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Skip to 0 minutes and 9 seconds Hello there. Welcome to this session on health facility planning, accessibility, and GIS. In this topic, we will feature four different elements. We’ll start with a short discussion on distributing scarce health resources, which is central to health service delivery. Given that this course is about GIS, we will concentrate on the distribution of health resources in geographic space. To do so, we make use of the accessibility concept. This is a concept used in many different disciplines, and, basically, it is very suitable to analyze if a given distribution of resources is a good one or not.

Skip to 0 minutes and 51 seconds After the introduction of the accessibility concepts, we will go into a more practical way of thinking by looking at some commonly used GIS measures of accessibility that are used in the geohealth domain. We conclude with a short video that illustrates how GIS can support spatial planning of health facilities in Africa. Let’s start with the first topic. In the slide that here, we see the continent of Africa. The left part of the slide, we see that sub-Saharan Africa suffers a lot from the incidence of malaria, a huge burden to the population in these countries, with millions of people being infected every year. If we look at the right side of the slide, we see the same map of Africa.

Skip to 1 minute and 39 seconds But now it shows the expenditure on health care per country. What is very obvious is that many of the countries have very, very low amounts of money available for health care to satisfy the health needs of their populations. So health services needs a lot of resources. If we go a bit further, we see that health services need to be distributed amongst the population. And if we take a geographic perspective, it is very clear that we need to have a situation where we bring the health services as close to the patients as possible and, at the same time, ensure that each health facility serves sufficient people.

Skip to 2 minutes and 23 seconds It is all about securing a geographical match between the need for resources and their allocation. This is important because, in the end, we use our GIS tools for planning purposes. So we need to be able to analyze an existing situation. We need to be able to prioritize planning interventions and, very importantly, we need to be able to evaluate this to make an assessment of the impacts that we expect. This is important because such information is vital to policymakers so that they can make informed decisions.

Skip to 2 minutes and 58 seconds The real added value, in the end, of using our GIS for health facility planning, though, comes back to the population because a better health service leads to improvement of the well being of the population that we try to address. What do we mean, actually, by distributing health resources? Well, we see a number of bullets in the slides. The first is, actually, we need to determine, how much money do we make available for health services? The second is, we need to determine what type of health services are we going to provide to the population? Which services best satisfy the needs of society?

Skip to 3 minutes and 39 seconds A third important decision that we need to make is we have to decide how these resources are best distributed among the members of society. Now, of course, all of us know that these are questions with an important economic and political nature. But again, we’re in a GIS course, and we have to realize that distributing health resources have a strong geographic dimension.

Skip to 4 minutes and 5 seconds Luckily, we have a number of guiding principles that can help us when we try to distribute resources. The guiding principles are well known to everybody working in the public health field. The first is equity. This is where we want to distribute resources in a way that we consider socially just. The second is effectiveness. We want to provide those health services that offer the best health gain to the population. The third is efficiency. We want to get the best results from the limited amount of resources that we get. Now these guiding principles, as I said, are well known. But the difficulty is they do not always go hand in hand. A very equitable distribution of resources might not be efficient.

Skip to 4 minutes and 54 seconds A very efficient distribution of health resources might not be equitable. So the difficulty is that we have to find the balance. We have to make trade off between achieving equity and efficiency results. And making these decisions, doing these trade offs, are complex.

Skip to 5 minutes and 18 seconds Back now to the geographic dimension of health services. In this slide, we see a person in the center. Let’s assume this person gets ill. At that moment, the person will have to go and attend a dispensary to get treated. To do so, this patient has to move from one location in geographic space to the other. The patient has to move from the location of his or her house and travel to the dispensary. And traveling from home to the dispensary normally means that somebody has to make use of the transportation network. We also see an ambulance there. This is the reverse situation. Imagine that somebody has an acute health problem, then the ambulance has to travel to the patient.

Skip to 6 minutes and 6 seconds And of course the shorter the travel time of the ambulance to the patient, the better the quality of the service provided. So our aim in this geographic perspective of health resources is to bring the health resources as close to the population as possible. The guiding principles that we’ve just discussed can be given a spatial perspective as well. We can speak about spatial equity. We can speak about spatial effectiveness. And we can speak about spatial efficiency. And the nice thing is that we can use our GIS tools to generate indicators of spatial equity, indicators or spatial efficiency, and in the line of the sessions that are ahead of us, we will clarify how this is done.

