distance to the nearest health facility in the district was 8.9 km. Fiankoma sub-district recorded the highest mean distance whereas Tweapease sub-district recorded the least. In general, 31.2 percent of the district population has no access to healthcare facility. Transportation was identified to be one of the major hindrances to healthcare accessibility and this was as a result of poor road network in the district. Research limitations/implications The study was restricted to the Amansie Central District of Ghana. This limits the extent of generalization of results. Originality/value The study proposed additional sites for siting new health facilities base on criteria such as population, distance, centrality and existing infrastructural development. This will consequently improve healthcare accessibility and utilization by increasing total coverage closer to 100 percent.

scholarly journals Improving Tanzanian childbirth service quality

2018 ◽  
Vol 31 (3) ◽  
pp. 190-202 ◽  
Author(s):  
Jennie Jaribu ◽  
Suzanne Penfold ◽  
Cathy Green ◽  
Fatuma Manzi ◽  
Joanna Schellenberg
Keyword(s):  
Health Facility ◽  
Low Income ◽  
Healthcare Providers ◽  
Health Facilities ◽  
Rural District ◽  
Local Data ◽  
Content Type ◽  
Primary Health ◽  
Primary Health Facilities ◽  
Childbirth Care

Purpose The purpose of this paper is to describe a quality improvement (QI) intervention in primary health facilities providing childbirth care in rural Southern Tanzania. Design/methodology/approach A QI collaborative model involving district managers and health facility staff was piloted for 6 months in 4 health facilities in Mtwara Rural district and implemented for 18 months in 23 primary health facilities in Ruangwa district. The model brings together healthcare providers from different health facilities in interactive workshops by: applying QI methods to generate and test change ideas in their own facilities; using local data to monitor improvement and decision making; and health facility supervision visits by project and district mentors. The topics for improving childbirth were deliveries and partographs. Findings Median monthly deliveries increased in 4 months from 38 (IQR 37-40) to 65 (IQR 53-71) in Mtwara Rural district, and in 17 months in Ruangwa district from 110 (IQR 103-125) to 161 (IQR 148-174). In Ruangwa health facilities, the women for whom partographs were used to monitor labour progress increased from 10 to 57 per cent in 17 months. Research limitations/implications The time for QI innovation, testing and implementation phases was limited, and the study only looked at trends. The outcomes were limited to process rather than health outcome measures. Originality/value Healthcare providers became confident in the QI method through engagement, generating and testing their own change ideas, and observing improvements. The findings suggest that implementing a QI initiative is feasible in rural, low-income settings.

Factors Influencing Choice of Delivery Place among Mothers in Rukungiri and Kanungu Districts, South Western Uganda: A Cross Sectional Study

2020 ◽  
Author(s):  
Richard Mugambe ◽  
Habib Yakubu ◽  
Solomon Wafula ◽  
Tonny Ssekamatte ◽  
Simon Kasasa ◽  
...  
Keyword(s):  
Health Facility ◽  
Rural Areas ◽  
Health Workers ◽  
Public Health Facility ◽  
Facility Delivery ◽  
Health Facilities ◽  
Public Facility ◽  
Cross Sectional ◽  
Western Uganda ◽  
Delivery Place

Abstract Background: Child birth in health facilities is generally associated with lower risk of maternal and neonatal mortality. However, in Uganda, little is known about factors that influence use of health facilities for delivery especially in rural areas. In this study, we examined the determinants of mothers’ decision of the choice of child delivery place in Western Uganda.Methods: Cross-sectional data was collected from 894 randomly-sampled mothers within the catchment of two private hospitals in Rukungiri and Kanungu districts. Data was collected on the place of delivery for the most recent child, mothers’ sociodemographic characteristics, health facility water, sanitation and hygiene (WASH) status. Modified Poisson regression was used to estimate prevalence ratios (PRs) for the determinants of mothers’ choice of delivery place as well as determinants for the choice of private versus public facility for delivery at 95% confidence intervals. Results: Majority of mothers (90.2%) delivered in health facilities. Non-facility deliveries were attributed to fast progression of labour (77.3%), lack of transport (31.8%) and high cost of hospital delivery (12.5%). Being engaged in business as an occupation [APR = 1.06, 95% CI (1.01 – 1.11)] and belonging to the highest wealth quintile [APR = 1.09, 95% CI (1.02 – 1.17)] favoured facility delivery while higher parity of 3 – 4 [APR = 0.93, 95% CI (0.88 – 0.99)] was inversely associated with facility delivery as compared to parity of 1-2. Choice of private facility over public facility was influenced by how mothers valued factors such as high skilled health workers [APR = 1.15, 95% CI (1.05 – 1.26)], higher quality of WASH services [APR = 1.11, 95% CI (1.04 – 1.17)], cost of the delivery [APR = 0.85, 95% CI (0.78 – 0.92)] and availability of caesarean services [APR = 1.13, 95% CI (1.08 – 1.19)].Conclusion: Utilization of health facility child delivery services was high. Health facility delivery service utilization was influenced by engaging in business, belonging to wealthiest quintile and being multiparous. Choice of private versus public health facility for child delivery was influenced by health facility WASH status, cost of services, and availability of skilled workforce and caesarean services.

