1
|
Li Y, Liu X. Effects of spatial accessibility of community health services on the activities of daily living among older adults in China: a propensity score matching study. Front Public Health 2024; 12:1335712. [PMID: 38932781 PMCID: PMC11199788 DOI: 10.3389/fpubh.2024.1335712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 06/03/2024] [Indexed: 06/28/2024] Open
Abstract
Background The Chinese government proposes to establish a hierarchical diagnosis and treatment system, and attaches great importance to community health services. Under the background of population aging and the increase of older adults with disability, this study aimed to analyze the effect of spatial accessibility of community health services on the activities of daily living (ADL) among older adults in China. Methods A research sample of 7,922 older adults from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) data in 2018 was adopted. There were 2,806 participants in the treatment group and 5,116 participants in the control group. The propensity score matching method was adopted to match the treatment and control groups to calculate the values of average treatment effects on treated (ATT). Results The results of kernel density matching method showed that the factual ADL score of the treatment group was 10.912, the counterfactual ADL score of the control group was 10.694, and the ATT value was 0.218 (p < 0.01). The spatial accessibility of community health services could significantly improve the activities of daily living among older adults in China. Meanwhile, there was urban-rural heterogeneity in the impact of spatial accessibility of community health services on the activities of daily living of older adults in China. The effect value in urban samples (ATT = 0.371, p < 0.01) was higher than that in rural samples (ATT = 0.180, p < 0.01). Conclusion Spatial accessibility of community health services could improve the activities of daily living among older adults in China. The Chinese government should take actions to improve the distribution of community health service resources.
Collapse
|
2
|
Sy Z, Guigoz Y, Brun M, Tossou Boco T, Vodungbo V, Lawalé T, Soude T, Agbigbi Y, Ray N. Optimization of the emergency obstetric and neonatal care network in Benin through expert-based sub-national prioritizations. Front Glob Womens Health 2024; 5:1265729. [PMID: 38887662 PMCID: PMC11180813 DOI: 10.3389/fgwh.2024.1265729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 05/17/2024] [Indexed: 06/20/2024] Open
Abstract
Introduction To reduce maternal mortality by 2030, Benin needs to implement strategies for improving access to high quality emergency obstetric and neonatal care (EmONC). This study applies an expert-based approach using sub-national travel specificities to identify and prioritize a network of EmONC maternities that maximizes both population coverage and functionality. Methods We conducted a series of workshops involving international, national, and department experts in maternal health to prioritize a set of EmONC facilities that meet international standards. Geographical accessibility modeling was used together with EmONC availability to inform the process. For women in need of EmONC, experts provided insights into travel characteristics (i.e., modes and speeds of travel) specific to each department, enabling more realistic travel times estimates modelled with the AccessMod software. Results The prioritization approach resulted in the selection of 109 EmONC maternities from an initial group of 125 designated maternities. The national coverage of the population living within an hour's drive of the nearest EmONC maternity increased slightly from 92.6% to 94.1% after prioritization. This increase in coverage was achieved by selecting maternities with sufficient obstetrical activities to be upgraded to EmONC maternities in the Plateau and Atlantique departments. Conclusion The prioritization approach enabled Benin to achieve the minimum EmONC availability, while ensuring very good geographical accessibility to the prioritized network. Limited human and financial resources can now be targetted towards a smaller number of EmONC facilities to make them fully functioning in the medium-term. By implementing this strategy, Benin aims to reduce maternal mortality rates and deliver effective, high-quality obstetric and neonatal care, especially during emergencies.
Collapse
Affiliation(s)
- Zeynabou Sy
- GeoHealth Group, Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Institute for Environmental Sciences, University of Geneva, Geneva, Switzerland
| | - Yaniss Guigoz
- GeoHealth Group, Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Institute for Environmental Sciences, University of Geneva, Geneva, Switzerland
| | - Michel Brun
- Technical Division, United Nations Population Fund (UNFPA), New York, NY, United States
| | | | - Venance Vodungbo
- Direction de la Programmation et de la Prospective, Ministère de la Santé, Cotonou, Benin
| | - Thierry Lawalé
- Agence Nationale des Soins de Santé Primaires, Cotonou, Benin
| | | | - Yawo Agbigbi
- United Nations Population Fund (UNFPA), Lomé, Togo
| | - Nicolas Ray
- GeoHealth Group, Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Institute for Environmental Sciences, University of Geneva, Geneva, Switzerland
| |
Collapse
|
3
|
Chao DL, Arzika AM, Abdou A, Maliki R, Karamba A, Galo N, Beidi D, Harouna N, Abarchi M, Root E, Mishra A, Lebas E, Arnold BF, Oldenburg CE, Keenan JD, Lietman TM, O’Brien KS. Distance to Health Centers and Effectiveness of Azithromycin Mass Administration for Children in Niger: A Secondary Analysis of the MORDOR Cluster Randomized Trial. JAMA Netw Open 2023; 6:e2346840. [PMID: 38100110 PMCID: PMC10724761 DOI: 10.1001/jamanetworkopen.2023.46840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 10/13/2023] [Indexed: 12/18/2023] Open
Abstract
