Abeyrathna Parami, Weerasinghe Manjula, Agampodi Suneth Buddhika, Samaranayake Shyamalee, Pushpakumara Pahala Hangidi Gedara Janaka
Department of Family Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka.
Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka.
PLOS Glob Public Health. 2025 Sep 11;5(9):e0005192. doi: 10.1371/journal.pgph.0005192. eCollection 2025.
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.
通过服务覆盖的公平性，尤其是在资源有限的环境中，可以优化初级保健的可及性。本研究考察了斯里兰卡阿努拉德普勒区私立和公立初级保健机构（PCF）的空间可及性，这些机构同时提供对抗疗法和替代医学，同时分析了与社会发展指数的相关性。采用两步浮动集水区（2SFCA）方法评估了657个格兰马·尼拉达里分区（GND）的空间可及性。从相应部门收集了人口、初级保健医生（PCD）、社会发展指数和空间行政地图的数据。在ArcGIS应用程序中对404个PCF的空间可及性指数（SAI）进行了分析，并表示为指定缓冲区（5公里/10公里）内每10000人口中的PCD数量。SAI与该地区的关键社会发展指数相关。研究发现，私立对抗疗法部门覆盖了63.7%的PCF和49%的PCD。通过纳入所有对抗疗法PCD，达到了每5000人口一名PCD的国家初级保健覆盖（NPCC）目标的86%，但仅公共部门时降至25%。一个GND的平均SAI在两个缓冲区分别为4.50和4.67，表明与NPCC目标相比，初级保健可及性充足。SAI与人口密度（r[21]=.735，p＜0.01）、教育设施可用性（r[21]=.600，p＜0.01）、内向医疗能力（r[21]=.810，p＜0.001）和金融基础设施可用性（r[21]=.572，p = 0.05）呈正相关。贫困指标呈负相关（r[21]=-.603，p = 0.03）。该研究确定该地区初级保健可及性充足，突出了私营部门在服务提供中的重要作用。然而，公共部门的对抗疗法PCD仅提供了NPCC目标的四分之一。人口密度高和教育资源丰富的地区可及性更好，而贫困与可及性降低有关。需要一种综合方法来解决空间和非空间因素，以改善农村地区的医疗可及性。
