Dynamic geographical accessibility assessments to improve health equity: protocol for a test case in Cali, Colombia

Abstract

This protocol proposes an approach to assessing the place of residence as a spatial determinant of health in cities where traffic congestion might impact health services accessibility. The study provides dynamic travel times presenting data in ways that help shape decisions and spur action by diverse stakeholders and sectors. Equity assessments in geographical accessibility to health services typically rely on static metrics, such as distance or average travel times. This new approach uses dynamic spatial accessibility measures providing travel times from the place of residence to the health service with the shortest journey time. It will show the interplay between traffic congestion, accessibility, and health equity and should be used to inform urban and health services monitoring and planning. Available digitised data enable efficient and accurate accessibility measurements for urban areas using publicly available sources and provide disaggregated sociodemographic information and an equity perspective. Test cases are done for urgent and frequent care (i.e., repeated ambulatory care). Situational analyses will be done with cross-sectional urban assessments; estimated potential improvements will be made for one or two new services, and findings will inform recommendations and future studies. This study will use visualisations and descriptive statistics to allow non-specialized stakeholders to understand the effects of accessibility on populations and health equity. This includes “time-to-destination” metrics or the proportion of the people that can reach a service by car within a given travel time threshold from the place of residence. The study is part of the AMORE Collaborative Project, in which a diverse group of stakeholders seeks to address equity for accessibility to essential health services, including health service users and providers, authorities, and community members, including academia.

Improving accessibility to radiotherapy services in Cali, Colombia: cross-sectional equity analyses using open data and big data travel times from 2020

“…51,52 The project examined tertiary care emergency services, for which time is critical, and two outpatient services that require frequent and prolonged attendance: haemodialysis and radiotherapy; this report focuses on the latter. 53 We developed the AMORE web-based platform to integrate open sources (adjusted census microdata matched to TAZs), add travel times and perform all measurements. We used design thinking throughout the platform's development.…”

“…We held twenty-eight interviews and discussion groups with key informants, experts and stakeholders to get feedback and insights as the AMORE Platform was developed, leading to enhanced prototypes and presenting data in ways relatable to end-users. 16,53 We identi ed radiotherapy services in Cali using the Colombian National Health Services Registry. We obtained travel times big data from Google Distance Matrix API for the weeks of July 6-12 and 23-29 November 2020.…”

“…This cross-sectional study used the AMORE web-based platform to integrate big data of travel times with georeferenced microdata from the adjusted 2018 national census, TAZs, and the geographic locations of radiotherapy services. 7,53,55,56 The data sources integrated into the platform Included the 2018 National Census Data for Cali, obtained from the public o cial databases of the Colombian National Department of Statistics (DANE in Spanish) 57,58 ; administrative divisions of Cali obtained from the Colombian IDESC Geoportal, Tra c Analysis Zones (TAZ), and census block sectors 59,60 ; Google's Distance Matrix API; and information about the ve radiation therapy services in Cali. The complete list of variables can be found in the study in the protocol.…”

“…The complete list of variables can be found in the study in the protocol. 53 For this baseline assessment of urban Cali, on July 3, 2020, we downloaded predicted travel times for the week of 6-12 July 2021. For the week of 23-29 November 2020, we downloaded the expected times on 27 October 2020.…”

“…Figure 1 summarises the sociodemographic characteristics of the population. 53 Cali consisted of 22 communes in 2020, but began transitioning to becoming a Special District with six localities in 2023. [64][65][66][67] This change might raise the interest of local advocates in accessibility assessments among constituencies concerned about the availability and quality of health services in their communities.…”