Importance The MORDOR (Macrolides Oraux pour Réduire les Décès avec un Oeil sur la Résistance) trial demonstrated that mass azithromycin administration reduced mortality by 18% among children aged 1 to 59 months in Niger. The identification of high-risk subgroups to target with this intervention could reduce the risk of antimicrobial resistance. Objective To evaluate whether distance to the nearest primary health center modifies the effect of azithromycin administration to children aged 1 to 59 months on child mortality. Design, Setting, and Participants The MORDOR cluster randomized trial was conducted from December 1, 2014, to July 31, 2017; this post hoc secondary analysis was conducted in 2023 among 594 clusters (communities or grappes) in the Boboye and Loga departments in Niger. All children aged 1 to 59 months in eligible communities were evaluated. Interventions Biannual (twice-yearly) administration of a single dose of oral azithromycin or matching placebo over 2 years. Main Outcomes and Measures A population-based census was used to monitor mortality and person-time at risk (trial primary outcome). Community distance to a primary health center was calculated as kilometers between the center of each community and the nearest health center. Negative binomial regression was used to evaluate the interaction between distance and the effect of azithromycin on the incidence of all-cause mortality among children aged 1 to 59 months. Results Between December 1, 2014, and July 31, 2017, a total of 594 communities were enrolled, with 76 092 children (mean [SD] age, 31 [2] months; 39 022 [51.3%] male) included at baseline, for a mean (SD) of 128 (91) children per community. Median (IQR) distance to the nearest primary health center was 5.0 (3.2-7.1) km. Over 2 years, 145 693 person-years at risk were monitored and 3615 deaths were recorded. Overall, mortality rates were 27.5 deaths (95% CI, 26.2-28.7 deaths) per 1000 person-years at risk in the placebo arm and 22.5 deaths (95% CI, 21.4-23.5 deaths) per 1000 person-years at risk in the azithromycin arm. For each kilometer increase in distance in the placebo arm, mortality increased by 5% (adjusted incidence rate ratio, 1.05; 95% CI, 1.03-1.07; P < .001). The effect of azithromycin on mortality varied significantly by distance (interaction P = .02). Mortality reduction with azithromycin compared with placebo was 0% at 0 km from the health center (95% CI, -19% to 17%), 4% at 1 km (95% CI, -12% to 17%), 16% at 5 km (95% CI, 7% to 23%), and 28% at 10 km (95% CI, 17% to 38%). Conclusions and Relevance In this secondary analysis of a cluster randomized trial of mass azithromycin administration for child mortality, children younger than 5 years who lived farthest from health facilities appeared to benefit the most from azithromycin administration. These findings may help guide the allocation of resources to ensure that those with the least access to existing health resources are prioritized in program implementation. Trial Registration ClinicalTrials.gov Identifier: NCT02047981.
Collapse
Affiliation(s)
| | - Ahmed M. Arzika
- Centre de Recherche et Interventions en Santé Publique, Birni N’Gaoure, Niger
| | - Amza Abdou
- Programme Nationale de Santé Oculaire, Niamey, Niger
| | - Ramatou Maliki
- Centre de Recherche et Interventions en Santé Publique, Birni N’Gaoure, Niger
| | - Alio Karamba
- Centre de Recherche et Interventions en Santé Publique, Birni N’Gaoure, Niger
| | - Nasser Galo
- Centre de Recherche et Interventions en Santé Publique, Birni N’Gaoure, Niger
| | - Diallo Beidi
- Centre de Recherche et Interventions en Santé Publique, Birni N’Gaoure, Niger
| | - Nasser Harouna
- Centre de Recherche et Interventions en Santé Publique, Birni N’Gaoure, Niger
| | - Moustapha Abarchi
- Centre de Recherche et Interventions en Santé Publique, Birni N’Gaoure, Niger
| | | | - Anu Mishra
- Bill & Melinda Gates Foundation, Seattle, Washington
| | - Elodie Lebas
- Francis I. Proctor Foundation, University of California, San Francisco
| | - Benjamin F. Arnold
- Francis I. Proctor Foundation, University of California, San Francisco
- Department of Ophthalmology, University of California, San Francisco
| | - Catherine E. Oldenburg
- Francis I. Proctor Foundation, University of California, San Francisco
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Jeremy D. Keenan
- Francis I. Proctor Foundation, University of California, San Francisco
- Department of Ophthalmology, University of California, San Francisco
| | - Thomas M. Lietman
- Francis I. Proctor Foundation, University of California, San Francisco
- Department of Ophthalmology, University of California, San Francisco
- Department of Epidemiology and Biostatistics, University of California, San Francisco
- Institute for Global Health Sciences, University of California, San Francisco
| | - Kieran S. O’Brien
- Francis I. Proctor Foundation, University of California, San Francisco
- Department of Ophthalmology, University of California, San Francisco
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| |
Collapse
|
4
|
Sánchez-Martínez LJ, Charle-Cuéllar P, Gado AA, Dougnon AO, Sanoussi A, Ousmane N, Lazoumar RH, Toure F, Vargas A, Hernández CL, López-Ejeda N. Impact of a simplified treatment protocol for moderate acute malnutrition with a decentralized treatment approach in emergency settings of Niger. Front Nutr 2023; 10:1253545. [PMID: 38099186 PMCID: PMC10719846 DOI: 10.3389/fnut.2023.1253545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 11/14/2023] [Indexed: 12/17/2023] Open
Abstract
Introduction Of the 45.4 million children under five affected by acute malnutrition in the world, the majority (31.8 million) are affected by moderate acute malnutrition (MAM). Its treatment is particularly complex in emergency settings such as the Diffa region in Niger. This study aims to evaluate the effectiveness and coverage of a simplified treatment protocol with Community Health Workers (CHWs) as treatment providers. Methods This study is a non-randomized controlled trial. The control group (n = 181) received the standard protocol currently used in country, delivered by nursing staff only in health centres and health posts, while the intervention group (n = 483) received the simplified protocol which included nursing at health centres and CHWs at health post as treatment providers. Results The recovery rate was higher in the simplified protocol group (99.6% vs. 79.56%, p < 0.001) recording lower time to recover and higher anthropometric gain. Treatment coverage in the intervention group increased from 28.8% to 84.9% and reduced in the control group (25.3% to 13.6%). No differences were found in the recovery rate of children treated by CHWs and nursing staff. Conclusion The outcomes using the simplified protocol exceeded humanitarian requirements and demonstrated improvements compared to the standard protocol showing that the simplified protocol could be safely provided by CHWs in an emergency context. Further research in other contexts is needed to scale up this intervention.
