Impact of traffic variability on geographic accessibility to 24/7 emergency healthcare for the urban poor: A GIS study in Dhaka, Bangladesh
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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DOI：
10.1371/journal.pone.0222488
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发表时间：
2019-09-16
期刊：
影响因子：
3.7
通讯作者：
Panciera, Rocco
中科院分区：
文献类型：
--
作者：
Ahmed, Shakil;Adams, Alayne M.;Panciera, Rocco
确保在紧急卫生情况下获得医疗保健是卫生系统规划者持续关注的问题。紧急服务，包括严重烧伤和冠状动脉事件的重症监护室，是交通时间最关键的服务之一，可能会决定生与死。尽管人们普遍认为，由于距离短，在人口稠密的城市地区获得医疗保健不是问题，但我们通过应用改进的方法来评估城市贫民获得紧急服务的可及性并考虑到交通变化，证明了事实并非如此。结合紧急卫生服务地点、交通流量变化和非正式住区边界的独特数据，我们生成了基于时间成本的服务区，以评估在考虑实际交通状况及其时间变化的情况下，城市贫民窟居民可以获得紧急卫生服务的程度。研究发现，交通拥堵的变化对贫民窟人口及时获得医疗服务和可用性的衡量有重大影响。在交通状况一般的情况下，达卡市的所有贫民窟都可以在 60 分钟内到达紧急服务中心，而在交通拥堵的情况下，只有 63% 的城市贫民窟人口可以在 60 分钟内到达大多数紧急服务中心，只有 32% 的贫民窟人口可以在 60 分钟内到达烧伤中心。此外，在交通拥堵的情况下，达卡市公司中只有 12% 的贫民窟符合孟加拉国的政策准则，该准则要求每 50,000 人获得 1 次针对大多数紧急服务类型的医疗服务，并且没有一个贫民窟达到烧伤单位的这一目标。紧急产科护理 (EmOC) 和急救与伤亡服务提供了最佳的覆盖范围，近 100% 的贫民窟人口在任何交通状况下都可以在 60 分钟内及时获得服务。忽视交通条件的变化会导致地理覆盖范围被高估三倍，并通过高估周边地区的地理可达性并低估中心城区的地理可达性，掩盖了城市内获得紧急护理的不平等。提供的证据可以帮助政策制定者和城市规划者改善为城市贫民提供的医疗服务。我们建议在未来基于GIS的城市地区医疗服务可达性分析和规划中考虑交通状况。
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 citys 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.