Spatial patterns of delivery service utilisation: using a spatial interaction model approach to reach every woman in Eastern Region, Ghana.

到2030年将孕产妇死亡率降至每10万活产70人以下的干预措施需要信息来提高服务质量，弥合获得和利用差距，并充分规划孕产妇保健服务。这项研究不仅对加纳的卫生服务提供有巨大的好处，而且对其他具有类似医疗保健信息的国家也有巨大的好处。它将为保健服务提供可能改变以前对利用模式的看法的信息，从而加强减少产妇死亡的计划。例如，了解医疗保健质量和利用率之间的相互作用将能够有针对性地提高医疗质量，从而节省与大规模实施干预措施相关的成本。这项研究的结果将为每个妇女公平分配熟练的分娩服务提供信息，从而避免孕产妇死亡。在理学硕士工作中探讨了医院之间的利用模式，但初级较低水平的卫生设施占该地区总出生人数的三分之一以上。因此，对数据的进一步分析将揭示初级卫生设施对总体利用模式的影响。理学硕士的报告显示，从靠近Nsawam医院的大阿克拉地区周边地区涌入了大量客户。将采用先进的贝叶斯统计模型来预测东部地区的送货服务使用情况。这种方法将提供一个框架，估计utilization patterns.ObjectivesThe本研究的目标是使用空间交互建模方法来了解利用交付服务。这一目标将通过对数据的分析实现以下目标：1.制定一个贝叶斯模型，估计使用交付服务的概率。评估卫生机构提供孕产妇保健服务的质量.根据观测到的流量，为输送服务划定现实的集水区。为了量化绕过熟练的交付设施，并确定促进它的个别因素。方法数据源以下来源将被咨询的数据，以满足设定的目标：1。在Quansah博士的支持下，将联系加纳卫生服务部门进行例行分娩记录2。将对卫生设施进行调查，以建立护理质量指数3。将与WorldPop4合作，制作妊娠计数网格曲面模型。将对与分娩服务有过互动的妇女进行访谈，以确定个人在获得护理方面的局限性，并根据交通类型调整开车时间。

Interventions for reducing the maternal mortality ratio to less than 70 per 100 000 live births by 2030 require information to improve service quality, bridge access and utilisation gaps, and adequately plan maternal health services. This study would be of immense benefit to health service delivery not only in Ghana, but in other countries with similar healthcare information as well as being of academic interest. It would provide the health service with information that might change previous perceptions of utilisation patterns, thereby enhancing plans to reduce maternal deaths. For instance, understanding the interaction between healthcare quality and utilisation would enable targeted improvement in quality care, hence saving costs associated with wholesale implementation of interventions. The output of this study would inform a fair distribution of skilled delivery services to reach every woman, thereby averting maternal deaths.Utilisation patterns among hospitals have been explored in the MSc work but primary lower level health facilities contribute more than one third of total births in the region. Hence further analysis of data would reveal the effect of primary health facilities on the overall utilisation patterns. The MSc report revealed a high influx of clients from the periphery of Greater Accra region closer to Nsawam hospital. Advanced Bayesian statistical models would be implemented to predict utilisation of delivery services in the Eastern region. This approach would provide a framework for estimation of utilisation patterns.ObjectivesThe goal of this study is to use spatial interaction modelling approach to understand utilisation of delivery services. This goal would be achieved through analysis of data to achieve the following objectives:1. To formulate a Bayesian model that estimates the probability of utilisation of delivery services.2. To estimate the quality of maternal health care delivery in health facilities.3. To delineate realistic catchments for delivery services based on observed flows.4. To quantify the bypassing of skilled delivery facilities and determine individual factors that promote it.MethodsData sourcesThe following sources would be consulted for data to meet the set objectives:1. With the support of Dr. Quansah, Ghana health service would be contacted for routine delivery records2. Health facilities would be surveyed to create quality of care indices3. Gridded surfaces of pregnancy counts would be modelled in collaboration with WorldPop.4. Women who have interacted with delivery services would be interviewed to determine individual limitations to accessing care and calibrate drive times based on type of transportation.