Collapse
Affiliation(s)
- Luis Javier Sánchez-Martínez
- Unit of Physical Anthropology, Department of Biodiversity, Ecology and Evolution, Faculty of Biological Sciences, Complutense University of Madrid, Madrid, Spain
| | | | | | | | - Atté Sanoussi
- Nutrition Direction, Ministry of Health, Niamey, Niger
| | | | | | - Fanta Toure
- Action Against Hunger, West and Central Africa Regional Office, Dakar, Senegal
| | | | - Candela Lucía Hernández
- Unit of Physical Anthropology, Department of Biodiversity, Ecology and Evolution, Faculty of Biological Sciences, Complutense University of Madrid, Madrid, Spain
| | - Noemí López-Ejeda
- Unit of Physical Anthropology, Department of Biodiversity, Ecology and Evolution, Faculty of Biological Sciences, Complutense University of Madrid, Madrid, Spain
- EPINUT Research Group (Ref. 920325), Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
| |
Collapse
|
5
|
Endalamaw A, Erku D, Khatri RB, Nigatu F, Wolka E, Zewdie A, Assefa Y. Successes, weaknesses, and recommendations to strengthen primary health care: a scoping review. Arch Public Health 2023; 81:100. [PMID: 37268966 DOI: 10.1186/s13690-023-01116-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 05/23/2023] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Primary health care (PHC) is a roadmap for achieving universal health coverage (UHC). There were several fragmented and inconclusive pieces of evidence needed to be synthesized. Hence, we synthesized evidence to fully understand the successes, weaknesses, effective strategies, and barriers of PHC. METHODS We followed the PRISMA extension for scoping reviews checklist. Qualitative, quantitative, or mixed-approach studies were included. The result synthesis is in a realistic approach with identifying which strategies and challenges existed at which country, in what context and why it happens. RESULTS A total of 10,556 articles were found. Of these, 134 articles were included for the final synthesis. Most studies (86 articles) were quantitative followed by qualitative (26 articles), and others (16 review and 6 mixed methods). Countries sought varying degrees of success and weakness. Strengths of PHC include less costly community health workers services, increased health care coverage and improved health outcomes. Declined continuity of care, less comprehensive in specialized care settings and ineffective reform were weaknesses in some countries. There were effective strategies: leadership, financial system, 'Diagonal investment', adequate health workforce, expanding PHC institutions, after-hour services, telephone appointment, contracting with non-governmental partners, a 'Scheduling Model', a strong referral system and measurement tools. On the other hand, high health care cost, client's bad perception of health care, inadequate health workers, language problem and lack of quality of circle were barriers. CONCLUSIONS There was heterogeneous progress towards PHC vision. A country with a higher UHC effective service coverage index does not reflect its effectiveness in all aspects of PHC. Continuing monitoring and evaluation of PHC system, subsidies to the poor, and training and recruiting an adequate health workforce will keep PHC progress on track. The results of this review can be used as a guide for future research in selecting exploratory and outcome parameters.
Collapse
Affiliation(s)
- Aklilu Endalamaw
- School of Public Health, The University of Queensland, Brisbane, Australia.
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
| | - Daniel Erku
- School of Public Health, The University of Queensland, Brisbane, Australia
- Centre for Applied Health Economics, School of Medicine, Griffith University, Brisbane, Australia
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Resham B Khatri
- School of Public Health, The University of Queensland, Brisbane, Australia
- Health Social Science and Development Research Institute, Kathmandu, Nepal
| | - Frehiwot Nigatu
- International Institute for Primary Health Care in Ethiopia, Addis Ababa, Ethiopia
| | - Eskinder Wolka
- International Institute for Primary Health Care in Ethiopia, Addis Ababa, Ethiopia
| | - Anteneh Zewdie
- International Institute for Primary Health Care in Ethiopia, Addis Ababa, Ethiopia
| | - Yibeltal Assefa
- School of Public Health, The University of Queensland, Brisbane, Australia
| |
Collapse
|
6
|
Charle-Cuéllar P, Lopez-Ejeda N, Aziz Gado A, Dougnon AO, Sanoussi A, Ousmane N, Hamidou Lazoumar R, Sánchez-Martínez LJ, Toure F, Vargas A, Guerrero S. Effectiveness and Coverage of Severe Acute Malnutrition Treatment with a Simplified Protocol in a Humanitarian Context in Diffa, Niger. Nutrients 2023; 15:nu15081975. [PMID: 37111194 PMCID: PMC10146545 DOI: 10.3390/nu15081975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/15/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND the aim of this study is to evaluate the effectiveness and coverage of a simplified protocol that is implemented in health centers (HCs) and health posts (HPs) for children who are suffering from severe acute malnutrition (SAM) in the humanitarian context of Diffa. METHODS We conducted a non-randomized community-controlled trial. The control group received outpatient treatment for SAM, without medical complications, at HCs and HPs with the standard protocol of community management of acute malnutrition (CMAM). Meanwhile, with respect to the intervention group, the children with SAM received treatment at the HCs and HPs through a simplified protocol wherein the mid-upper arm circumference (MUAC) and the presence of edema were used as the admission criteria, and the children with SAM were administered doses of fixed ready-to-use therapeutic food (RUTF). RESULTS A total of 508 children, who were all under 5 years and had SAM, were admitted into the study. The cured proportion was 87.4% in the control group versus 96.6% in the intervention group (p value = 0.001). There was no difference between the groups in the length of stay, which was 35 days, but the intervention group used a lower quantity of RUTF-70 sachets versus 90 sachets, per child cured. Coverage increases were observed in both groups. DISCUSSION the simplified protocol used at the HCs and HPs did not result in worse recovery and resulted in fewer discharge errors compared to the standard protocol.
