Department of Women's and Children's Health, International Maternal and Child Health-IMCH, Uppsala University, Uppsala, Sweden.
Int J Health Geogr. 2012 Sep 17;11:40. doi: 10.1186/1476-072X-11-40.
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.
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.
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%.
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.
初级卫生保健对于改善和维持人口健康至关重要。它有可能加速实现千年发展目标，并履行《阿拉木图宣言》的“人人享有卫生保健”原则。从地理角度了解卫生系统的绩效对于改善卫生规划和循证政策制定至关重要。本研究的目的是衡量地理可达性，模拟现有初级保健设施网络的空间覆盖范围，估计工作能力不足的初级保健设施数量和服务不足的人群在卢旺达西部省。
本研究使用了卢旺达西部省的卫生设施、人口和辅助数据。定义了三种不同的人群前往最近的初级保健设施的出行情景，最大出行时间为 60 分钟：情景 1-步行；情景 2-步行和骑自行车；情景 3-步行和公共交通。考虑到这些情景，开发了一个初级保健设施和人口之间旅行时间的栅格表面。为了模拟空间覆盖范围并估计工作能力不足的初级保健设施数量，通过考虑人口覆盖能力、人口分布、地形地形和不同土地类别下的出行方式，计算了每个设施的集水区。
情景 2（步行和骑自行车）的地理可达性最高，其次是情景 3（步行和公共交通）。情景 1（步行）的可达性最低。不同出行情景下的总人口覆盖范围不同。现有的初级卫生保健设施网络仅覆盖情景 1 中 26.6%的人口。在情景 2 中，使用自行车大大增加了服务人口，达到了 58%的居民。考虑到情景 3，服务的总人口为 34.3%。
在三种出行情景中观察到地理可达性和空间覆盖的显著空间差异。分析表明，无论使用哪种出行情景，西部省的大多数人口都无法获得现有的初级卫生保健设施网络。我们的研究结果还表明，GIS 方法在空间框架中利用来自不同来源的多个数据集非常有用，可支持发展中国家的循证规划和资源分配决策。
