Evaluating spatial access to primary care and health disparities in a rural district of Sri Lanka: Implications for strategic health policy interventions.

Primary care accessibility is optimised by equity in service coverage, especially in resource-limited settings. This study examined spatial accessibility to private and public primary care facilities (PCFs) in the Anuradhapura District, Sri Lanka, which offer both allopathic and alternative medicine, while analysing the correlation to social development indices. A two-step floating catchment area (2SFCA) was applied to evaluate spatial accessibility across 657 Grama Niladhari Divisions (GNDs). Data on population, primary care doctors (PCDs), social development indices, and spatial administrative maps were collected from corresponding departments. The Spatial Accessibility Index (SAI) was analysed among 404 PCFs in the ArcGIS application and expressed as the number of PCDs per 10,000 population within a designated buffer (5km/ 10km). SAIs were correlated with the district's key social development indices. The study found that the private allopathic sector covered 63.7% of PCFs and 49% of PCDs. The national primary care coverage (NPCC) target of one PCD:5000 population was met at 86% by including all allopathic PCDs, but reduced to 25% with only the public sector. The average SAI for a GND was 4.50 and 4.67 for both buffers, indicating sufficient primary care accessibility compared to NPCC targets. SAIs were positively correlated with population density (r[21]=.735, p < 0.01), availability of education facilities (r[21]=.600, p < 0.01), inward healthcare capacity (r[21]=.810, p < 0.001), and availability financial infrastructure (r[21]=.572, p = 0.05). A negative correlation was reported for poverty measures (r[21]=-.603, p = 0.03). The study identified adequate access to primary care in the district, highlighting the private sector's vital role in service delivery. However, only one-quarter of the NPCC target is provided by public-sector allopathic PCDs. Areas with high population density and educational resources show better access, while poverty is linked to reduced access. A comprehensive approach that addresses both spatial and aspatial factors is necessary to enhance rural healthcare access.