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，以提高服务质量，弥合获取和利用差距，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卫生保健信息和学术兴趣的国家也有巨大的好处。它将向保健服务部门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之间的相互作用将有助于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。这项研究的成果将有助于公平分配熟练接生服务，使每个妇女都能得到服务，从而避免产妇死亡。MSc工作探索了医院之间的利用模式，但初级较低水平的卫生设施贡献了该地区分娩总数的三分之一以上。因此，对数据的进一步分析将揭示初级保健设施对总体利用模式的影响。MSc报告显示，大量客户从靠近Nsawam医院的大阿克拉地区外围涌入。将实施先进的贝叶斯统计模型来预测东部地区递送服务的利用情况。这种方法将为估计利用模式提供一个框架。目的本研究的目的是利用空间交互建模方法来了解递送服务的利用情况。这一目标将通过分析数据来实现，以实现以下目标：1。制定一个贝叶斯模型，估计利用交付服务的概率。2 .评估卫生机构提供产妇保健服务的质量。根据观察到的流量，划定切合实际的送餐服务集水区。量化绕过熟练接生设施的情况，并确定促进这种情况的个别因素。数据来源为满足既定目标，将参考以下数据来源：1。在Quansah医生的支持下，将向加纳卫生服务部门索取常规分娩记录。将对保健设施进行调查，以制定保健质量指数。怀孕计数的网格表面将与WorldPop.4合作建模。将对与分娩服务有互动的妇女进行访谈，以确定获得护理的个人限制，并根据交通工具的类型校准驾驶时间。

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.