scholarly journals Spatial access inequities and childhood immunisation uptake in Kenya

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Noel K. Joseph ◽  
Peter M. Macharia ◽  
Paul O. Ouma ◽  
Jeremiah Mumo ◽  
Rose Jalang’o ◽  
...  
Keyword(s):  
Travel Time ◽  
Health Facility ◽  
Total Population ◽  
Univariate Analysis ◽  
Household Wealth ◽  
Health Facilities ◽  
Spatial Accessibility ◽  
Immunisation Coverage ◽  
Spatial Access ◽  
Major Barrier

Abstract Background Poor access to immunisation services remains a major barrier to achieving equity and expanding vaccination coverage in many sub-Saharan African countries. In Kenya, the extent to which spatial access affects immunisation coverage is not well understood. The aim of this study was to quantify spatial accessibility to immunising health facilities and determine its influence on immunisation uptake in Kenya while controlling for potential confounders. Methods Spatial databases of immunising facilities, road network, land use and elevation were used within a cost friction algorithim to estimate the travel time to immunising health facilities. Two travel scenarios were evaluated; (1) Walking only and (2) Optimistic scenario combining walking and motorized transport. Mean travel time to health facilities and proportions of the total population living within 1-h to the nearest immunising health facility were computed. Data from a nationally representative cross-sectional survey (KDHS 2014), was used to estimate the effect of mean travel time at survey cluster units for both fully immunised status and third dose of diphtheria-tetanus-pertussis (DPT3) vaccine using multi-level logistic regression models. Results Nationally, the mean travel time to immunising health facilities was 63 and 40 min using the walking and the optimistic travel scenarios respectively. Seventy five percent of the total population were within one-hour of walking to an immunising health facility while 93% were within one-hour considering the optimistic scenario. There were substantial variations across the country with 62%(29/47) and 34%(16/47) of the counties with < 90% of the population within one-hour from an immunising health facility using scenarios 1 and 2 respectively. Travel times > 1-h were significantly associated with low immunisation coverage in the univariate analysis for both fully immunised status and DPT3 vaccine. Children living more than 2-h were significantly less likely to be fully immunised [AOR:0.56(0.33–0.94) and receive DPT3 [AOR:0.51(0.21–0.92) after controlling for household wealth, mother’s highest education level, parity and urban/rural residence. Conclusion Travel time to immunising health facilities is a barrier to uptake of childhood vaccines in regions with suboptimal accessibility (> 2-h). Strategies that address access barriers in the hardest to reach communities are needed to enhance equitable access to immunisation services in Kenya.

scholarly journals A temporal analysis of maternal deaths in some selected health facilities in Zamfara State, Northwest Nigeria: How far were United Nations Millennium Development Goals (MDG) 5 achieved?

2016 ◽  
Vol 15 (1) ◽  
Author(s):  
Abdullahi Mohammed Maiwada ◽  
Nor Azlina A Rahman ◽  
Suzanah Abdul Rahman ◽  
Nik Mazlan Mamat ◽  
Tukur A Baba ◽  
...  
Keyword(s):  
Maternal Mortality ◽  
Health Facility ◽  
Rural Areas ◽  
Urban Areas ◽  
Maternal Mortality Ratio ◽  
Temporal Analysis ◽  
Health Facilities ◽  
Steady Increase ◽  
Maternal Deaths ◽  
Mortality Ratio

