A geospatial approach to assess health coverage and scaling-up of healthcare facilities

Oinam Bakimchandra, Joymati Oinam & RK Kajal
ACCESS is defined as ‘the ability to secure a specified set of healthcare services, at a specified level of quality, subject to a specified maximum level of personal inconvenience and cost, while in possession of a specified amount of information.
The main principle of nearest for equity is equal access for those in equal need for healthcare.
The UN Sustainable Development Goals (SDGs) seek universal health coverage and accessibility to quality healthcare services by 2030, for creating a healthier and equitable world. According to India’s vision for health and its perspectives from the XII five-year plan (2012–17), it has been documented that the focus remains on public provisioning of quality healthcare at affordable cost and bridging disparities in accessibility to healthcare services across regions and communities.
However, it is observed that the distribution of public and private healthcare facilities in many developing countries is always a challenge due to variations in health facility coverage and population density, which are found to occur at different geographic levels. Understanding the spatial relationship between locations of existing healthcare centres and physical accessibility to them are considered to be important factors for decision-making by the policy makers.
For the establishment of any new healthcare centre, the major task is to identify the most appropriate location so that local populations can access it without any difficulty. Various factors like existing healthcare facilities, land use land cover (LULC), road network, human population of the region, topography, physical barriers like rivers, lakes, etc. should be taken into account. This will help decision makers to determine the distribution of the existing network of healthcare facilities of a region and how much of the population of the region is covered.
Geospatial technology (GIS, remote sensing and GPS) has a potential role in monitoring and mapping the distribution of healthcare services and understanding the prevalence of diseases in a region. Various past studies have highlighted developments in the areas of health GIS, i.e. particularly where it is effectively used for mapping and monitoring the geographic accessibility of healthcare centres by population groups to address the disparities and inequalities; study the prevalence of disease burden and map the spread of any epidemic in a particular region both in spatial and temporal domains. Various techniques like hotspot analysis, floating catchment area method, nearest neighbour method, buffer zone analysis, location-allocation analysis, Moran’s I method, ordinary least square (OLS) and geographically weighted regression (GWR) method are found to be effective to address various public health-related issues, both in the spatial and temporal context in past studies.
A literature survey showed that there was lack of detailed studies regarding the spatial characteristics of health facilities in Manipur, North East India, particularly the geographic patterns and accessibility. Considering the topography of the region, it often takes an average of about 2–3 h for a patient to reach any healthcare location, specially tertiary/district hospitals in remote and hilly regions. Hence it is important to study the spatial distribution of existing healthcare facilities and the need for identification of locations where new healthcare facilities may be established to increase population coverage of the region. In this study, AccessMod (ver. 5) developed by the World Health Organization (WHO) was used to evaluate the physical accessibility analysis of the existing network of healthcare facilities and the need for scaling them up based on geographic coverage analysis in Manipur.
Methods
Study area
Manipur lies between 23*50’–25*41’N lat. and 92*58’– 94*45’E long. with an area of 22,327 sq. km (Figure 1). Majority of the population is found to be concentrated in the valley region which is about 10% of the total geographical area, while the remaining population is found in the hilly region which is almost 90% of the geographical area of the state.
Geographically, this region comes under complex terrain, and is characterized by poor infrastructure, economic underdevelopment and disturbed area status. According to the Census of India, 2011, Manipur has a population of 2,855,794, of which 57.2% lives in the Imphal valley (10% of total area) and 42.8% resides in the hilly region (90% of the total area). There are nine districts in Manipur, of which four are located in the valley region and five districts make up the hilly region.
On 8 December 2016, seven new districts were created by bifurcating the existing districts (five hill districts and two valley districts). This study considers the administrative boundaries that correspond to nine districts. Figure 2 shows the urban–rural population distribution for each district.
The State Programme Implementation Plan (SPIP) 2010–11, State Health Society, Manipur under National Rural Health Mission (NRHM), India mentions that ‘the existing physical infrastructure of health institutions in the state, which should be further augmented by NRHM, were actually in abysmal position to begin with. To that extent, the onus on NRHM was huge, as the task of having standard physical infrastructure of health institutions was to begin from the scratch effectively. For creation of physical infrastructure of health institutions, preference is given to inaccessible and most difficult areas. This may ensure better attendance of healthcare personnel, which, in turn, is expected to enhance delivery of health services to the underserved and the neediest.
In light of the above discussion, Manipur was selected as the study area in which there is large inequality in the existing healthcare infrastructure.
(To be contd)