Measuring the availability and geographical accessibility of maternal health services across sub-Saharan Africa.

Publisher: BioMed Central Country of Publication: England NLM ID: 101190723 Publication Model: Electronic Cited Medium: Internet ISSN: 1741-7015 (Electronic) Linking ISSN: 17417015 NLM ISO Abbreviation: BMC Med Subsets: MEDLINE

Original Publication: [London] : BioMed Central, 2003-

Health Services Accessibility/*organization & administration ; Maternal Health Services/*organization & administration; Africa South of the Sahara/epidemiology ; Female ; Geography ; Humans ; Pregnancy

Background: With universal health coverage a key component of the 2030 Sustainable Development Goals, targeted monitoring is crucial for reducing inequalities in the provision of services. However, monitoring largely occurs at the national level, masking sub-national variation. Here, we estimate indicators for measuring the availability and geographical accessibility of services, at national and sub-national levels across sub-Saharan Africa, to show how data at varying spatial scales and input data can considerably impact monitoring outcomes.
Methods: Availability was estimated using the World Health Organization guidelines for monitoring emergency obstetric care, defined as the number of hospitals per 500,000 population. Geographical accessibility was estimated using the Lancet Commission on Global Surgery, defined as the proportion of pregnancies within 2 h of the nearest hospital. These were calculated using geo-located hospital data for sub-Saharan Africa, with their associated travel times, along with small area estimates of population and pregnancies. The results of the availability analysis were then compared to the results of the accessibility analysis, to highlight differences between the availability and geographical accessibility of services.
Results: Despite most countries meeting the targets at the national level, we identified substantial sub-national variation, with 58% of the countries having at least one administrative unit not meeting the availability target at province level and 95% at district level. Similarly, 56% of the countries were found to have at least one province not meeting the accessibility target, increasing to 74% at the district level. When comparing both availability and accessibility within countries, most countries were found to meet both targets; however sub-nationally, many countries fail to meet one or the other.
Conclusion: While many of the countries met the targets at the national level, we found large within-country variation. Monitoring under the current guidelines, using national averages, can mask these areas of need, with potential consequences for vulnerable women and children. It is imperative therefore that indicators for monitoring the availability and geographical accessibility of health care reflect this need, if targets for universal health coverage are to be met by 2030.

Lancet. 2016 Oct 29;388(10056):2164-2175. (PMID: 27642022)
Sci Data. 2017 Jan 31;4:170004. (PMID: 28140397)
Glob Health Action. 2016 Aug 05;9:31880. (PMID: 27498964)
Biosci Trends. 2010 Dec;4(6):318-24. (PMID: 21248430)
Bull World Health Organ. 2013 Aug 1;91(8):546-546A. (PMID: 23940398)
PeerJ. 2016 Nov 3;4:e2675. (PMID: 27833824)
Med Care. 1981 Feb;19(2):127-40. (PMID: 7206846)
Trop Med Int Health. 2012 Jun;17(6):694-6. (PMID: 22512353)
Int J Health Geogr. 2017 Jan 13;16(1):1. (PMID: 28086893)
Lancet. 2016 Nov 5;388(10057):2307-2320. (PMID: 27642018)
Midwifery. 1991 Jun;7(2):64-70. (PMID: 1857258)
Nat Commun. 2018 Nov 26;9(1):4994. (PMID: 30478314)
Int J Health Geogr. 2004 Feb 26;3(1):3. (PMID: 14987337)
Bull World Health Organ. 1978;56(2):295-303. (PMID: 96953)
BMC Pregnancy Childbirth. 2015 Feb 05;15:14. (PMID: 25652262)
Lancet Glob Health. 2018 Feb;6(2):e152-e168. (PMID: 29248365)
Sci Data. 2019 Jul 25;6(1):134. (PMID: 31346183)
PLoS Med. 2011 Jan 25;8(1):e1000394. (PMID: 21283606)
BMC Pregnancy Childbirth. 2009 Aug 11;9:34. (PMID: 19671156)
Sci Data. 2018 May 22;5:180090. (PMID: 29786689)
Int J Health Geogr. 2014 Jan 04;13:2. (PMID: 24387010)
Int J Health Geogr. 2012 Feb 15;11:6. (PMID: 22336441)
Lancet Glob Health. 2018 Mar;6(3):e342-e350. (PMID: 29396220)
BMC Public Health. 2012 Nov 16;12:991. (PMID: 23158554)
J Glob Health. 2019 Jun;9(1):010414. (PMID: 30603080)
BMC Emerg Med. 2020 Jan 13;20(1):3. (PMID: 31931748)
PLoS One. 2015 Feb 17;10(2):e0107042. (PMID: 25689585)
Int J Health Geogr. 2011 Jul 25;10:44. (PMID: 21787394)
BMJ Glob Health. 2019 Jul 1;4(Suppl 5):e000778. (PMID: 31354979)
Int J Gynaecol Obstet. 2016 Jan;132(1):130-4. (PMID: 26725855)
Int J Gynaecol Obstet. 2006 Nov;95(2):192-208. (PMID: 17074557)
Lancet. 2015 Aug 8;386(9993):569-624. (PMID: 25924834)
Int J Health Geogr. 2008 Dec 16;7:63. (PMID: 19087277)
PLoS One. 2016 Aug 25;11(8):e0162006. (PMID: 27561009)
Syst Rev. 2017 Jun 6;6(1):110. (PMID: 28587676)
BMC Public Health. 2012 Dec 05;12:1049. (PMID: 23217157)

United Kingdom WT_ Wellcome Trust; 211208/Z/18/Z United Kingdom WT_ Wellcome Trust; 204613/Z/16/Z United Kingdom WT_ Wellcome Trust

Keywords: Emergency obstetric care; GIS; Healthcare accessibility; Maternal and newborn health; Universal health coverage

Date Created: 20200908 Date Completed: 20210208 Latest Revision: 20240216

20240216

PMC7487649

10.1186/s12916-020-01707-6

32895051