Introduction: The steady increase in maternal deaths in Nigeria is a serious source of concern to policy makers and key stakeholders as one of the major threats to the achievement of the MDGs. Nigeria is reported to have one of the highest maternal mortality ratios in the world. This study was aimed at examining the challenges confronting the achievement of the MDGs Goals 5 in Zamfara State northwest Nigeria in terms of maternal mortality ratio, causes and frequency of antenatal visits. Methods: Health facility based approach and statistics were used in assessing maternal mortality ratio. Data was collected from health facility records and folders of patients who lost their lives due to pregnancy and childbirth related illnesses in some selected health facilities in Zamfara State from 2011- 2015. Results: The results showed the highest maternal deaths are in the rural areas 5120/100,000 as compared to 750/100,000 urban health facilities. Haemorrhage was the leading medical cause of maternal death. Others include sepsis, eclampsia, sickle cell anaemia, obstructed labour and abortion. However, there was a significant increase in the number of antenatal care visits from 7.20% to 30.93% within the last five years. However, the maternal mortality rate has increased, though not stable from 735/100,000 in 2011 to 1248/100,000 in 2013 and 930/100,000 in mid-2015. Conclusions: There was an increase in maternal deaths in rural compared to urban areas health clinics despite increased in the attendance of ante natal care visits thus the 5th Millennium Development Goal in Zamfara State not achieved.

scholarly journals Pentavalent Vaccination in Rural Kenya: Coverage and Geographical Accessibility to Health Facilities Using Data from a Community Demographic and Health Surveillance System in Kilifi County.

2020 ◽  
Author(s):  
Morris Ogero ◽  
James Orwa ◽  
Rachael Odhiambo ◽  
Felix Agoi ◽  
Adelaide Lusambili ◽  
...  
Keyword(s):  
Travel Time ◽  
Health Facility ◽  
Vaccination Coverage ◽  
Surveillance System ◽  
Immunization Coverage ◽  
Health Facilities ◽  
Spatial Accessibility ◽  
Immunisation Coverage ◽  
Spatial Access ◽  
Routine Immunisation

Abstract BackgroundThere is substantial evidence that immunization is one of the most significant and cost-effective pillars of preventive and promotive health interventions. Effective childhood immunization coverage is thus essential in stemming persistent childhood illnesses. The main indicator of performance of the immunisation programme is the third dose of diphtheria-tetanus-pertussis (DTP3) vaccine for children because it mirrors the completeness of a child’s immunisation schedule. Spatial access to a health facility, especially in SSA countries, is a significant determinant of DTP3 vaccination coverage, as the vaccine is mainly administered during routine immunisation schedules at health facilities. Rural areas and densely populated informal settlements are most affected by poor access to healthcare services. We therefore sought to determine vaccination coverage of DTP3, estimate the travel time to health facilities offering immunisation services, and explore its effect on immunisation coverage in one of the predominantly rural counties on the coast of Kenya.MethodsCoordinates of health facilities, information on land cover, digital elevation models, and road networks were used to compute spatial accessibility to immunizing health facilities for eligible children within the Kaloleni-Rabai Community Health Demographic Surveillance System (HDSS). To explore the effect of travel time on DTP3 coverage, we fitted a hierarchical multivariable model adjusting for other a priori identified confounding factors.ResultsSpatial access to health facilities that offer immunization services significantly affected DTP3 coverage, with travel times of more than one hour to a health facility significantly associated with reduced odds of receiving DTP3 vaccine (AOR= 0.84 (95% CI 0.74 – 0.94).ConclusionIncreased travel time is a significant barrier to the uptake of facility-delivered immunizations in this rural community. To improve immunisation coverage, local health authorities and policy makers in remote settings can use high-resolution maps to identify areas where distance and travel time may impede the achievement of high immunization coverage and identify appropriate interventions. These could include improving the road network, establishing new health centres and/or stepping up health outreach activities that include vaccinations in hard-to-reach areas within the county.

scholarly journals The experience, results, and possible perspectives of organizing the optimally accessible primary medical care for the rural population of Zaporizhzhia region

2021 ◽  
Vol 14 (3) ◽  
pp. 369-373
Author(s):  
O. H. Aleksieiev ◽  
V. V. Taranov ◽  
V. P. Petrykhin
Keyword(s):  
Primary Care ◽  
Medical Care ◽  
Primary Healthcare ◽  
Rural Areas ◽  
Rural Population ◽  
Healthcare Facility ◽  
Service Area ◽  
Healthcare Facilities ◽  
Care Facilities