Collapse
Affiliation(s)
| | - Noemi Lopez-Ejeda
- EPINUT Research Group (Ref. 920325), Unit of Physical Anthropology, Department of Biodiversity, Ecology, Faculty of Biological Sciences, and Evolution, Complutense University of Madrid, 28040 Madrid, Spain
| | | | | | - Atté Sanoussi
- Nutrition Direction, Ministry of Health, Niamey BP 623, Niger
| | - Nassirou Ousmane
- Centre de Recherche Médicale et Sanitaire (CERMES), Niamey BP 10887, Niger
| | | | - Luis Javier Sánchez-Martínez
- EPINUT Research Group (Ref. 920325), Unit of Physical Anthropology, Department of Biodiversity, Ecology, Faculty of Biological Sciences, and Evolution, Complutense University of Madrid, 28040 Madrid, Spain
| | - Fanta Toure
- Action against Hunger, West and Central Africa Regional, Dakar BP 29621, Senegal
| | - Antonio Vargas
- Action against Hunger, C/Duque de Sevilla no. 3, 28002 Madrid, Spain
| | - Saul Guerrero
- United Nations International Children's Emergency Fund-UNICEF, 3 United Nations Plaza, New York, NY 10017, USA
| |
Collapse
|
7
|
Ashton RA, Hamainza B, Lungu C, Rutagwera MRI, Porter T, Bennett A, Hainsworth M, Burnett S, Silumbe K, Slater H, Eisele TP, Miller JM. Effectiveness of community case management of malaria on severe malaria and inpatient malaria deaths in Zambia: a dose-response study using routine health information system data. Malar J 2023; 22:96. [PMID: 36927440 PMCID: PMC10022244 DOI: 10.1186/s12936-023-04525-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 03/07/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Community case management of malaria (CCM) has been expanded in many settings, but there are limited data describing the impact of these services in routine implementation settings or at large scale. Zambia has intensively expanded CCM since 2013, whereby trained volunteer community health workers (CHW) use rapid diagnostic tests and artemether-lumefantrine to diagnose and treat uncomplicated malaria. METHODS This retrospective, observational study explored associations between changing malaria service point (health facility or CHW) density per 1000 people and severe malaria admissions or malaria inpatient deaths by district and month in a dose-response approach, using existing routine and programmatic data. Negative binomial generalized linear mixed-effect models were used to assess the impact of increasing one additional malaria service point per 1000 population, and of achieving Zambia's interim target of 1 service point per 750 population. Access to insecticide-treated nets, indoor-residual spraying, and rainfall anomaly were included in models to reduce potential confounding. RESULTS The study captured 310,855 malaria admissions and 7158 inpatient malaria deaths over 83 districts (seven provinces) from January 2015 to May 2020. Total CHWs increased from 43 to 4503 during the study period, while health facilities increased from 1263 to 1765. After accounting for covariates, an increase of one malaria service point per 1000 was associated with a 19% reduction in severe malaria admissions among children under five (incidence rate ratio [IRR] 0.81, 95% confidence interval [CI] 0.75-0.87, p < 0.001) and 23% reduction in malaria deaths among under-fives (IRR 0.77, 95% CI 0.66-0.91). After categorizing the exposure of population per malaria service point, there was evidence for an effect on malaria admissions and inpatient malaria deaths among children under five only when reaching the target of one malaria service point per 750 population. CONCLUSIONS CCM is an effective strategy for preventing severe malaria and deaths in areas such as Zambia where malaria diagnosis and treatment access remains challenging. These results support the continued investment in CCM scale-up in similar settings, to improve access to malaria diagnosis and treatment.
Collapse
Affiliation(s)
- Ruth A Ashton
- Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2300, New Orleans, LA, USA.
| | - Busiku Hamainza
- National Malaria Elimination Centre, Zambia Ministry of Health, Lusaka, Zambia
| | - Chris Lungu
- PATH Malaria Control and Elimination Partnership in Africa (MACEPA), Lusaka, Zambia
| | | | - Travis Porter
- Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2300, New Orleans, LA, USA
| | | | | | | | - Kafula Silumbe
- PATH Malaria Control and Elimination Partnership in Africa (MACEPA), Lusaka, Zambia
| | | | - Thomas P Eisele
- Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2300, New Orleans, LA, USA
| | - John M Miller
- PATH Malaria Control and Elimination Partnership in Africa (MACEPA), Lusaka, Zambia
| |
Collapse
|
8
|
Liu Y, Gu H, Shi Y. Spatial Accessibility Analysis of Medical Facilities Based on Public Transportation Networks. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16224. [PMID: 36498300 PMCID: PMC9738403 DOI: 10.3390/ijerph192316224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 11/26/2022] [Accepted: 11/29/2022] [Indexed: 06/17/2023]
Abstract
Aiming to look at the problems of the unreasonable layout of medical facilities and low coverage of primary medical services. This paper selects tertiary grade A hospitals, general hospitals, specialized hospitals, community-level hospitals, clinics, and pharmacies in the main urban areas of Chongqing as research objects. The nearest analysis, kernel density, mean center, and standard deviational ellipse method were used to analyze the spatial differentiation characteristics of medical facilities and public transportation stations. Spatial accessibility was assessed from the perspective of service area ratios and service population ratios by constructing multiple modes of transportation (pedestrian systems, bus lines, rail lines). The results show that (1) the spatial layout of medical facilities in the main urban area of Chongqing is unbalanced; and the spatial distribution of medical facilities is characterized by "large agglomeration, small dispersion" and "multi-center group"; (2) the sub-core circle is centered on the Southwest University Area in Beibei District, the University Town Area in Shapingba, the Yudong Area and Lijiatuo Area in Banan District, the Pingan Light Rail Station Area in Dadukou District, the Chongqing No. 8 Middle School Area in Jiulongpo District, the Tea Garden Area in Nanan District, and the Jiangbei Airport Area in Yubei District; (3) the medical facilities with the weakest average accessibility are tertiary grade A hospitals, and the strongest are pharmacies; (4) the areas with vital average accessibility are Yuzhong District, Shapingba District, Dadukou District, and Nanan District.
