Florio Pietro, Freire Sergio, Melchiorri Michele
European Commission, Joint Research Centre, Ispra, Italy.
Appl Geogr. 2023 Nov;160:None. doi: 10.1016/j.apgeog.2023.103118.
Measuring rates of coverage and spatial access to healthcare services is essential to inform policies for development. These rates tend to reflect the urban-rural divide, typically with urban areas experiencing higher accessibility than rural ones. Especially in Sub-Saharan Africa (SSA), a region experiencing high disease burden amid fast urbanisation and population growth. However, such assessment has been hindered by a lack of updated and comparable geospatial data on urbanisation and health facilities. In this study, we apply the UN-endorsed Degree of Urbanisation (DoU or DEGURBA) method to investigate how geographic access to healthcare facilities varies across the urban-rural continuum in SSA as a whole and in each country, for circa 2020. Results show that geographic access is overall highest in and , where more than 95% of inhabitants live within 30 min from the nearest HCF, with this share decreasing to 80-90% in . This share is lowest in and (65%), with about 10-15% of population more than 3 h away from any health post. Challenges in geographic access seem mostly determined by high travel impedance, since overall spatial densities of HCF are comparable to European levels.
衡量医疗服务的覆盖范围和空间可达性对于制定发展政策至关重要。这些比率往往反映了城乡差距，通常城市地区的可达性高于农村地区。特别是在撒哈拉以南非洲地区（SSA），该地区在快速城市化和人口增长的同时面临着高疾病负担。然而，由于缺乏关于城市化和卫生设施的最新且可比的地理空间数据，此类评估受到了阻碍。在本研究中，我们应用联合国认可的城市化程度（DoU或DEGURBA）方法，来调查在大约2020年时，整个撒哈拉以南非洲地区以及每个国家内，城乡连续体中获得医疗设施的地理可达性如何变化。结果表明，地理可达性总体上在[具体地区1]和[具体地区2]最高，超过95%的居民居住在距离最近的医疗保健设施30分钟路程内，在[具体地区3]这一比例降至80 - 90%。这一比例在[具体地区4]和[具体地区5]最低（65%），约10 - 15%的人口距离任何卫生站超过3小时路程。地理可达性方面的挑战似乎主要由高出行阻抗决定，因为医疗保健设施的总体空间密度与欧洲水平相当。