Nowadays, the assessment of the activity of the domestic healthcare system is an important and actual issue, especially against the background the active reformation of this industry. One of the important elements of the assessment is studying the availability of primary healthcare to the rural population. The aim of this work is to study the territorial accessibility of primary healthcare, the adequacy and effectiveness of the principles of forming a network of primary care facilities in the rural areas of Zaporizhzhia region that enables to address issues and optimize the location of primary care facilities in the rural areas. Materials and methods. The materials of the research were the data of the official statistical reports for the past 20 years, which characterize the state of health and the degree of medical care accessibility to the rural population. During the research, the technique of complex social and hygienic research was applied, with the use of historical, sociological, sanitary and statistical methods, organizational experiment and others. Results. The article presents the main results of studying the current state of primary healthcare organization for the rural population of Zaporіzhzhia region against the background of active reforming processes. According to the research results, the main elements forming the system of accessibility are territorial, medical, social and economic. The main factors of impact on territorial accessibility are identified. These are: the nature of the settlement of rural residents (density, compactness, service-area radius, the proportion of the rural population, the distance between villages, the distance from a household to a healthcare facility); quality of roads; transport connections between settlements and healthcare facilities; availability of communication means. Conclusions. As a result of the research, the following conclusions were drawn. Such factors as population density, compactness of its location, service-area radius, distance between villages, distance from a household to a healthcare facility, condition and quality of roads, transport connections between settlements and healthcare facilities are important during forming or improving the network of healthcare facilities in rural areas. These factors must be considered for the rational placement of primary care facilities in rural areas.  

scholarly journals Spatial accessibility to basic public health services in South Sudan

2017 ◽  
Vol 12 (1) ◽  
Author(s):  
Peter M. Macharia ◽  
Paul O. Ouma ◽  
Ezekiel G. Gogo ◽  
Robert W. Snow ◽  
Abdisalan M. Noor
Keyword(s):  
Public Health ◽  
Health Facility ◽  
Service Provider ◽  
Population Distribution ◽  
South Sudan ◽  
Civil Conflict ◽  
Health Facilities ◽  
Spatial Accessibility ◽  
Walking Distance ◽  
Health Access

At independence in 2011, South Sudan’s health sector was almost non-existent. The first national health strategic plan aimed to achieve an integrated health facility network that would mean that 70% of the population were within 5 km of a health service provider. Publically available data on functioning and closed health facilities, population distribution, road networks, land use and elevation were used to compute the fraction of the population within 1 hour walking distance of the nearest public health facility offering curative services. This metric was summarised for each of the 78 counties in South Sudan and compared with simpler metrics of the proportion of the population within 5 km of a health facility. In 2016, it is estimated that there were 1747 public health facilities, out of which 294 were non-functional in part due to the on-going civil conflict. Access to a service provider was poor with only 25.7% of the population living within one-hour walking time to a facility and 28.6% of the population within 5 km. These metrics, when applied sub-nationally, identified the same high priority, most vulnerable counties. Simple metrics based upon population distribution and location of facilities might be as valuable as more complex models of health access, where attribute data on travel routes are imperfect or incomplete and sparse. Disparities exist in South Sudan among counties and those with the poorest health access should be targeted for priority expansion of clinical services.

scholarly journals Pentavalent vaccination in rural Kenya: coverage and geographical accessibility to health facilities using data from a community demographic and health surveillance system in Kilifi County.

2020 ◽  
Author(s):  
Morris Ogero ◽  
James Orwa ◽  
Rachael Odhiambo ◽  
Felix Agoi ◽  
Adelaide Lusambili ◽  
...  
Keyword(s):  
Travel Time ◽  
Health Facility ◽  
Vaccination Coverage ◽  
Surveillance System ◽  
Road Network ◽  
Health Facilities ◽  
Spatial Accessibility ◽  
Immunisation Coverage ◽  
Spatial Access ◽  
Routine Immunisation

Abstract Background There is substantial evidence that immunization is one of the most significant and cost-effective pillars of preventive and promotive health interventions. Effective childhood immunization coverage is thus essential in stemming persistent childhood illnesses. The main indicator of performance of the immunisation programme is the third dose of diphtheria-tetanus-pertussis (DTP3) vaccine for children, because it mirrors the completeness of a child’s immunisation schedule. Spatial access to a health facility, especially in SSA countries, is a significant determinant of DTP3 vaccination coverage as the vaccine is mainly administered during routine immunisation schedules at health facilities. Rural areas and densely populated informal settlements are most affected by poor access to healthcare services. We therefore sought to determine vaccination coverage of DTP3, estimate the travel time to health facilities offering immunisation services, and explore of its effect on immunisation coverage in one of the predominantly rural counties in the coast of Kenya.Methods Coordinates of health facilities, information on land cover, digital elevation model, and road network were used to compute spatial accessibility to immunising health facilities for eligible children within Kaloleni-Rabai Community Health Demographic Surveillance System (HDSS). To explore the effect of the travel-time on DTP3 coverage, we fitted a hierarchical multivariable model adjusting for other apriori identified confounding factors. Results Spatial access to health facilities that offer immunization services significantly affected DTP3 coverage with travel times of more than one hour to a health facility significantly associated with reduced odds of receiving DTP3 vaccine (AOR= 0.84 (95% CI 0.74 – 0.94).Conclusion Increased travel time is a significant barrier to the uptake of facility-delivered immunizations in this rural community. To improve immunisation coverage, local health authorities and policy makers in remote settings can use high resolution maps to identify areas where distance and travel time may impede achievement of high immunizations coverage and identify appropriate interventions. These could include improving the road network, establishing new health centres and/or stepping up health outreach activities that include vaccinations in hard to reach areas within the county.