Collapse
Affiliation(s)
| | - Han Gu
- College of Architecture and Urban Planning, Chongqing Jiaotong University, Chongqing 400075, China
| | | |
Collapse
|
9
|
Charle-Cuéllar P, Espí-Verdú L, Goyanes J, Bunkembo M, Samake S, Traore M, Coulibaly AB, Landouré A, Diawara F, Dougnon AO, Vargas A, López-Ejeda N. Scaling severe acute malnutrition treatment with community health workers: a geospatial coverage analysis in rural Mali. HUMAN RESOURCES FOR HEALTH 2022; 20:74. [PMID: 36271427 PMCID: PMC9587545 DOI: 10.1186/s12960-022-00771-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 10/10/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND In 2015, the Ministry of Health in Mali included the treatment of severe acute malnutrition (SAM) into the package of activities of the integrated Community Case Management (iCCM). This paper aims to analyze the impact of including community health workers (CHWs) as treatment providers outside the Health Facilities (HFs) on the coverage of SAM treatment when scaling up the intervention in the three largest districts of the Kayes Region in Mali. METHODS A baseline coverage assessment was conducted in August 2017 in the three districts before the CHWs started treating SAM. The end-line assessment was conducted one year later, in August 2018. Coverage was assessed by the standardized methodology called Semi-Quantitative Evaluation of Access and Coverage (SQUEAC). The primary outcome was treatment coverage and other variables evaluated were the geographical distribution of the HFs, CHW's sites and overlapping between both health providers, the estimation of children with geographical access to health care and the estimation of children screened for acute malnutrition in their communities. RESULTS Treatment coverage increased in Kayes (28.7-57.1%) and Bafoulabé (20.4-61.1%) but did not in Kita (28.4-28.5%). The decentralization of treatment has not had the same impact on coverage in all districts, with significant differences. The geospatial analyses showed that Kita had a high proportion of overlap between HFs and/or CHWs 48.7% (39.2-58.2), a high proportion of children without geographical access to health care 70.4% (70.1-70.6), and a high proportion of children not screened for SAM in their communities 52.2% (51.9-52.5). CONCLUSIONS Working with CHWs in SAM increases treatment coverage, but other critical aspects need to be considered by policymakers if this intervention model is intended to be scaled up at the country level. To improve families' access to nutritional health care, before establishing decentralized treatment in a whole region it must be considered the geographical location of CHWs. This previous assessment will avoid overlap among health providers and ensure the coverage of all unserved areas according to their population densities need. TRIAL REGISTRATION ISRCTN registry with ID 1990746. https://doi.org/10.1186/ISRCTN14990746.
Collapse
Affiliation(s)
| | - Lidia Espí-Verdú
- Action Against Hunger Spain, C/ Duque de Sevilla No. 3. 28002, Madrid, Spain
| | - Juan Goyanes
- Action Against Hunger Spain, C/ Duque de Sevilla No. 3. 28002, Madrid, Spain
| | | | | | - Mamadou Traore
- Nutrition Direction of the Ministry of Hygiene and Public Health, BP 232, Bamako, Mali
| | - Adama Balla Coulibaly
- Nutrition Direction of the Ministry of Hygiene and Public Health, BP 232, Bamako, Mali
| | - Aly Landouré
- Institut National de Recherche en Santé Publique, BP 235, Bamako, Mali
| | - Fatou Diawara
- Institut National de Recherche en Santé Publique, BP 235, Bamako, Mali
| | | | - Antonio Vargas
- Action Against Hunger Spain, C/ Duque de Sevilla No. 3. 28002, Madrid, Spain
| | - Noemí López-Ejeda
- EPINUT Research Group (Ref. 920325), Faculty of Biological Sciences, Department of Biodiversity, Ecology and Evolution, Unit of Physical Anthropology, Complutense University of Madrid, Jose Antonio Novais, 12, 8th Floor, 28040 Madrid, Spain
| |
Collapse
|
10
|
Champagne C, Rajkumar AS, Auxila P, Perrone G, Plötz M, Young A, Bazaz Jazayeri S, Napier HG, Le Menach A, Battle K, Amratia P, Cameron E, Alfred JP, Deslouches YG, Pothin E. Improving access to care and community health in Haiti with optimized community health worker placement. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000167. [PMID: 36962155 PMCID: PMC10022239 DOI: 10.1371/journal.pgph.0000167] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 03/09/2022] [Indexed: 11/18/2022]
Abstract
The national deployment of polyvalent community health workers (CHWs) is a constitutive part of the strategy initiated by the Ministry of Health to accelerate efforts towards universal health coverage in Haiti. Its implementation requires the planning of future recruitment and deployment activities for which mathematical modelling tools can provide useful support by exploring optimised placement scenarios based on access to care and population distribution. We combined existing gridded estimates of population and travel times with optimisation methods to derive theoretical CHW geographical placement scenarios including constraints on walking time and the number of people served per CHW. Four national-scale scenarios that align with total numbers of existing CHWs and that ensure that the walking time for each CHW does not exceed a predefined threshold are compared. The first scenario accounts for population distribution in rural and urban areas only, while the other three also incorporate in different ways the proximity of existing health centres. Comparing these scenarios to the current distribution, insufficient number of CHWs is systematically identified in several departments and gaps in access to health care are identified within all departments. These results highlight current suboptimal distribution of CHWs and emphasize the need to consider an optimal (re-)allocation.
