Int J Health Geogr - A spatial model to quantify the mortality impact of service delivery in Sub-Saharan Africa: an ecological design utilizing data from South Africa.


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CKGROUND: Sub Saharan Africa is confronted with a wide range of interlinked health and economic problems that include high levels of mortality and poor service delivery. The objective of the paper is to develop a spatial model for Sub-Saharan Africa that can quantify the mortality impact of (poor) service delivery at sub-district level in order to integrate related health and local level policy interventions. In this regard, an expanded composite service delivery index was developed, and the data were analysed using a Bayesian Poisson spatial model.RESULTS: The results indicate significant differences in the risk of mortality and poor service delivery at sub-district level. In particular, the results indicate clusters of high mortality and poor service delivery in two of the bigger, poorer provinces with large rural communities. Conversely, two of the wealthier provinces have lower levels of mortality and higher levels of service delivery, but income inequality is more widespread. The bivariate and multivariate models, moreover, reflect significant positive linkages (p<0.01) between increased mortality and poor service delivery after adjusting for HIV/AIDS, income inequality, population density and the protective influence of metropolitan areas. Finally, the hypothesized provision of a basket of services reduced the mortality rate in South Africa's 248 sub-districts by an average of 5.3 (0.3-15.4) deaths per 1000.CONCLUSION: The results indicate that the model can accurately plot mortality and service delivery "hotspots' at sub-district level, as well as explain their associations and causality. A mortality reduction index shows that mortality in the highest risk sub-districts can be reduced by as much as 15.4 deaths per 1000 by providing a range of basic services. The ability to use the model in a wider SSA context and elsewhere is also feasible given the innovative use of available databases. Finally, the paper illustrates the importance of developing policy in SSA that can simultaneously solve both economic and health problems.

Resumo Limpo

ckground sub saharan africa confront wide rang interlink health econom problem includ high level mortal poor servic deliveri object paper develop spatial model subsaharan africa can quantifi mortal impact poor servic deliveri subdistrict level order integr relat health local level polici intervent regard expand composit servic deliveri index develop data analys use bayesian poisson spatial modelresult result indic signific differ risk mortal poor servic deliveri subdistrict level particular result indic cluster high mortal poor servic deliveri two bigger poorer provinc larg rural communiti convers two wealthier provinc lower level mortal higher level servic deliveri incom inequ widespread bivari multivari model moreov reflect signific posit linkag p increas mortal poor servic deliveri adjust hivaid incom inequ popul densiti protect influenc metropolitan area final hypothes provis basket servic reduc mortal rate south africa subdistrict averag death per conclus result indic model can accur plot mortal servic deliveri hotspot subdistrict level well explain associ causal mortal reduct index show mortal highest risk subdistrict can reduc much death per provid rang basic servic abil use model wider ssa context elsewher also feasibl given innov use avail databas final paper illustr import develop polici ssa can simultan solv econom health problem

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