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Edited by Douglas S. Massey, Princeton University, Princeton, NJ, and approved October 23, 2020 (received for review May 8, 2020)
Significance
Achieving universal health care access is a key development priority and a target of Sustainable Development Goal number 3. The COVID-19 pandemic has only reinforced this urge. A rapid expansion of public, affordable health care infrastructure is particularly crucial in sub-Saharan Africa (SSA): communicable diseases are the first cause of death, infant mortality rates are above 5%, and lengthy journeys to health care facilities undermine the accessibility to basic health care for millions. This paper provides a planning-oriented, inequality-focused analysis of health care accessibility in SSA based on a state-of-the-art georeferenced database of public health care facilities. We devise a spatial optimization framework to identify the optimal location and required bed capacity of public health care facilities in the region.
Abstract
Achieving universal health care coverage—a key target of the United Nations Sustainable Development Goal number 3—requires accessibility to health care services for all. Currently, in sub-Saharan Africa, at least one-sixth of the population lives more than 2 h away from a public hospital, and one in eight people is no less than 1 h away from the nearest health center. We combine high-resolution data on the location of different typologies of public health care facilities [J. Maina et al., Sci. Data 6, 134 (2019)] with population distribution maps and terrain-specific accessibility algorithms to develop a multiobjective geographic information system framework for assessing the optimal allocation of new health care facilities and assessing hospitals expansion requirements. The proposed methodology ensures universal accessibility to public health care services within prespecified travel times while guaranteeing sufficient available hospital beds. Our analysis suggests that to meet commonly accepted universal health care accessibility targets, sub-Saharan African countries will need to build ∼6,200 new facilities by 2030. We also estimate that about 2.5 million new hospital beds need to be allocated between new facilities and ∼1,100 existing structures that require expansion or densification. Optimized location, type, and capacity of each facility can be explored in an interactive dashboard. Our methodology and the results of our analysis can inform local policy makers in their assessment and prioritization of health care infrastructure. This is particularly relevant to tackle health care accessibility inequality, which is not only prominent within and between countries of sub-Saharan Africa but also, relative to the level of service provided by health care facilities.
Footnotes
- ↵1To whom correspondence may be addressed. Email: giacomo.falchetta{at}feem.it.
Author contributions: G.F. designed research; G.F. and A.T.H. contributed new reagents/analytic tools; G.F., A.T.H., and S.S. performed research; and G.F., A.T.H., and S.S. wrote the paper.
The authors declare no competing interest.
This article is a PNAS Direct Submission.
This article contains supporting information online at https://www.pnas.org/lookup/suppl/doi:10.1073/pnas.2009172117/-/DCSupplemental.
Data Availability.
Computer code and input data to replicate or update the analysis and the figures and the result data of baseline and sensitivity analysis model runs are publicly hosted at Zenodo (http://doi.org/10.5281/zenodo.3757084). Powerful (or cloud; e.g., Google Earth Engine, RStudio Cloud, or Google Colab) computing facilities are recommended for a successful replication.
Published under the PNAS license.
References
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Planning universal accessibility to public health care in sub-Saharan Africa
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