Defining equity in physical access to clinical services using geographical information systems as part of malaria planning and monitoring in Kenya

Abstract

SummaryDistance is a crucial feature of health service use and yet its application and utility to health care planning have not been well explored, particularly in the light of large-scale international and national efforts such as Roll Back Malaria. We have developed a high-resolution map of population-to-service access in four districts of Kenya. Theoretical physical access, based upon national targets, developed as part of the Kenyan health sector reform agenda, was compared with actual health service usage data among 1668 paediatric patients attending 81 sampled government health facilities. Actual and theoretical use were highly correlated. Patients in the larger districts of Kwale and Makueni, where access to government health facilities was relatively poor, travelled greater mean distances than those in Greater Kisii and Bondo. More than 60% of the patients in the four districts attended health facilities within a 5-km range. Interpolated physical access surfaces across districts highlighted areas of poor access and large differences between urban and rural settings. Users from rural communities travelled greater distances to health facilities than those in urban communities. The implications of planning and monitoring equitable delivery of clinical services at national and international levels are discussed.

Creating spatially defined databases for equitable health service planning in low-income countries: the example of Kenya

“…These were identified principally through the KMD (20%), the FPLM list (19%) and telephone directories (17%) and only 38% were found on the MoH-HMIS list. Among four districts studied intensively for health service providers (Noor et al, 2003), 50% of private sector providers were not recorded on any official list and identified only through district-level investigation.…”

“…We have focused on five districts (Kilifi, Kwale, Makeuni, Kisii/Gucha, and Bondo) that formed part of detailed GIS studies between 2000 and 2002 (Noor et al, 2003;KEMRI-Kilifi-unpublished data). Among these districts a total of 25 out of 274 MoH, Mission/NGO and LA facilities were identified in collaboration with district health management teams that were not on centrally-held lists and databases, representing an average of 5 facilities per district that were not on any published list.…”

Malaria treatment in remote areas of Mali: use of modern and traditional medicines, patient outcome

“…However, travel is often difficult, especially during the rainy season, and health professionals attribute many of their treatment failures to delayed access to modern treatment in the case of severe malaria, as well as delayed or inappropriate treatment in the case of uncomplicated malaria (Muller et al, 2003;Noor et al, 2003). The first few malaria episodes are the most dangerous, because immunity to malaria rises rapidly after a limited number of infections (Gupta et al, 1999), so it seems important to study every potential way of improving the care of young patients.…”

Sensitivity of hospital-based surveillance for severe disease: a geographic information system analysis of access to care in Kilifi district, Kenya

“…[3][4][5][6] However, limited data are available at the district level to help identify geographic inequities in health outcomes and target the delivery of services to disadvantaged populations. 7,8 In rural settings with a low density of health facilities, physical access to sources of care is a known determinant of health-care utilization, with substantial decreases in rates of clinic attendance observed with increasing distance from the homestead to the clinic; [9][10][11][12][13][14][15][16][17][18][19] this phenomenon is frequently termed "distance decay." However, studies have not directly linked distance to health facilities to morbidity rates in the community.…”