Int J Health Geogr - Monitoring the impact of decentralised chronic care services on patient travel time in rural Africa--methods and results in Northern Malawi.

Tópicos

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Resumo

CKGROUND: 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. 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.METHODS: Clinic 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.RESULTS: The 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.DISCUSSION: Integrating 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.

Resumo Limpo

ckground decentralis health servic form key part chronic care strategi resourcelimit set reduc distanc patient clinic therebi time cost involv travel howev tool exist evalu impact decentralis patient travel time proport patient attend nearest clinic develop method monitor chang travel time use data antiretrovir therapi art rollout rural district north malawimethod clinic posit combin gps inform home villag patient access art servic karonga district north malawi juli juli potenti travel time estim travel time individu attend nearest clinic estim actual travel time time clinic attend allow us calcul chang potenti actual travel time new clinic open track proport origin patient access nearest clinicresult model show open art clinic karonga district reduc median potenti travel time minut median actual travel time fell minut proport patient attend nearest clinic increas two clinic open four opendiscuss integr gps inform patient data show impact decentralis travel time clinic choic inform polici research question case studi travel time decreas accompani increas uptak servic howev model also identifi increas proport art patient attend nearest clinic

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