Assessment of spatial distribution and accessibility level of healthcare facilities from 1990 to 2020; a case of Morogoro municipality, Tanzania

Abstract

Background: About 1.3 billion people worldwide have no reliable access to healthcare facilities and the majority of these people are residents of Developing Nations including Tanzania. The distribution of most healthcare facilities in urban areas of developing countries is characterized by location disparity. This has given rise to geographic inequality. Healthcare facilities are essential for service provision in urban areas Unfortunately these services are inadequately found in people’s settlements. The aim of this study was to assess the spatial distribution and accessibility level of healthcare facilities for a period of 30 years in an urban area.

Methods: Satellite imageries incorporate supervised classification and Kappa Index of Agreement methods were used to determine urban expansion over 30 years study period. A handheld global position system was used to geo-reference the coordinates locations of all healthcare facilities. Face-to-face interview with municipality health officers and facility in-charges was conducted to know the historical background information of healthcare facilities. The distribution and accessibility level of healthcare facilities was determined by buffering analysis in the ArchGIS program incorporated with WHO standards.

Results: From 1990 to 2020 built-up land increased from 3.9% to 18.9% and none built up land decreased from 96.1% to 81.9% of the total urban area of Morogoro municipality. A total number 69 of healthcare facilities location points were collected where 48 (69.6%) are dispensaries, 17 (24.6%) are health centres and 4 (5.8%) are hospitals. Out of the 69 healthcare facilities that are in existence, 79% are private institutions and 21% are government owned. Healthcare facilities accessibility decreased from 79.86% to 45.6% covering urban settlements area.

Conclusion. Despite urban settlements expansion and an increase in the number of healthcare facilities still, there is decrease in the accessible urban area to healthcare facilities. It is evident from the locations of the existing facilities that proper consultation and analysis were not carried out. The new health facilities must be located in underserved areas within urban settlements. Such planned facilities are required to be located and distributed according to geographic distance and population standards per health facility.