The geography of vulnerability and health service access in southern Africa

Access to health services is a fundamental right for all, yet poor and vulnerable people may face a number of barriers in low-income contexts. Access to health services is determined by a number of factors, with the interaction of individual level factors and geographical factors being of particularly high importance. The study seeks to expand existing knowledge about access to health services among vulnerable groups in Malawi and Namibia in southern Africa. We have combined existing data about individuals' perception of access to health services with GPS coordinates and data about geographical distance to services. This is the basis for a screening process where we have categorized households according to their perceived and actual access to health services. Results that are in the process of being published demonstrate the applicability of combining geographical data with self-reported survey data and that this combination can be helpful in the choice of where to carry out field studies for qualitative studies. Further, the results show that the combination of data can improve our understanding of the complexity of access and that this can have positive impact on developing an equitable health service. Another important results is that even though there are sizeable challenges connected to remoteness, lack of transport and poverty, the quality of services has a substantial impact on the perception of access.

GeoHealthAccess bidrar til økt oppmerksomhet om helsetjenesters tilgjengelighet gjennom publiserte arbeider og deltagelse i møter med myndigheter og andre. Publisering og presentasjon av resultater vil fortsette også etter at finansieringen er avsluttet og resultater fra prosjektet skal blant annet presenteres på AfriNEAD konferansen i Cape Town i november 2020. Kunnskapen som er fremskaffet og publisert, og ytterligere publikasjoner i 2020 +, har potensiell betydning for utvikling av policy og tiltak for å bedre tilgangen til helsetjenester for befolkningen i LMICs generelt og spesielt for utsatte grupper. Kombinasjonen av geografiske data og selvrapportert tilgjengelighet bringer en ny dimensjon inn i eksisterende kunnskap om barrierer for tilbang til tjenester som kan bidra til å gjøre policy mer presis og tiltak mer effektive. Publikasjonene fra GeoHealthAccess vil bidra til forskingsfronten om utvikling av tjenester i LMICs og påvirke fremtidig forskning på dette området.

The proposed project is a follow-up of an international research project on equitable access to health services in southern Africa. To improve access to health care for those who need it the most, more knowledge is needed on barriers to access in resource poor contexts. Access to health services is determined by an interaction of individual vulnerability and geographical accessibility. To understand this interaction, information on physical surroundings, such as topography and availability of facilities, must be combined with people's own evaluation of access, as well as health status and socioeconomic background. The results from our analysis will be used to ensure that policies are targeted at the most central barriers in specific areas, for specific groups. If the most vulnerable parts of the population have access to health service, less marginalized groups should also have decent access. The main research question is: How do individual level vulnerability and geographical characteristics affect access to health services in resource poor settings? Secondary questions are: 1) What is the relationship between perceived access to health care and measured accessibility? 2) How can divergence between measured accessibility and perceived access be explained? To answer these questions, we use survey data from Malawi and Namibia, combined with data on geographical access. Focus group discussions with users and providers will be used to identify potential causes of divergence. While the importance of geographical access is often recognized in the literature, it is rarely taken explicitly into account. A geographical information systems approach (GIS) to health care evaluation and planning has proved useful in high-income countries, but so far, few studies exist from resource-poor settings with poor provision of health care, and few GIS studies on access combine geographical access with information on how the access is actually perceived by users/potential users.