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Skip to 0 minutes and 9 secondsWelcome again to this micro lecture. In the first session, we talked about distributing scarce health resources. In this one, we address the second topic, the accessibility concept. OK, so what do we mean with accessibility? Basically, we mean with it that people have to move from one location to the other, and it depends how easy or difficult this is. It is all about overcoming the friction of distance. Overcoming distances is not the same for all people. Imagine an elderly person having to walk for 10 kilometers. This would be quite a difficult issue. If you would be a young, strong adult, overcoming such a distance would be much easier.

Skip to 0 minutes and 57 secondsThe main thing about health systems is that if they are well organized, you try to bring the health services as close to its clients. You want to minimize the friction of distance. We're not interested in minimizing the friction of distance for every individual, but for the society as a whole, for the city as a whole, we want to ensure that the health facilities are not too far located from the people. Now, the accessibility concept is very important because we can generate indicators that tell us how good or bad the geographical match is between the locations of the health facilities on the one hand and the locations of the population that they serve on the other.

Skip to 1 minute and 41 secondsVery important also is that using accessibility analysis outcomes can help a lot to make informed policy and decision making. I've said that before, but in the end, this is what we are aiming for. Let's take a closer look at this diagram. We see here a not-very-simple diagram with, in the center, accessibility opportunities. But if we look at the diagram a bit closer, we see it is made up out of four components, a land use component, a transport component, an individual component, and a temporal component. Let's take a look at each of the components in some more detail. If we look at the land use component, with it, we mean actually the system of health facilities.

Skip to 2 minutes and 34 secondsWe are interested to know where are the health facilities located, and what are the services on offer? It's the supply element of health care. We're also interested to know the spatial distribution of the people. Where do the people live that need the health services? This represents the demand element. Second component that we need to consider is the transport component. As we can read, the transport component is everything about how people are able to get from their homes to the health facility. It is all about the role of the transportation system of moving from one place to the other. And of course, the transportation system is not standard. Some people will have access to a car. Others will not.

Skip to 3 minutes and 22 secondsSome people have access to public transport. Others may not. Some people may have to walk to reach a health facility. So the transport component itself also consists of many different options. In short, the transport component describes how difficult it is to overcome the friction of distance. The third component that we need to consider is the individual component. As I already said, people are not all the same. We do not all have the same needs or abilities. All elder people will have more trouble in traveling than young people have. Maybe income plays a role because you can or cannot afford to take public transport.

Skip to 4 minutes and 6 secondsAnd also of course, your own physical condition-- imagine that you have a high fever and have to walk for a long distance in able to reach a health facility. So the individual component also has an effect on overall accessibility. The final component that we need to consider is the temporal one. Here, we actually are interested more in the time element. Health facilities will not be open 24 hours per day, so if I have a problem at night, the number of health facilities that I can reach will be much more limited than during the daytime. Also, vice versa-- at the moment that I am at work, I do not have time to make use of health services.

Skip to 4 minutes and 51 secondsWe bring back the components together. We see that the land use, the transport, the individual, and the temporal components all interact. They are glued together, and only the combination of the four components together determine the level of accessibility to opportunities.

Skip to 5 minutes and 12 secondsA few words about the accessibility concept and the link to GIS-- we have already said it is all about the ability of people to overcome distances. We know already that we have a number of important components. We have people on the one hand. We have the opportunities on the other, the health facilities in our case. And we have the transport system that links together. And the nice thing is that GIS is very suited to analyze this type of issues because in a GIS, we can place a point of origin to represent where the people live.

Skip to 5 minutes and 52 secondsWe can put a location to describe the actual location of a health facility, and we can model the transport system to get an insight in how much or how little the friction of distance affects the difficulty of traveling.

Skip to 6 minutes and 13 secondsIn short, what did we discuss in these few slides? Well, first of all, accessibility has everything to do with the ease of overcoming distances. We have seen that it consists of different components. Land use, transport, temporal, and individual elements play a role. We know also by now that accessibility indicators are important information for policymakers. And the nice thing is that accessibility can very easily be operationalized in our GIS software, and this is actually the topic of the next short video, where we look into some more detail on common GIS-based accessibility measures that are used in the health domain.

Accessibility concept

Spatial planning of health care facilities concerns the identification of suitable locations for a given number of health facilities in a defined territory, in such a way that the health needs of a spatially dispersed population are served in an optimal way. Basic to this type of location planning is the concept of accessibility.

Stated in general terms, accessibility relates to the ability of people to overcome the friction of distance to avail themselves of (health) services at fixed locations in geographic space.

Accessibility is determined by the spatial distribution of potential destinations (health facilities in our case), the ease of reaching each destination, and the quality and character of the services provided at each destination. Travel cost is central: the less time and money spent in travel, the more places patients can reach within a certain budget. The more destinations, and the greater the variety of serves offered, the higher the level of accessibility. Accessibility can therefore be seen as a performance indicator that shows in how far an existing spatial constellation of health facilities is capable of serving the health needs of a spatially dispersed population.

Although accessibility is a familiar planning objective and a frequently used term in the literature, it is a slippery notion, which has been defined, and operationalized in a variety of ways. A useful yet simple framework is to look at accessibility as consisting of three broad sets of factors:

  • People: the characteristics of individuals utilising health services or, more commonly, the characteristics of the areas in which they reside.
  • Transport: the role of the transport system in getting individuals to the health facilities, including (can be private and public transport).
  • Opportunities: the spatial configuration and characteristics of the health delivery system.

The strength of this framework is that it makes explicit that accessibility varies according to the characteristics of people, of the health services, and of the transportation infrastructure that separates people from the health services. Accessibility is the outcome of the combined characteristics of the three factor sets together.

In the next article some further detail is provided on commonly used GIS-based measures of access to health care services.

Reference: Geurs, K.T. and van Wee (2004). Accessibility evaluation of land-use and transport strategies: review and research directions. Journal of Transport Geography 12 (2004) 127–140.

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Geohealth: Improving Public Health through Geographic Information

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