Measuring disparities in access to district and referral hospitals in the city of Kigali, Rwanda

Abstract

The study focused on the identification of theoretical and methodological constructs that can be used to analyse and improve the spatial performance of  public health service delivery systems and the development of a corresponding spatial-analysis and GIS-based planning approach using the city of Kigali  as a case study. Access to health care as a multi-tiered system was measured by using five dimensions of access, namely geographic accessibility,  availability, affordability, acceptability and accommodation. Geo-statistical analysis was performed to measure and evaluate access to the district and  referral health care. For geographic access, the travel time for every trip is approximated for the two main modes of transport (walking and public  transport). To realistically represent the friction of distance, the street network was categorised into several road classes for which different travel speeds  are estimated for each transport mode on the basis of local knowledge. A factor analysis model was used for availability, affordability, acceptability, and  accommodation dimensions. Different indicators were evaluated in various units and scales and standardized to see how satisfaction levels varied with  each dimension. Based on the type of indicator, for the cost or benefit, the score was zero (0) or one (1). One (1) was considered a positive impact, while  zero (0) was considered a negative impact. Summary scores were developed for all indicators by combining more than one indicator into a single value.  The created summary score also ranges from 0 to 1, and the higher the score, the better the access attainment. To find areas that need intervention, the  comparison of all five indicators and the scores of access for each indicator was made. The dimensions of geographic accessibility and availability  appeared to be the most problematic. The district health care dimensions have revealed a low performance level in geographic accessibility (0.64) and a  high-performance level in affordability (0.94). The referral health care dimensions have revealed a low performance level of geographic accessibility (0.17)  and a high-performance level of acceptability (0.92). Health planners and policy makers will commonly require such a planning method,  particularly in the developing world where spatial contexts are highly dynamic as a result of rapid urbanisation.