Collapse
Affiliation(s)
- Clara Champagne
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | | | - Paul Auxila
- Global Financing Facility, Port-au-Prince, Haiti
| | | | - Marvin Plötz
- World Bank, Washington, DC, United States of America
| | - Alyssa Young
- Clinton Health Access Initiative, Port-au-Prince, Haiti
- Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, United States of America
| | - Samuel Bazaz Jazayeri
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Harriet G. Napier
- Clinton Health Access Initiative, Boston, MA, United States of America
| | - Arnaud Le Menach
- Clinton Health Access Initiative, Boston, MA, United States of America
| | - Katherine Battle
- Institute for Disease Modeling, Seattle, WA, United States of America
| | | | | | | | | | - Emilie Pothin
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Clinton Health Access Initiative, Boston, MA, United States of America
| |
Collapse
|
11
|
Oliphant NP, Ray N, Curtis A, Musa E, Sesay M, Kandeh J, Kamara A, Hassen K, O'Connor S, Suehiro Y, Legesse H, Chimoun EFT, Jackson D, Doherty T. Optimising scale and deployment of community health workers in Sierra Leone: a geospatial analysis. BMJ Glob Health 2022; 7:e008141. [PMID: 35589152 PMCID: PMC9121426 DOI: 10.1136/bmjgh-2021-008141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 05/04/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Little is known about strategies for optimising the scale and deployment of community health workers (CHWs) to maximise geographic accessibility of primary healthcare services. METHODS We used data from a national georeferenced census of CHWs and other spatial datasets in Sierra Leone to undertake a geospatial analysis exploring optimisation of the scale and deployment of CHWs, with the aim of informing implementation of current CHW policy and future plans of the Ministry of Health and Sanitation. RESULTS The per cent of the population within 30 min walking to the nearest CHW with preservice training increased from 16.1% to 80.4% between 2000 and 2015. Contrary to current national policy, most of this increase occurred in areas within 3 km of a health facility where nearly two-thirds (64.5%) of CHWs were deployed. Ministry of Health and Sanitation-defined 'easy-to-reach' and 'hard-to-reach' areas, geographic areas that should be targeted for CHW deployment, were less well covered, with 19.2% and 34.6% of the population in 2015 beyond a 30 min walk to a CHW, respectively. Optimised CHW networks in these areas were more efficiently deployed than existing networks by 22.4%-71.9%, depending on targeting metric. INTERPRETATIONS Our analysis supports the Ministry of Health and Sanitation plan to rightsize and retarget the CHW workforce. Other countries in sub-Saharan Africa interested in optimising the scale and deployment of their CHW workforce in the context of broader human resources for health and health sector planning may look to Sierra Leone as an exemplar model from which to learn.
Collapse
Affiliation(s)
- Nicholas Paul Oliphant
- University of the Western Cape, School of Public Health, Bellville, South Africa
- The Global Fund to Fight AIDS, Tuberculosis, and Malaria, Geneva, Switzerland
| | - Nicolas Ray
- Geohealth Group, University of Geneva, Institute of Global Health, Geneva, Switzerland
- University of Geneva, Institute of Environmental Sciences, Geneva, Switzerland
| | - Andrew Curtis
- Geohealth Group, University of Geneva, Institute of Global Health, Geneva, Switzerland
- University of Geneva, Institute of Environmental Sciences, Geneva, Switzerland
| | - Elizabeth Musa
- CHW Hub, Directorate of Primary Health Care, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Momodu Sesay
- Directorate of Primary Health Care, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Joseph Kandeh
- Directorate of Primary Health Care, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Anitta Kamara
- National Malaria Control Program, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Kebir Hassen
- UNICEF Sierra Leone, Freetown, Sierra Leone
- UNICEF Sudan, Khartoum, Sudan
| | | | | | | | | | - Debra Jackson
- University of the Western Cape, School of Public Health, Bellville, South Africa
- London School of Hygiene and Tropical Medicine, Centre for Maternal Adolescent Reproductive and Child Health, London, UK
| | - Tanya Doherty
- University of the Western Cape, School of Public Health, Bellville, South Africa
- Health Systems Research Unit, South African Medical Research Council, Tygerberg, South Africa
| |
Collapse
|
12
|
Chênes C, Albert H, Kao K, Ray N. Use of Physical Accessibility Modelling in Diagnostic Network Optimization: A Review. Diagnostics (Basel) 2022; 12:diagnostics12010103. [PMID: 35054270 PMCID: PMC8774366 DOI: 10.3390/diagnostics12010103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 12/29/2021] [Accepted: 01/03/2022] [Indexed: 11/16/2022] Open
Abstract
Diagnostic networks are complex systems that include both laboratory-tested and community-based diagnostics, as well as a specimen referral system that links health tiers. Since diagnostics are the first step before accessing appropriate care, diagnostic network optimization (DNO) is crucial to improving the overall healthcare system. The aim of our review was to understand whether the field of DNO, and especially route optimization, has benefited from the recent advances in geospatial modeling, and notably physical accessibility modeling, that have been used in numerous health systems assessment and strengthening studies. All publications published in English between the journal’s inception and 12 August 2021 that dealt with DNO, geographical accessibility and optimization, were systematically searched for in Web of Science and PubMed, this search was complemented by a snowball search. Studies from any country were considered. Seven relevant publications were selected and charted, with a variety of geospatial approaches used for optimization. This paucity of publications calls for exploring the linkage of DNO procedures with realistic accessibility modeling framework. The potential benefits could be notably better-informed travel times of either the specimens or population, better estimates of the demand for diagnostics through realistic population catchments, and innovative ways of considering disease epidemiology to inform DNO.
