Department of Geography, University of Florida, 3141 Turlington Hall, 330 Newell Dr, Gainesville, FL, 32601, USA.
Department of Environmental and Global Health, University of Florida, Gainesville, USA.
Int J Equity Health. 2021 Jan 18;20(1):38. doi: 10.1186/s12939-020-01371-5.
Rural access to health care remains a challenge in Sub-Saharan Africa due to urban bias, social determinants of health, and transportation-related barriers. Health systems in Sub-Saharan Africa often lack equity, leaving disproportionately less health center access for the poorest residents with the highest health care needs. Lack of health care equity in Sub-Saharan Africa has become of increasing concern as countries enter a period of simultaneous high infectious and non-communicable disease burdens, the second of which requires a robust primary care network due to a long continuum of care. Bicycle ownership has been proposed and promoted as one tool to reduce travel-related barriers to health-services among the poor.
An accessibility analysis was conducted to identify the proportion of Ugandans within one-hour travel time to government health centers using walking, bicycling, and driving scenarios. Statistically significant clusters of high and low travel time to health centers were calculated using spatial statistics. Random Forest analysis was used to explore the relationship between poverty, population density, health center access in minutes, and time saved in travel to health centers using a bicycle instead of walking. Linear Mixed-Effects Models were then used to validate the performance of the random forest models.
The percentage of Ugandans within a one-hour walking distance of the nearest health center II is 71.73%, increasing to 90.57% through bicycles. Bicycles increased one-hour access to the nearest health center III from 53.05 to 80.57%, increasing access to the tiered integrated national laboratory system by 27.52 percentage points. Significant clusters of low health center access were associated with areas of high poverty and urbanicity. A strong direct relationship between travel time to health center and poverty exists at all health center levels. Strong disparities between urban and rural populations exist, with rural poor residents facing disproportionately long travel time to health center compared to wealthier urban residents.
The results of this study highlight how the most vulnerable Ugandans, who are the least likely to afford transportation, experience the highest prohibitive travel distances to health centers. Bicycles appear to be a "pro-poor" tool to increase health access equity.
在撒哈拉以南非洲地区，农村地区的医疗服务获取仍然是一个挑战，这是由于城市偏向、健康的社会决定因素以及与交通相关的障碍所导致的。撒哈拉以南非洲地区的卫生系统往往缺乏公平性，最贫困、最需要医疗保健的居民获得卫生中心的机会相对较少。由于需要一个强大的初级保健网络来满足长期的医疗服务需求，因此，该地区缺乏医疗保健公平性，这一问题引起了越来越多的关注。在这个时期，国家同时面临着传染病和非传染性疾病负担增加的问题，后者需要一个强大的初级保健网络。自行车的拥有已被提出并推广为一种减少贫困人口获得医疗服务的交通相关障碍的工具。
本研究进行了可达性分析，以确定在步行、骑自行车和驾车的情况下，在一小时旅行时间内可到达政府卫生中心的乌干达人的比例。使用空间统计学计算了卫生中心旅行时间的高和低聚类。随机森林分析用于探索贫困程度、人口密度、以分钟计算的卫生中心可达性以及使用自行车代替步行前往卫生中心所节省的时间之间的关系。然后，使用线性混合效应模型验证随机森林模型的性能。
在一小时步行距离内可到达最近卫生中心 II 的乌干达人比例为 71.73%，通过自行车增加到 90.57%。自行车将一小时内到达最近卫生中心 III 的人数从 53.05%增加到 80.57%，从而使分级综合国家实验室系统的可达性增加了 27.52 个百分点。卫生中心可达性低的显著聚类与高贫困和城市化地区有关。在所有卫生中心层面，到卫生中心的旅行时间与贫困程度之间存在直接的强关系。城乡人口之间存在巨大的差异，与富裕的城市居民相比，农村贫困居民前往卫生中心的旅行时间过长。
本研究的结果强调了最脆弱的乌干达人（最不可能负担得起交通费用的人）面临的最高禁止性的前往卫生中心的旅行距离。自行车似乎是增加卫生服务获取公平性的“扶贫”工具。
