Travel scenario workshops for geographical accessibility modeling of health services: A transdisciplinary evaluation study

Abstract

IntroductionLimited geographical access to quality Emergency Obstetric and Newborn Care (EmONC) is a major driver of high maternal mortality. Geographic access to EmONC facilities is identified by the global community as a critical issue for reducing maternal mortality and is proposed as a global indicator by the Ending Preventable Maternal Mortality (EPMM) initiative. Geographic accessibility models can provide insight into the population that lacks adequate access and on the optimal distribution of facilities and resources. Travel scenarios (i.e., modes and speed of transport) used to compute geographical access to healthcare are a key input to these models and should approximate reality as much as possible. This study explores strategies to optimize and harmonize knowledge elicitation practices for developing travel scenarios.MethodsKnowledge elicitation practices for travel scenario workshops (TSW) were studied in 14 African and South-Asian countries where the United Nations Population Fund supported ministries of health and governments in strengthening networks of EmONC facilities. This was done through a mixed methods evaluation study following a transdisciplinary approach, applying the four phases of the Interactive Learning and Action methodology: exploration, in-depth, integration, and prioritization and action planning. Data was collected in November 2020–June 2021 and involved scoping activities, stakeholder identification, semi-structured interviews (N = 9), an evaluation survey (N = 31), and two co-creating focus group discussions (N = 8).ResultsEstimating realistic travel speeds and limited time for the workshop were considered as the largest barriers. The identified opportunities were inclusively prioritized, whereby preparation; a favorable composition of attendees; validation practices; and evaluation were anticipated to be the most promising improvement strategies, explaining their central place on the co-developed initial standard operating procedure (SOP) for future TSWs. Mostly extensive preparation—both on the side of the organization and the attendees—was anticipated to address nearly all of the identified TSW challenges.ConclusionThis study showed that the different identified stakeholders had contradicting, complementing and overlapping ideas about strategies to optimize and harmonize TSWs. Yet, an initial SOP was inclusively developed, emphasizing practices for before, during and after each TSW. This SOP is not only relevant in the context of the UNFPA EmONC development approach, but also for monitoring the newly launched EPMM indicator and even in the broader field of geographic accessibility modeling.

Optimization of the emergency obstetric and neonatal care network in Benin through expert-based sub-national prioritizations

“…Walking speeds (towards the maternities) are corrected by the slope according to Tobler equation ( 29 ), which is not the case for the speeds of motorized vehicles. The means of travel and associated on- and off-road speeds were determined by consensus between national experts and departmental experts ( Supplementary Material S1 ) following a standardized methodology ( 30 ). This process was carried out independently for each department to take into account departmental specificities.…”

A geospatial database of close-to-reality travel times to obstetric emergency care in 15 Nigerian conurbations

“…Health-seeking data define parameters such as choices of pregnant women on whether to seek care, choices they make as to which facilities they trust to provide good-quality care, financial affordability, the means of transport and corresponding travel speeds for different road network classes and landcover categories 12 , 17 . However, there is a lack of such observational data on health-seeking behaviour to parametrise the models for the majority of the LMICs 18 .…”

“…As a result, many models rely on average or plausibility-based speeds and modes of transport that are simplistic and underestimate travel times 20 – 23 . Thus, in a bid to improve access to EmOC services, policymakers often rely on inaccurate information or fail to rely on it because of the approximations 10 , 17 , 18 .…”