Geospatial mapping of access to timely essential surgery in sub-Saharan Africa

Juran, Sabrina; Broer, P. Niclas; Klug, Stefanie J.; Snow, Rachel; Okiro, Emelda A.; Ouma, Paul; Snow, Robert W.; Tatem, Andrew J.; Meara, John G.; Alegana, Victor A.

doi:10.1136/bmjgh-2018-000875

Cited by 97 publications

(113 citation statements)

References 35 publications

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“…A travel time of one or two hours to health services is a generally accepted threshold of poor accessibility to health services, delaying or preventing health seeking behaviors that can have severe consequences [22,26,39,65,66]. We found that three quarters of the population in Ifanadiana district (76%) lived more than 1 h from a PHC and forty percent lived further than 2 h, with a larger percentage in the rainy season.…”

Section: Discussionmentioning

confidence: 84%

Improving geographical accessibility modeling for operational use by local health actors

Ihantamalala¹,

Herbreteau

Révillion³

et al. 2020

Preprint

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Background Geographical accessibility to health facilities remains one of the main barriers to access care in rural areas of the developing world. Although methods and tools exist to model geographic accessibility, the lack of basic geographic information prevents their widespread use at the local level for targeted program implementation. The aim of this study was to develop very precise, context-specific estimates of geographic accessibility to care in a rural district of Madagascar to help with the design and implementation of interventions that improve access for remote populations. Methods We used a participatory approach to map all the paths, residential areas, buildings and rice fields on OpenStreetMap (OSM). We estimated shortest route from every household in the District to the nearest primary health care center (PHC) and community health site (CHS) with the Open Source Routing Machine (OSMR) tool. Then, we used remote sensing methods to obtain a high resolution land cover map, a digital elevation model and rainfall data to model travel speed. Travel speed models were calibrated with field data obtained by GPS tracking in a sample of 168 walking routes. Model results were used to predict travel time to seek care at PHCs and CHSs for all the shortest route estimated earlier. Finally, we integrated geographical accessibility results into an e-health platform developed with R Shiny. Results We mapped over 100,000 buildings, 23,000 km of footpaths, and 4,925 residential areas throughout Ifanadiana district; this data is freely available on OSM. We found that over three quarters of the population lived more than one hour away from a PHC, and 10-15% lived more than one hour away from a CHS. Moreover, we identified areas in the North and East of the district where the nearest PHC was further than 5 hours away, and vulnerable populations across the district with poor geographical access (>1 hour) to both PHCs and CHSs. Conclusion Our study demonstrates how to improve geographical accessibility modeling so that results can be context-specific and operationally actionable by local health actors. The importance of such approaches is paramount for achieving universal health coverage in rural areas throughout world.

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Section: Discussionmentioning

confidence: 84%

Improving geographical accessibility modeling for operational use by local health actors

Ihantamalala¹,

Herbreteau

Révillion³

et al. 2020

Preprint

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“…For countries with data, most people appear to be within 2h of a facility able to provide the bellwether procedures. Two studies using similar methodology, but without taking into account the capacity to provide bellwether procedures, found that, from 47 and 48 countries across Africa respectively, 71–92 per cent of the population were within 2h of a hospital. However, using methodologies that measure local travel time to facilities more precisely, other studies have found considerably lower proportions of the population within 2h of a facility.…”

Section: Discussionmentioning

confidence: 99%

Evaluating the collection, comparability and findings of six global surgery indicators

Holmer

Bekele

Hagander

et al. 2018

British Journal of Surgery

102

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Background In 2015, six indicators were proposed to evaluate global progress towards access to safe, affordable and timely surgical and anaesthesia care. Although some have been adopted as core global health indicators, none has been evaluated systematically. The aims of this study were to assess the availability, comparability and utility of the indicators, and to present available data and updated estimates. Methods Nationally representative data were compiled for all World Health Organization (WHO) member states from 2010 to 2016 through contacts with official bodies and review of the published and grey literature, and available databases. Availability, comparability and utility were assessed for each indicator: access to timely essential surgery, specialist surgical workforce density, surgical volume, perioperative mortality, and protection against impoverishing and catastrophic expenditure. Where feasible, imputation models were developed to generate global estimates. Results Of all WHO member states, 19 had data on the proportion of the population within 2h of a surgical facility, 154 had data on workforce density, 72 reported number of procedures, and nine had perioperative mortality data, but none could report data on catastrophic or impoverishing expenditure. Comparability and utility were variable, and largely dependent on different definitions used. There were sufficient data to estimate that worldwide, in 2015, there were 2 038 947 (i.q.r. 1 884 916–2 281 776) surgeons, obstetricians and anaesthetists, and 266·1 (95 per cent c.i. 220·1 to 344·4) million operations performed. Conclusion Surgical and anaesthesia indicators are increasingly being adopted by the global health community, but data availability remains low. Comparability and utility for all indicators require further resolution.

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“…Since then, perioperative research has been conducted in SA to quantify the LCoGS indicators and identify health system gaps in workforce, [13,14] infrastructure [15][16][17] and quality. [18][19][20] While more than 96% of South Africans live within 2 hours of a government hospital, [21] quality surgical care is variable and lags behind global standards. [20] Governance, financing, service delivery, infrastructure, the workforce and data systems must be optimised to improve surgical outcomes at a national level.…”

Section: Editorialmentioning

confidence: 99%