Department of International Economics, Institutions and Development, Cattolica University, 20123 Milan, Italy;
Future Energy Program, Fondazione Eni Enrico Mattei, 20123 Milan, Italy.
Proc Natl Acad Sci U S A. 2020 Dec 15;117(50):31760-31769. doi: 10.1073/pnas.2009172117. Epub 2020 Nov 30.
Achieving universal health care coverage-a key target of the United Nations Sustainable Development Goal number 3-requires accessibility to health care services for all. Currently, in sub-Saharan Africa, at least one-sixth of the population lives more than 2 h away from a public hospital, and one in eight people is no less than 1 h away from the nearest health center. We combine high-resolution data on the location of different typologies of public health care facilities [J. Maina et al., 6, 134 (2019)] with population distribution maps and terrain-specific accessibility algorithms to develop a multiobjective geographic information system framework for assessing the optimal allocation of new health care facilities and assessing hospitals expansion requirements. The proposed methodology ensures universal accessibility to public health care services within prespecified travel times while guaranteeing sufficient available hospital beds. Our analysis suggests that to meet commonly accepted universal health care accessibility targets, sub-Saharan African countries will need to build ∼6,200 new facilities by 2030. We also estimate that about 2.5 million new hospital beds need to be allocated between new facilities and ∼1,100 existing structures that require expansion or densification. Optimized location, type, and capacity of each facility can be explored in an interactive dashboard. Our methodology and the results of our analysis can inform local policy makers in their assessment and prioritization of health care infrastructure. This is particularly relevant to tackle health care accessibility inequality, which is not only prominent within and between countries of sub-Saharan Africa but also, relative to the level of service provided by health care facilities.
实现全民健康覆盖——联合国可持续发展目标 3 的一个关键目标——要求所有人都能获得医疗服务。目前，在撒哈拉以南非洲，至少有六分之一的人口距离公立医院超过 2 小时的路程，每 8 个人中就有 1 个人距离最近的卫生中心超过 1 小时。我们结合了不同类型公共医疗设施位置的高分辨率数据[J. Maina 等人，6,134（2019）]、人口分布地图和特定地形的可达性算法，开发了一个多目标地理信息系统框架，用于评估新医疗设施的最佳分配和评估医院扩展需求。所提出的方法确保在指定的旅行时间内普及公共医疗服务的可及性，同时保证有足够的可用医院床位。我们的分析表明，为了达到普遍接受的全民健康可及性目标，撒哈拉以南非洲国家需要在 2030 年前建造约 6200 个新设施。我们还估计，大约需要在新设施和大约 1100 个需要扩建或加密的现有结构之间分配 250 万张新的医院床位。每个设施的位置、类型和容量优化都可以在交互式仪表板中进行探索。我们的方法和分析结果可以为地方决策者评估和优先考虑医疗基础设施提供信息。这对于解决医疗可及性不平等问题尤为重要，因为这种不平等不仅在撒哈拉以南非洲国家内部和国家之间很突出，而且相对于医疗设施提供的服务水平而言也是如此。
