Use of a geographic information system to assess accessibility to health facilities providing emergency obstetric and newborn care in Bangladesh

Chowdhury, Mahbub Elahi; Biswas, Taposh Kumar; Rahman, Monjur; Pasha, Kamal; Hossain, Mollah A

doi:10.1002/ijgo.12196

Cited by 9 publications

(17 citation statements)

References 13 publications

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“…A strategy is needed to foster PPP to fill the gaps in the availability of EmONC services nationwide. A mapping of service availability with the help of geographic information system (GIS) application [ 14 ] may help identify the gaps and, accordingly, services should be ensured in both public and private sectors, complementing each other’s gaps in areas where needed.…”

Section: Discussionmentioning

confidence: 99%

Emergency obstetric and newborn care signal functions in public and private facilities in Bangladesh

2017

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BackgroundSignal functions for emergency obstetric and newborn care (EmONC) are the major interventions for averting maternal and neonatal mortalities. Readiness of the facilities is essential to provide all the basic and comprehensive signal functions for EmONC to ensure emergency services from the designated facilities. The study assessed population coverage and availability of EmONC services in public and private facilities in Bangladesh.MethodsAn assessment was conducted in all the public and private facilities providing obstetric care in to in-patients 24 districts. Data were collected on the performance of signal functions for EmONC from the study facilities in the last three months prior to the date of assessment. Trained data-collectors interviewed the facility managers and key service providers, along with review of records, using contextualized tools. Population coverage of signal functions was assessed by estimating the number of facilities providing the signal functions for EmONC compared to the United Nations requirements. Availability was assessed in terms of the proportion of facilities providing the services by type of facilities and by district.ResultsCaesarean section (CS) delivery and blood transfusion (BT) services (the two major components of comprehensive EmONC) were respectively available in 6.4 (0.9 public and 5.5 private) and 5.6 (1.3 public and 4.3 private) facilities per 500,000 population. The signal functions for basic EmONC, except two (parental anticonvulsants and assisted vaginal delivery), were available in a minimum of 5 facilities (public and private sectors combined) per 500,000 population. A major inter-district variation in the availability of signal functions was observed in each public- and private-sector facility. Among the various types of facilities, only the public medical college hospitals had all the signal functions. The situation was poor in other public facilities at the district and sub-district levels as well as in private facilities.ConclusionsIn the public sector, CS delivery and BT services were available in the minimum required number of facilities. However, to ensure basic EmONC services, participation of the private sector is necessary. Public-private partnership should be promoted for nationwide coverage of signal functions for EmONC in Bangladesh.

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Section: Discussionmentioning

confidence: 99%

Emergency obstetric and newborn care signal functions in public and private facilities in Bangladesh

2017

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“…Using actual journey time is needed in lieu of straight distance, because the latter fails to reflect real-life travel experience. For example, while 7 of 10 regions of Ghana and 16 of 24 districts in Bangladesh exceeded the recommended target of one CEmONC facility per 500 000 population, most women were unable to access these facilities within safe journey times 4 6…”

Section: Introductionmentioning

confidence: 99%

Proposing standardised geographical indicators of physical access to emergency obstetric and newborn care in low-income and middle-income countries

Ebener

Stenberg²,

Brun

et al. 2019

BMJ Glob Health

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Emergency obstetric and newborn care (EmONC) can be life-saving in managing well-known complications during childbirth. However, suboptimal availability, accessibility, quality and utilisation of EmONC services hampered meeting Millennium Development Goal target 5A. Evaluation and modelling tools of health system performance and future potential can help countries to optimise their strategies towards reaching Sustainable Development Goal (SDG) 3: ensure healthy lives and promote well-being for all at all ages. The standard set of indicators for monitoring EmONC has been found useful for assessing quality and utilisation but does not account for travel time required to physically access health services. The increased use of geographical information systems, availability of free geographical modelling tools such as AccessMod and the quality of geographical data provide opportunities to complement the existing EmONC indicators by adding geographically explicit measurements. This paper proposes three additional EmONC indicators to the standard set for monitoring EmONC; two consider physical accessibility and a third addresses referral time from basic to comprehensive EmONC services. We provide examples to illustrate how the AccessMod tool can be used to measure these indicators, analyse service utilisation and propose options for the scaling-up of EmONC services. The additional indicators and analysis methods can supplement traditional EmONC assessments by informing approaches to improve timely access to achieve Universal Health Coverage and reach SDG 3.

