Toward Equitable Access to Tertiary Cancer Care in Rwanda: A Geospatial Analysis

Abstract

PURPOSE Geographic access to care is an important measure of health equity. In this study, we describe geographic access to cancer care centers (CCCs) in Rwanda with the current facilities providing care and examine how access could change with expanded care infrastructure. METHODS Health facilities included are public hospitals administered by the Rwanda Ministry of Health. The WorldPop Project was used to estimate population distribution, and OpenStreetMap was used to determine travel routes. On the basis of geolocations of the facilities, AccessMod 5 was used to estimate the percentage of the population that live within 1 hour, 2 hours, and 4 hours of CCCs under the current (two facilities) and expanded care (seven facilities) scenarios. Variations in access by region, poverty, and level of urbanization were described. RESULTS Currently, 13%, 41%, and 85% of Rwandans can access CCCs within one, two, and 4 hours of travel, respectively. With expansion of CCCs to seven facilities, access increases to 37%, 84%, and 99%, respectively. There is a substantial variation in current geographic access by province, with 1-hour access in Kigali at 98%, whereas access in the Western Province is 0%; care expansion could increase 2-hour access in the Western Province from 1% to 71%. Variation in access is also seen across the level of urbanization, with current 1-hour access in urban versus rural areas of 45% and 8%, respectively. Expanded care results in improvement of 1-hour access to 67% and 33%, respectively. Similar trends were also noted across poverty levels. CONCLUSION Geographical access to CCCs varies substantially by province, level of urbanization, and poverty. These disparities can be alleviated by strategic care expansion to other tertiary care facilities across Rwanda.

Physical activity interventions on physical health, behavior and personality by social status of urban and rural children in the world: A systematic review

“…Some of the environmental factors that may influence these differences include access to healthcare, air pollution, lifestyle, and socioeconomics. Studies suggest that differences in access to healthcare and diet may affect health outcomes between urban and rural areas [22,23,[35][36][37]. In addition, studies highlight the impact of air pollution on public health in urban areas [23].…”

Effects of Physical Activity on Physical Health, Behavior and Personality by Social Status of Urban and Rural Children: A Systematic Review

“…Some of the environmental factors that may influence these differences include access to healthcare, air pollution, lifestyle, and socio-economics. Studies suggest that differences in access to healthcare and diet may affect health outcomes between urban and rural areas Smith et al, 2019;Fadelu et al, 2022;Samosir, Radjiman & Aninditya, 2023;Kalinda, 2023). In addition, studies highlight the impact of air pollution on public health in urban areas.…”

Financial Toxicity: Unveiling the Burden of Cancer Care on Patients in Rwanda

“…In a recent study by Fadelu et al showed that 13%, 41%, and 85% of Rwandans can access cancer centers within 1, 2, and 4 hours of travel, respectively. 15 The same study also shows that some provinces in Rwanda have no access to cancer centers, hence patients have to travel long distances to other get diagnosed and treated for cancer in other provinces.…”