Measuring access to primary health care: use of a GIS-based accessibility analysis (conference paper)

Abstract

Spatial analytical tools and analyses are key enabling instruments which can be used to efficiently plan for public-spaces such as health care facilities in a metropolitan context. Improving the levels of access to public-spaces through various planning approaches is necessary especially in light of the magnitude of development in metropolitan areas. However, planning for the provision of services in the health care sector is somewhat more complicated than planning for any other type of service. In the perfect world, health service delivery systems would be able to cater for all the health care needs of the entire population. However, realistically speaking, this has currently proven unattainable as the health care needs of people differ along many dimensions. Health care service planning requires consideration of a range of issues when looking at serving the health care needs of a spatially dispersed population. From the perspective of the provider, the challenge is therefore to optimally provide services in such a way that the health care needs of the greatest number of people are served. Recent increases in the availability of Geographical Information Systems (GIS) and associated modelling approaches have provided a good basis for the planning for the need of public services. Successful applications of these approaches have been useful in indicating average accessibility of an existing or potential service. However, it is increasingly realised that there has been a growing need for a paradigm shift in planning approaches. The spatial planning of primary health care services based on GIS accessibility analysis has only been used to a very limited extent in South Africa. In this study, facility utilisation rates in the form of headcounts are incorporated in a GIS-based accessibility analysis to assist in the spatial planning of health care services. Due to the absence of accurate patient databases and / or registers, GIS tools are used to determine three different scenarios of defining public primary health care demand. The three scenarios are tested in a GIS-based form of catchment area modelling. The results show no significant difference in the spatial extent of the catchment areas of facilities but a significant increase in the allocated demand from scenario 1 through to scenario 3. When compared to the facility headcounts, the total allocated demand in scenario 3 tends to be more strongly in line with the total number of facility headcounts recorded in the city showing a moderate positive correlation. This type of analysis promotes and facilitates the development of future facility plans in relation to actual demand and usage, and also improving current service provision access at overburdened focal points where previously not realised.