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“…To date, the majority of accessibility studies in LMICs have focused on rural areas [1, 29, 46–48]. Only a few have considered the urban scenario [49–52], which is partly a function of the dearth of reliable information on health service locations and their characteristics in urban settings, and the assumption that geographical accessibility is not a major problem in urban areas.…”

Section: Introductionmentioning

confidence: 99%

“…Only a few have considered the urban scenario [49–52], which is partly a function of the dearth of reliable information on health service locations and their characteristics in urban settings, and the assumption that geographical accessibility is not a major problem in urban areas. Moreover, GIS-based studies in Bangladesh have mostly assessed access to emergency services for obstetric care [48, 52] or primary healthcare in rural areas [49]. Accessibility to other emergency health services such as Burn Units and Intensive Care Units (ICU) in urban settings, have not been considered.…”

Section: Introductionmentioning

confidence: 99%

Impact of traffic variability on geographic accessibility to 24/7 emergency healthcare for the urban poor: A GIS study in Dhaka, Bangladesh

et al. 2019

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Ensuring access to healthcare in emergency health situations is a persistent concern for health system planners. Emergency services, including critical care units for severe burns and coronary events, are amongst those for which travel time is the most crucial, potentially making a difference between life and death. Although it is generally assumed that access to healthcare is not an issue in densely populated urban areas due to short distances, we prove otherwise by applying improved methods of assessing accessibility to emergency services by the urban poor that take traffic variability into account. Combining unique data on emergency health service locations, traffic flow variability and informal settlements boundaries, we generated time-cost based service areas to assess the extent to which emergency health services are reachable by urban slum dwellers when realistic traffic conditions and their variability in time are considered. Variability in traffic congestion is found to have significant impact on the measurement of timely access to, and availability of, healthcare services for slum populations. While under moderate traffic conditions all slums in Dhaka City are within 60-minutes travel time from an emergency service, in congested traffic conditions only 63% of the city’s slum population is within 60-minutes reach of most emergency services, and only 32% are within 60-minutes reach of a Burn Unit. Moreover, under congested traffic conditions only 12% of slums in Dhaka City Corporation comply with Bangladesh’s policy guidelines that call for access to 1 health service per 50,000 population for most emergency service types, and not a single slum achieved this target for Burn Units. Emergency Obstetric Care (EmOC) and First Aid & Casualty services provide the best coverage, with nearly 100% of the slum population having timely access within 60-minutes in any traffic condition. Ignoring variability in traffic conditions results in a 3-fold overestimation of geographic coverage and masks intra-urban inequities in accessibility to emergency care, by overestimating geographic accessibility in peripheral areas and underestimating the same for central city areas. The evidence provided can help policy makers and urban planners improve health service delivery for the urban poor. We recommend that taking traffic conditions be taken into account in future GIS-based analysis and planning for healthcare service accessibility in urban areas.

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Use of a geographic information system to assess accessibility to health facilities providing emergency obstetric and newborn care in Bangladesh

Abstract: Assessing only the number of EmONC facilities does not ensure universal coverage; accessibility should be assessed when planning health systems.

Cited by 9 publications

References 13 publications

Emergency obstetric and newborn care signal functions in public and private facilities in Bangladesh

Emergency obstetric and newborn care signal functions in public and private facilities in Bangladesh

Proposing standardised geographical indicators of physical access to emergency obstetric and newborn care in low-income and middle-income countries

Impact of traffic variability on geographic accessibility to 24/7 emergency healthcare for the urban poor: A GIS study in Dhaka, Bangladesh

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