Skip to 6 minutes and 57 seconds The difficulty of the trade offs between equity and efficiency remain.

Skip to 7 minutes and 4 seconds Let me try to give you an example using this slide. On the left hand side, we see a map of a city. We see pink dots which represent the locations of the health care facilities. And we see colors ranging from green to red. Green colors mean that the people living in those areas have to travel only very short distances to reach a health facility. But the people living in the red areas, they have to walk for more than one hour to reach the nearest health facility. So we see there are large differences in travel time between people. The question that we have to see is, are these travel time differences acceptable, or are they too big?

Skip to 7 minutes and 48 seconds If they are too big, we have to intervene and bring new health services closer to the people. So spatial equality is an issue that we need to address when providing health services to our population. You now also see a bar chart. This shows us, for every health facility in the study area on the left, how many patients live within a reasonable walking time of that particular clinic? From left to right, we see that some health facilities can only reach very few patients. Whereas, on the right hand side, we see health facilities that reach very, very large numbers of patients.

Skip to 8 minutes and 30 seconds If a health facilities located somewhere where it can reach only a very few patients, we could say, this is not an efficient use of health resources. You have build the health facilities. You have to staff it with medical staff. If you can only reach a few people, you are actually not using your resources in an efficient manner.

Skip to 8 minutes and 54 seconds I think we have now covered the introductory part of this session. We have actually discussed that health care delivery is very much associated with distribution of health resources. We have seen that this resource distribution has a strong geographical dimension. And we know that we can make use of guiding principles, such as spatial equity, spatial effectiveness, and spatial efficiency, in our further analysis. The big question, of course, that remains is how we can incorporate the spatial dimension in health services planning. And we have a number of videos ahead of us in which we’ll explain this. In the forthcoming video, we will explain in more detail what the concept of accessibility is all about. Thank you very much.

Health services delivery - distributing scarce resources

Health is a universal human right and a major focus of social and political concern worldwide. Health also is a somewhat elusive concept that can be defined in various ways. We might think of health as being physically and mentally ‘fit’ and capable of functioning effectively for the good of the wider society.

Seen from this perspective, health is viewed upon as a prerequisite for social advancement and economic progress: the healthier people are, the more likely they are able to contribute to social and economic development. Economic growth, in turn, can enable responsible authorities to provide better health care and thus improve the health status of a population. This does not mean that economic growth automatically results in improved health status or that a high Gross National Product is required before health can be improved. Much will depend on the level of available health resources and on the distribution mechanism that is in place.

When making decisions about the provision of public health services the following guiding principles generally apply. The first is to provide services in an equitable way. Notions of fairness and social justice are invariably stated as being at the core of public health care interventions. Normally, this viewpoint entails that priority should be given to the more vulnerable population groups. The second objective is to provide services that are effective. Treatments should offer real benefit, resources should not be wasted on providing services that offer little health gain. The third objective is to provide services in an efficient manner. By this we mean to provide services that maximize health benefit to society while minimizing the cost of provision. As a general rule there will be tension between the efficiency and equity objectives: providers wish to manage resources efficiently whereas the wish of users will be to have resources provided equitably. Health care provision is thus inevitably tied up with issues of resource allocation, distribution and priority-setting. Decisions have to be made about the nature and range of services to provide and how they are distributed amongst the members of society. Obviously, these are questions of an economic and political nature.

At the same time these are questions of a geographical nature as some degree of geographical separation between health providers and health seekers is inevitable. Health services are provided at discrete locations to a population which is geographically dispersed. Clients that only need to travel short distances incur less disutility and, thus are in a better position than those that have to come from far. The real question that needs to be addressed, therefore, is whether a given degree of geographical separation is acceptable or represents inequality. What is acceptable or unequal is not cast in stone but generally depends on some socially acceptable norm which is mostly expressed in terms of a minimum standard of service delivery (e.g. no person should live more than 30 minutes away from a healthcare provider). In the following reference we present a well-known geographic concept that can be used to assess spatial inequality. This is an optional reading.

Reference: Amer, S., Ottens, H.F.L. (promoter) and de Jong, T. (co-promoter) (2007). Towards spatial justice in urban health services planning : a spatial - analytic GIS - based approach using Dar es Salaam, Tanzania as a case study. Utrecht, Utrecht University, 2007. ITC Dissertation 140, ISBN: 90-6164-253-1. Download this dissertation

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