scholarly journals Impact of Traffic Congestion on Spatial Access to Healthcare Services in Nairobi: an ecological study

2021 ◽  
Author(s):  
Mutono Nyamai ◽  
Jim A. Wright ◽  
Mumbua Mutunga ◽  
Henry Mutembei ◽  
SM Thumbi
Keyword(s):  
Health Facility ◽  
Traffic Congestion ◽  
One Health ◽  
Healthcare Professionals ◽  
Access To Healthcare ◽  
Health Care Facilities ◽  
Health Facilities ◽  
Healthcare Facilities ◽  
African Cities ◽  
Geographical Access

Abstract Background Geographic accessibility is an important determinant of healthcare utilisation and is critical for achievement of universal health coverage. Despite the high disease burden and severe traffic congestion in many African cities, few studies have assessed how traffic congestion impacts geographical access to healthcare facilities and to health professionals in these settings. Methods Using data on health facilities obtained from the Ministry of Health in Kenya, we mapped 944 primary, 94 secondary and four tertiary healthcare facilities in Nairobi County. We then used traffic probe data to identify areas within a 15-, 30- and 45-minute drive from each health facility during peak and off-peak hours and calculated the proportion of the population with access to healthcare in the County. We employed a 2-step floating catchment area model to calculate the ratio of healthcare and healthcare professionals to population during these times. Results During peak hours, <70% of Nairobi’s 4.1 million population was within a 30-minute drive from a health facility. This increased to >75% during off-peak hours. In 45 minutes, the majority of the population had an accessibility index of one health facility accessible to more than 100 people (<0.01) for primary health care facilities while secondary and tertiary health facilities had a ratio of one health facility for more than 10,000 people (<0.0001) and at least two health facilities per 100,000 people (>0.00002) respectively. Of people with access to health facilities, a sub-optimal ratio of <2.3 healthcare professionals per 1000 people was observed in facilities offering primary and secondary healthcare during peak and off-peak hours. Conclusion These findings can guide urban planners and policymakers in improving access to healthcare facilities to optimise coverage during peak and off-peak traffic times. Similarly, growing availability of traffic probe data in African cities should enable similar analysis in other countries.

scholarly journals 1369Probabilistic data linkage of health facility and individual data using PMA2020 surveys

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Cauane Blumenberg ◽  
Franciele Hellwig ◽  
Aluisio Barros
Keyword(s):  
Health Facility ◽  
Rural Areas ◽  
Urban Areas ◽  
Performance Monitoring ◽  
Health Facilities ◽  
Sufficient Information ◽  
Public And Private ◽  
Individual Level ◽  
Match Rate ◽  
Probabilistic Linkage

Abstract Background Most studies rely on clustered analyses to study how the characteristics of health facilities influence individual outcomes. Our aim was to perform a probabilistic linkage between individual and health facility data to enable individual-level analyses. Methods We linked data from the most recent female questionnaire from 11 countries monitored by the Performance Monitoring for Action 2020 to a master health facility dataset (appending all rounds of surveys). Only women that reported which type of facility they visited were considered in the analysis. A probabilistic linkage was performed using 13 blocking variables (e.g., facility type and cluster of residence/location of the woman/facility) and 11 matching variables (e.g., types of contraceptive methods used/offered by the women/facility). Each concordant matching variable received a + 1 score, or a 0 score otherwise. We assessed linkage quality by pooled odds ratio of non-matches according to wealth tertiles (richest vs. poorest) and area of residence (urban vs. rural) using a meta-analytical approach. Results A total of 21,102 women and 7,056 facilities were considered in the linkage process. The average match rate was 57.9%, ranging from 42.5% in Indonesia to 69.1% in Burkina Faso. The pooled odds of non-match were 74% higher for the richest women compared to the poorest, and 67% higher for women living in urban areas compared to rural areas. Conclusions High match rates were achieved in countries with sufficient information on public and private facilities. The lack of information about private facilities contributed to the higher odds of non-match among the better off. Key messages We performed a probabilistic linkage approach to link individual and health facility data, making it possible to understand how the characteristics of health facilities can influence individual-level outcomes. Our findings also bring light to the importance of sampling both public and private facilities, aiming to maximise match rates and reduce differences on match rates according to socio demographic characteristics of the sample.

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