Defining equity in physical access to clinical services using geographical information systems as part of malaria planning and monitoring in Kenya
Defining equity in physical access to clinical services using geographical information systems as part of malaria planning and monitoring in Kenya
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DOI：
10.1046/j.1365-3156.2003.01112.x
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发表时间：
2003-10-01
影响因子：
3.3
通讯作者：
Snow, RW
中科院分区：
文献类型：
--
作者：
Noor, AM;Zurovac, D;Snow, RW
距离是卫生服务利用的一个关键特征，然而其在卫生保健规划中的应用和效用尚未得到充分探究，特别是考虑到诸如“击退疟疾”等大规模的国际和国家行动。我们绘制了肯尼亚四个地区人口获取服务的高分辨率地图。基于作为肯尼亚卫生部门改革议程一部分所制定的国家目标的理论实际获取情况，与在81个抽样的政府卫生机构就诊的1668名儿科患者的实际卫生服务使用数据进行了比较。实际使用情况和理论使用情况高度相关。在夸莱和马库埃尼这两个较大地区的患者，由于获取政府卫生设施的机会相对较差，其平均行程距离比大基西和邦多地区的患者更远。四个地区中超过60%的患者在5公里范围内就医。跨地区的插值实际获取情况表面突出显示了获取困难的区域以及城市和农村环境之间的巨大差异。农村社区的使用者前往卫生设施的距离比城市社区的使用者更远。文中讨论了在国家和国际层面规划和监测临床服务公平提供的影响。
Distance is a crucial feature of health service use and yet its application and utility to health care planning have not been well explored, particularly in the light of large-scale international and national efforts such as Roll Back Malaria. We have developed a high-resolution map of population-to-service access in four districts of Kenya. Theoretical physical access, based upon national targets, developed as part of the Kenyan health sector reform agenda, was compared with actual health service usage data among 1668 paediatric patients attending 81 sampled government health facilities. Actual and theoretical use were highly correlated. Patients in the larger districts of Kwale and Makueni, where access to government health facilities was relatively poor, travelled greater mean distances than those in Greater Kisii and Bondo. More than 60% of the patients in the four districts attended health facilities within a 5-km range. Interpolated physical access surfaces across districts highlighted areas of poor access and large differences between urban and rural settings. Users from rural communities travelled greater distances to health facilities than those in urban communities. The implications of planning and monitoring equitable delivery of clinical services at national and international levels are discussed.