Geospatial evaluation of trade-offs between equity in physical access to healthcare and health systems efficiency.
Geospatial evaluation of trade-offs between equity in physical access to healthcare and health systems efficiency.
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DOI：
10.1136/bmjgh-2020-003493
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发表时间：
2020-10
影响因子：
8.1
通讯作者：
Rebbeck TR
中科院分区：
文献类型：
--
作者：
Iyer HS;Flanigan J;Wolf NG;Schroeder LF;Horton S;Castro MC;Rebbeck TR
有关医疗服务地理位置的决策需要考虑公平与效率之间的权衡，但可用的实证评估很少。我们应用了一种新颖的地理空间框架来研究四个非洲国家的这些权衡。肯尼亚、马拉维、坦桑尼亚和卢旺达的人口密度（效率的替代指标）、卫生中心和癌症转诊中心的地理定位数据是从在线数据库获得的。使用 Access Mod 5 最小成本距离算法以 1 公里分辨率估计到最近设施（公平的替代）的行程时间。我们使用 Pearson 相关性研究了每个国家地区级平均人口密度与前往最近设施的旅行时间之间的关联，并使用 Global Moran’s I 统计数据研究了空间自相关。使用空间自相关的双变量局部指标来识别资源分配效率低下的地区的地理集群。对于所有国家和卫生系统水平而言，人口密度与出行时间呈负相关（皮尔逊相关范围，卫生中心：-0.89 至 -0.71；癌症转诊中心：-0.92 至 -0.43），有利于效率。对于卫生中心而言，卢旺达（-0.310）和坦桑尼亚（-0.292）的负空间自相关（人口密度和旅行时间不同值的地理聚类）较弱，这两个国家有明确的政策支持公平获得农村医疗保健，相对于肯尼亚（-0.579）和马拉维（-0.543）。癌症转诊中心的空间自相关性更强（卢旺达：-0.341；坦桑尼亚：-0.259；肯尼亚：-0.595；马拉维：-0.666）。各国都发现了人口稀少地区的重要地理集群，这些地区前往护理所需的时间较长。负空间相关性表明，卫生服务的地理分布有利于效率而非公平，但空间自相关测量显示某些国家的设施地理分布更为公平。这些发现表明，即使在优先考虑效率的情况下，有关地理分配的深思熟虑的决策也可以增加公平地获得服务的实际机会。
Decisions regarding the geographical placement of healthcare services require consideration of trade-offs between equity and efficiency, but few empirical assessments are available. We applied a novel geospatial framework to study these trade-offs in four African countries. Geolocation data on population density (a surrogate for efficiency), health centres and cancer referral centres in Kenya, Malawi, Tanzania and Rwanda were obtained from online databases. Travel time to the closest facility (a surrogate for equity) was estimated with 1 km resolution using the Access Mod 5 least cost distance algorithm. We studied associations between district-level average population density and travel time to closest facility for each country using Pearson’s correlation, and spatial autocorrelation using the Global Moran’s I statistic. Geographical clusters of districts with inefficient resource allocation were identified using the bivariate local indicator of spatial autocorrelation. Population density was inversely associated with travel time for all countries and levels of the health system (Pearson’s correlation range, health centres: −0.89 to −0.71; cancer referral centres: −0.92 to −0.43), favouring efficiency. For health centres, negative spatial autocorrelation (geographical clustering of dissimilar values of population density and travel time) was weaker in Rwanda (−0.310) and Tanzania (−0.292), countries with explicit policies supporting equitable access to rural healthcare, relative to Kenya (−0.579) and Malawi (−0.543). Stronger spatial autocorrelation was observed for cancer referral centres (Rwanda: −0.341; Tanzania: −0.259; Kenya: −0.595; Malawi: −0.666). Significant geographical clusters of sparsely populated districts with long travel times to care were identified across countries. Negative spatial correlations suggested that the geographical distribution of health services favoured efficiency over equity, but spatial autocorrelation measures revealed more equitable geographical distribution of facilities in certain countries. These findings suggest that even when prioritising efficiency, thoughtful decisions regarding geographical allocation could increase equitable physical access to services.
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影响因子：
3.6
作者：
ANSELIN, L
通讯作者：
ANSELIN, L
影响因子：
2.8
作者：
Abiiro GA;Mbera GB;De Allegri M
通讯作者：
De Allegri M
DOI：
10.2471/blt.11.097253
发表时间：
2012-08-01
期刊：
Bulletin of the World Health Organization: International Journal of Public Health
影响因子：
--
作者：
Binagwaho, Agnes;Wagner, Claire M;Ngabo, Fidele
通讯作者：
Ngabo, Fidele
影响因子：
1.7
作者：
Lwasa, Shuaib
通讯作者：
Lwasa, Shuaib
影响因子：
12.7
作者：
Hartley, D
通讯作者：
Hartley, D