Collapse
Affiliation(s)
- Camille Chênes
- Institute for Environmental Sciences, University of Geneva, 1205 Geneva, Switzerland;
| | | | | | - Nicolas Ray
- Institute for Environmental Sciences, University of Geneva, 1205 Geneva, Switzerland;
- GeoHealth Group, Institute of Global Health, University of Geneva, 1202 Geneva, Switzerland
- Correspondence: ; Tel.: +41-22-379-07-84
| |
Collapse
|
13
|
Oliphant NP, Sy Z, Koné B, Berthé M, Beebe M, Samake M, Diabaté M, Tounkara S, Diarra B, Diarra AB, Diawara CH, Yakimova T, Florisse S, Jackson D, Ray N, Doherty T. Improving the efficiency of scale-up and deployment of community health workers in Mali: A geospatial analysis. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000626. [PMID: 36962591 PMCID: PMC10021816 DOI: 10.1371/journal.pgph.0000626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 08/04/2022] [Indexed: 11/06/2022]
Abstract
Optimising the scale and deployment of community health workers (CHWs) is important for maximizing geographical accessibility of integrated primary health care (PHC) services. Yet little is known about approaches for doing so. We used geospatial analysis to model optimised scale-up and deployment of CHWs in Mali, to inform strategic and operational planning by the Ministry of Health and Social Development. Accessibility catchments were modelled based on travel time, accounting for barriers to movement. We compared geographic coverage of the estimated population, under-five deaths, and plasmodium falciparum (Pf) malaria cases across different hypothetical optimised CHW networks and identified surpluses and deficits of CHWs compared to the existing CHW network. A network of 15 843 CHW, if optimally deployed, would ensure that 77.3% of the population beyond 5 km of the CSCom (community health centre) and CSRef (referral health facility) network would be within a 30-minute walk of a CHW. The same network would cover an estimated 59.5% of U5 deaths and 58.5% of Pf malaria cases. As an intermediary step, an optimised network of 4 500 CHW, primarily filling deficits of CHW in the regions of Kayes, Koulikoro, Sikasso, and Ségou would ensure geographic coverage for 31.3% of the estimated population. There were no important differences in geographic coverage percentage when prioritizing CHW scale-up and deployment based on the estimated population, U5 deaths, or Pf malaria cases. Our geospatial analysis provides useful information to policymakers and planners in Mali for optimising the scale-up and deployment of CHW and, in turn, for maximizing the value-for-money of resources of investment in CHWs in the context of the country's health sector reform. Countries with similar interests in optimising the scale and deployment of their CHW workforce may look to Mali as an exemplar model from which to learn.
Collapse
Affiliation(s)
- Nicholas P Oliphant
- University of the Western Cape, School of Public Health, Bellville, Republic of South Africa
- The Global Fund to Fight AIDS, Tuberculosis, and Malaria, Geneva, Switzerland
| | - Zeynabou Sy
- Faculty of Medicine, GeoHealth group, Institute of Global Health, University of Geneva, Geneva, Switzerland
- Institute for Environmental Sciences, University of Geneva, Geneva, Switzerland
| | - Brehima Koné
- Ministère de la Santé et du Développement Social du Mali, Direction Générale de la Santé et de l'Hygiène Publique, Bamako, Mali
| | - Mohamed Berthé
- Ministère de la Santé et du Développement Social du Mali, L'Unité de Mise en Œuvre de Renforcement du Système de Santé, Bamako, Mali
| | - Madeleine Beebe
- Ministère de la Santé et du Développement Social du Mali, L'Unité de Mise en Œuvre de Renforcement du Système de Santé, Bamako, Mali
| | - Moussa Samake
- Ministère de la Santé et du Développement Social du Mali, Cellule de Planification et de Statistique Secteur Santé, Développment Social et Promotion de la Famille, Bamako, Mali
| | - Mamoutou Diabaté
- Ministère de la Santé et du Développement Social du Mali, Direction National de la Santé, Bamako, Mali
| | - Salimata Tounkara
- Ministère de la Santé et du Développement Social du Mali, Direction Générale de la Santé et de l'Hygiène Publique, Bamako, Mali
| | - Borodjan Diarra
- Ministère de la Santé et du Développement Social du Mali, Direction Générale de la Santé et de l'Hygiène Publique, Bamako, Mali
| | - Amadou B Diarra
- Ministère de la Santé et du Développement Social du Mali, L'Unité de Mise en Œuvre de Renforcement du Système de Santé, Bamako, Mali
- MUSO, Bamako, Mali
| | - Cheickna H Diawara
- Ministère de la Santé et du Développement Social du Mali, L'Unité de Mise en Œuvre de Renforcement du Système de Santé, Bamako, Mali
- MUSO, Bamako, Mali
| | - Tsvetana Yakimova
- The Global Fund to Fight AIDS, Tuberculosis, and Malaria, Geneva, Switzerland
| | - Sonia Florisse
- The Global Fund to Fight AIDS, Tuberculosis, and Malaria, Geneva, Switzerland
| | - Debra Jackson
- University of the Western Cape, School of Public Health, Bellville, Republic of South Africa
- London School of Hygiene and Tropical Medicine (LSHTM), Centre for Maternal Adolescent Reproductive and Child Health (MARCH), London, United Kingdom
| | - Nicolas Ray
- Faculty of Medicine, GeoHealth group, Institute of Global Health, University of Geneva, Geneva, Switzerland
- Institute for Environmental Sciences, University of Geneva, Geneva, Switzerland
| | - Tanya Doherty
- University of the Western Cape, School of Public Health, Bellville, Republic of South Africa
- South African Medical Research Council, Health Systems Research Unit, Tygerberg, Republic of South Africa
| |
Collapse
|
14
|
Evans MV, Andréambeloson T, Randriamihaja M, Ihantamalala F, Cordier L, Cowley G, Finnegan K, Hanitriniaina F, Miller AC, Ralantomalala LM, Randriamahasoa A, Razafinjato B, Razanahanitriniaina E, Rakotonanahary RJL, Andriamiandra IJ, Bonds MH, Garchitorena A. Geographic barriers to care persist at the community healthcare level: Evidence from rural Madagascar. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0001028. [PMID: 36962826 PMCID: PMC10022327 DOI: 10.1371/journal.pgph.0001028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 11/26/2022] [Indexed: 12/28/2022]
Abstract
Geographic distance is a critical barrier to healthcare access, particularly for rural communities with poor transportation infrastructure who rely on non-motorized transportation. There is broad consensus on the importance of community health workers (CHWs) to reduce the effects of geographic isolation on healthcare access. Due to a lack of fine-scale spatial data and individual patient records, little is known about the precise effects of CHWs on removing geographic barriers at this level of the healthcare system. Relying on a high-quality, crowd-sourced dataset that includes all paths and buildings in the area, we explored the impact of geographic distance from CHWs on the use of CHW services for children under 5 years in the rural district of Ifanadiana, southeastern Madagascar from 2018-2021. We then used this analysis to determine key features of an optimal geographic design of the CHW system, specifically optimizing a single CHW location or installing additional CHW sites. We found that consultation rates by CHWs decreased with increasing distance patients travel to the CHW by approximately 28.1% per km. The optimization exercise revealed that the majority of CHW sites (50/80) were already in an optimal location or shared an optimal location with a primary health clinic. Relocating the remaining CHW sites based on a geographic optimum was predicted to increase consultation rates by only 7.4%. On the other hand, adding a second CHW site was predicted to increase consultation rates by 31.5%, with a larger effect in more geographically dispersed catchments. Geographic distance remains a barrier at the level of the CHW, but optimizing CHW site location based on geography alone will not result in large gains in consultation rates. Rather, alternative strategies, such as the creation of additional CHW sites or the implementation of proactive care, should be considered.
