Spatial Accessibility of Primary Healthcare in Rural Population: A Review

Abstract

Background: Access to healthcare can be defined as opportunity or ease for patients to come to the services, while accessibility can be defined as the potential or ease for certain health services or health facilities to be reach and utilized by the patients. Spatial accessibility is assessment of accessibility determinant which can be segregated according to geographical location. The aim of this manuscript is to identify spatial accessibility assessments methods used in the primary healthcare accessibility studies within rural population setting and integration with its determinants. Materials and Methods:Scoping systematic review was done using public domain search engine. Keywords used for article search are Spatial Accessibility; Geographical Accessibility; Primary Health Care; Primary Care; Rural; Non-Urban and Remote. All articles within 15 years of publication were included with the exclusion criteria of review article, research methodology protocol and non-English articles. After screening, 10 final articles were eligible for qualitative synthesis. Content analysis was carried out, then synthesized into location of study, purpose of the study, method of spatial accessibility assessment and accessibility determinants. Result:Most of the studies in this review used gravity method (floating catchment method), three studies using physician population ratio and one study used travel impedance. Travel impedance and physician population ratio were described descriptively, which later were correlated with utilization and mortality. Several aspatial factors were also been associated with spatial accessibility through correlation, integration through formula calculation, aggregation in index and overlaying through geographical information system.Conclusion: Development of geographical information system has made more studies to use floating catchment method as a tool to assess spatial accessibility. Alteration to existing floating catchment method to allow researcher to address limitation for its predecessor. Recent development also integrates spatial accessibility with aspatial factor and its determinants. This knowledge will facilitate policy maker to improve the accessibility by overcoming the barriers.