Int J Health Geogr - Geographical accessibility and spatial coverage modeling of the primary health care network in the Western Province of Rwanda.

Tópicos

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Resumo

CKGROUND: Primary health care is essential in improving and maintaining the health of populations. It has the potential to accelerate achievement of the Millennium Development Goals and fulfill the "Health for All" doctrine of the Alma-Ata Declaration. Understanding the performance of the health system from a geographic perspective is important for improved health planning and evidence-based policy development. The aims of this study were to measure geographical accessibility, model spatial coverage of the existing primary health facility network, estimate the number of primary health facilities working under capacity and the population underserved in the Western Province of Rwanda.METHODS: This study uses health facility, population and ancillary data for the Western Province of Rwanda. Three different travel scenarios utilized by the population to attend the nearest primary health facility were defined with a maximum travelling time of 60 minutes: Scenario 1--walking; Scenario 2--walking and cycling; and Scenario 3--walking and public transportation. Considering these scenarios, a raster surface of travel time between primary health facilities and population was developed. To model spatial coverage and estimate the number of primary health facilities working under capacity, the catchment area of each facility was calculated by taking into account population coverage capacity, the population distribution, the terrain topography and the travelling modes through the different land categories.RESULTS: Scenario 2 (walking and cycling) has the highest degree of geographical accessibility followed by Scenario 3 (walking and public transportation). The lowest level of accessibility can be observed in Scenario 1 (walking). The total population covered differs depending on the type of travel scenario. The existing primary health facility network covers only 26.6% of the population in Scenario 1. In Scenario 2, the use of a bicycle greatly increases the population being served to 58% of inhabitants. When considering Scenario 3, the total population served is 34.3%.CONCLUSIONS: Significant spatial variations in geographical accessibility and spatial coverage were observed across the three travel scenarios. The analysis demonstrates that regardless of which travel scenario is used, the majority of the population in the Western Province does not have access to the existing primary health facility network. Our findings also demonstrate the usefulness of GIS methods to leverage multiple datasets from different sources in a spatial framework to provide support to evidence-based planning and resource allocation decision-making in developing countries.

Resumo Limpo

ckground primari health care essenti improv maintain health popul potenti acceler achiev millennium develop goal fulfil health doctrin almaata declar understand perform health system geograph perspect import improv health plan evidencebas polici develop aim studi measur geograph access model spatial coverag exist primari health facil network estim number primari health facil work capac popul underserv western provinc rwandamethod studi use health facil popul ancillari data western provinc rwanda three differ travel scenario util popul attend nearest primari health facil defin maximum travel time minut scenario walk scenario walk cycl scenario walk public transport consid scenario raster surfac travel time primari health facil popul develop model spatial coverag estim number primari health facil work capac catchment area facil calcul take account popul coverag capac popul distribut terrain topographi travel mode differ land categoriesresult scenario walk cycl highest degre geograph access follow scenario walk public transport lowest level access can observ scenario walk total popul cover differ depend type travel scenario exist primari health facil network cover popul scenario scenario use bicycl great increas popul serv inhabit consid scenario total popul serv conclus signific spatial variat geograph access spatial coverag observ across three travel scenario analysi demonstr regardless travel scenario use major popul western provinc access exist primari health facil network find also demonstr use gis method leverag multipl dataset differ sourc spatial framework provid support evidencebas plan resourc alloc decisionmak develop countri

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