Collapse
Affiliation(s)
| | | | | | - Felana Ihantamalala
- NGO PIVOT, Ranomafana, Ifanadiana, Madagascar
- Department of Global Health and Social Medicine, Blavatnik Institute at Harvard Medical School, Boston, MA, United Sates of America
| | | | | | | | | | - Ann C Miller
- Department of Global Health and Social Medicine, Blavatnik Institute at Harvard Medical School, Boston, MA, United Sates of America
| | | | | | | | | | | | | | - Matthew H Bonds
- NGO PIVOT, Ranomafana, Ifanadiana, Madagascar
- Department of Global Health and Social Medicine, Blavatnik Institute at Harvard Medical School, Boston, MA, United Sates of America
| | - Andres Garchitorena
- MIVEGEC, Univ. Montpellier, CNRS, IRD, Montpellier, France
- NGO PIVOT, Ranomafana, Ifanadiana, Madagascar
| |
Collapse
|
15
|
Ihantamalala FA, Bonds MH, Randriamihaja M, Rakotonirina L, Herbreteau V, Révillion C, Rakotoarimanana S, Cowley G, Andriatiana TA, Mayfield A, Rich ML, Rakotonanahary RJL, Finnegan KE, Ramarson A, Razafinjato B, Ramiandrisoa B, Randrianambinina A, Cordier LF, Garchitorena A. Geographic barriers to establishing a successful hospital referral system in rural Madagascar. BMJ Glob Health 2021; 6:bmjgh-2021-007145. [PMID: 34880062 PMCID: PMC8655550 DOI: 10.1136/bmjgh-2021-007145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 11/17/2021] [Indexed: 12/13/2022] Open
Abstract
Background The provision of emergency and hospital care has become an integral part of the global vision for universal health coverage. To strengthen secondary care systems, we need to accurately understand the time necessary for populations to reach a hospital. The goal of this study was to develop methods that accurately estimate referral and prehospital time for rural districts in low and middle-income countries. We used these estimates to assess how local geography can limit the impact of a strengthened referral programme in a rural district of Madagascar. Methods We developed a database containing: travel speed by foot and motorised vehicles in Ifanadiana district; a full mapping of all roads, footpaths and households; and remotely sensed data on terrain, land cover and climatic characteristics. We used this information to calibrate estimates of referral and prehospital time based on the shortest route algorithms and statistical models of local travel speed. We predict the impact on referral numbers of strategies aimed at reducing referral time for underserved populations via generalised linear mixed models. Results About 10% of the population lived less than 2 hours from the hospital, and more than half lived over 4 hours away, with variable access depending on climatic conditions. Only the four health centres located near the paved road had referral times to the hospital within 1 hour. Referral time remained the main barrier limiting the number of referrals despite health system strengthening efforts. The addition of two new referral centres is estimated to triple the population living within 2 hours from a centre with better emergency care capacity and nearly double the number of expected referrals. Conclusion This study demonstrates how adapting geographic accessibility modelling methods to local scales can occur through improving the precision of travel time estimates and pairing them with data on health facility use.
Collapse
Affiliation(s)
- Felana Angella Ihantamalala
- Research, NGO PIVOT, Ifanadiana, Fianarantsoa, Madagascar .,Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Matthew H Bonds
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA.,NGO PIVOT, Ranomafana, Madagascar
| | | | | | - Vincent Herbreteau
- Espace-Dev, IRD, Université des Antilles, Université de Guyane, Université de Montpellier, Université de La Réunion, Phnom Penh, Cambodia
| | - Christophe Révillion
- Espace-Dev, IRD, Université des Antilles, Université de Guyane, Université de Montpellier, Université de La Réunion, Saint-Pierre, France
| | | | | | | | - Alishya Mayfield
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA.,NGO PIVOT, Ranomafana, Madagascar
| | - Michael L Rich
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA.,NGO PIVOT, Ranomafana, Madagascar.,Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | | | | | | | | | | | | | - Andres Garchitorena
- NGO PIVOT, Ranomafana, Madagascar.,MIVEGEC, Université de Montpellier, CNRS, IRD, Montpellier, France
| |
Collapse
|