Creating spatially defined databases for equitable health service planning in low-income countries: the example of Kenya.
Creating spatially defined databases for equitable health service planning in low-income countries: the example of Kenya.
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DOI：
10.1016/j.actatropica.2004.05.003
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发表时间：
2004-08
期刊：
影响因子：
2.7
通讯作者：
Snow, RW
中科院分区：
文献类型：
--
作者：
Noor, AM;Gikandi, PW;Hay, SI;Muga, RO;Snow, RW
关键词：
公平是评估卫生系统绩效的一项重要标准。制定一个公平且有效的卫生资源分配框架，取决于对服务提供者及其相对于应服务人群的位置的了解。肯尼亚最新的卫生服务提供者地图是1959年绘制的。我们从各种传统的政府渠道以及一些偶然获得的非政府渠道建立了一个卫生服务提供者数据库，并利用全球定位系统、手绘地图、地形图和其他来源对这些设施进行了空间定位。在确定的6674个服务提供者中，3355个（50%）是私营部门、雇主提供的或专科设施，2001年期间只有39%在肯尼亚卫生部数据库中注册。在卫生部、教会、非营利组织和地方当局支持的3319个公共服务设施中，84%在卫生部数据库中注册，我们能够获取其中92%的坐标。公共卫生服务与人口的比例从1959年的1∶26000变为1999 - 2002年的1∶9300。
82%的人口居住在距离公共卫生设施5公里范围内，这些人口分布在该国20%的区域。我们重新创建一个全面的、有空间定义的卫生服务提供者列表的努力，发现了现有国家卫生管理信息系统中的一些弱点，只要加大投入且付出极小的成本，这些弱点是可以纠正的。这将使地理信息系统能够更充分地利用基于设施的发病率数据、人口分布和卫生服务获取模型，以便有针对性地分配资源，并监测卫生部门改革在提供服务方面实现公平的能力。
Equity is an important criterion in evaluating health system performance. Developing a framework for equitable and effective resource allocation for health depends upon knowledge of service providers and their location in relation to the population they should serve. The last available map of health service providers in Kenya was developed in 1959. We have built a health service provider database from a variety of traditional government and opportunistic non-government sources and positioned spatially these facilities using global positioning systems, hand-drawn maps, topographical maps and other sources. Of 6674 identified service providers 3355 (50%) were private sector, employer-provided or specialist facilities and only 39% were registered in the Kenyan Ministry of Health database during 2001. Of 3319 public service facilities supported by the Ministry of Health, missions, not-for-profit organizations and local authorities, 84% were registered on a Ministry of Health database and we were able to acquire co-ordinates for 92% of these. The ratio of public health services to population changed from 1:26,000 in 1959 to 1:9,300 in 1999-2002. There were 82% of the population within 5km of a public health facility and resident in 20% of the country. Our efforts to recreate a comprehensive, spatially defined list of health service providers has identified a number of weaknesses in existing national health management information systems which with an increased commitment and minimal costs can be redressed. This will enable geographic information systems to exploit more fully facility-based morbidity data, population distribution and health access models to target resources and monitor the ability of health sector reforms to achieve equity in service provision.
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