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Access to emergency hospital care provided by the public sector in sub-Saharan Africa in 2015: a geocoded inventory and spatial analysis

Access to emergency hospital care provided by the public sector in sub-Saharan Africa in 2015: a geocoded inventory and spatial analysis
Access to emergency hospital care provided by the public sector in sub-Saharan Africa in 2015: a geocoded inventory and spatial analysis
Background

Timely access to emergency care can substantially reduce mortality. International benchmarks for access to emergency hospital care have been established to guide ambitions for universal health care by 2030. However, no Pan-African database of where hospitals are located exists; therefore, we aimed to complete a geocoded inventory of hospital services in Africa in relation to how populations might access these services in 2015, with focus on women of child bearing age.

Methods

We assembled a geocoded inventory of public hospitals across 48 countries and islands of sub-Saharan Africa, including Zanzibar, using data from various sources. We only included public hospitals with emergency services that were managed by governments at national or local levels and faith-based or non-governmental organisations. For hospital listings without geographical coordinates, we geocoded each facility using Microsoft Encarta (version 2009), Google Earth (version 7.3), Geonames, Fallingrain, OpenStreetMap, and other national digital gazetteers. We obtained estimates for total population and women of child bearing age (15–49 years) at a 1 km2 spatial resolution from the WorldPop database for 2015. Additionally, we assembled road network data from Google Map Maker Project and OpenStreetMap using ArcMap (version 10.5). We then combined the road network and the population locations to form a travel impedance surface. Subsequently, we formulated a cost distance algorithm based on the location of public hospitals and the travel impedance surface in AccessMod (version 5) to compute the proportion of populations living within a combined walking and motorised travel time of 2 h to emergency hospital services.

Findings

We consulted 100 databases from 48 sub-Saharan countries and islands, including Zanzibar, and identified 4908 public hospitals. 2701 hospitals had either full or partial information about their geographical coordinates. We estimated that 287 282 013 (29·0%) people and 64 495 526 (28·2%) women of child bearing age are located more than 2-h travel time from the nearest hospital. Marked differences were observed within and between countries, ranging from less than 25% of the population within 2-h travel time of a public hospital in South Sudan to more than 90% in Nigeria, Kenya, Cape Verde, Swaziland, South Africa, Burundi, Comoros, São Tomé and Príncipe, and Zanzibar. Only 16 countries reached the international benchmark of more than 80% of their populations living within a 2-h travel time of the nearest hospital.

Interpretation

Physical access to emergency hospital care provided by the public sector in Africa remains poor and varies substantially within and between countries. Innovative targeting of emergency care services is necessary to reduce these inequities. This study provides the first spatial census of public hospital services in Africa.

Funding

Wellcome Trust and the UK Department for International Development.
e342-e350
Ouma, Paul
f66781f7-ddc4-41ea-b138-9f87b81e8294
Joseph, Maina
71ff9280-cb38-4259-ae35-cf63f4a08cc9
Thuranira, Pamela
1248ec41-30ee-458b-8029-53f286c88f9e
Macharia, Peter
9e88c6b8-5c52-40a6-889d-4849cba446fd
Alegana, Victor
f5bd6ab7-459e-4122-984f-2bdb5f906d82
English, Mike
f7756ca1-8e1a-4673-b399-72ed7b41b678
Okiro, Emelda
3174a4d7-b9a8-4e64-a0cb-668c2c194227
Snow, Robert
57e68ebe-7cbc-41d0-b72a-4b5667f3f490
Ouma, Paul
f66781f7-ddc4-41ea-b138-9f87b81e8294
Joseph, Maina
71ff9280-cb38-4259-ae35-cf63f4a08cc9
Thuranira, Pamela
1248ec41-30ee-458b-8029-53f286c88f9e
Macharia, Peter
9e88c6b8-5c52-40a6-889d-4849cba446fd
Alegana, Victor
f5bd6ab7-459e-4122-984f-2bdb5f906d82
English, Mike
f7756ca1-8e1a-4673-b399-72ed7b41b678
Okiro, Emelda
3174a4d7-b9a8-4e64-a0cb-668c2c194227
Snow, Robert
57e68ebe-7cbc-41d0-b72a-4b5667f3f490

Ouma, Paul, Joseph, Maina, Thuranira, Pamela, Macharia, Peter, Alegana, Victor, English, Mike, Okiro, Emelda and Snow, Robert (2018) Access to emergency hospital care provided by the public sector in sub-Saharan Africa in 2015: a geocoded inventory and spatial analysis. Lancet Global Health, 6 (3), e342-e350. (doi:10.1016/S2214-109X(17)30488-6).

Record type: Article

Abstract

Background

Timely access to emergency care can substantially reduce mortality. International benchmarks for access to emergency hospital care have been established to guide ambitions for universal health care by 2030. However, no Pan-African database of where hospitals are located exists; therefore, we aimed to complete a geocoded inventory of hospital services in Africa in relation to how populations might access these services in 2015, with focus on women of child bearing age.

Methods

We assembled a geocoded inventory of public hospitals across 48 countries and islands of sub-Saharan Africa, including Zanzibar, using data from various sources. We only included public hospitals with emergency services that were managed by governments at national or local levels and faith-based or non-governmental organisations. For hospital listings without geographical coordinates, we geocoded each facility using Microsoft Encarta (version 2009), Google Earth (version 7.3), Geonames, Fallingrain, OpenStreetMap, and other national digital gazetteers. We obtained estimates for total population and women of child bearing age (15–49 years) at a 1 km2 spatial resolution from the WorldPop database for 2015. Additionally, we assembled road network data from Google Map Maker Project and OpenStreetMap using ArcMap (version 10.5). We then combined the road network and the population locations to form a travel impedance surface. Subsequently, we formulated a cost distance algorithm based on the location of public hospitals and the travel impedance surface in AccessMod (version 5) to compute the proportion of populations living within a combined walking and motorised travel time of 2 h to emergency hospital services.

Findings

We consulted 100 databases from 48 sub-Saharan countries and islands, including Zanzibar, and identified 4908 public hospitals. 2701 hospitals had either full or partial information about their geographical coordinates. We estimated that 287 282 013 (29·0%) people and 64 495 526 (28·2%) women of child bearing age are located more than 2-h travel time from the nearest hospital. Marked differences were observed within and between countries, ranging from less than 25% of the population within 2-h travel time of a public hospital in South Sudan to more than 90% in Nigeria, Kenya, Cape Verde, Swaziland, South Africa, Burundi, Comoros, São Tomé and Príncipe, and Zanzibar. Only 16 countries reached the international benchmark of more than 80% of their populations living within a 2-h travel time of the nearest hospital.

Interpretation

Physical access to emergency hospital care provided by the public sector in Africa remains poor and varies substantially within and between countries. Innovative targeting of emergency care services is necessary to reduce these inequities. This study provides the first spatial census of public hospital services in Africa.

Funding

Wellcome Trust and the UK Department for International Development.

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More information

Accepted/In Press date: 4 December 2017
e-pub ahead of print date: 24 January 2018
Published date: March 2018

Identifiers

Local EPrints ID: 418052
URI: https://eprints.soton.ac.uk/id/eprint/418052
PURE UUID: abb96f00-6977-4db4-9274-df5aaf1526d9
ORCID for Victor Alegana: ORCID iD orcid.org/0000-0001-5177-9227

Catalogue record

Date deposited: 21 Feb 2018 17:30
Last modified: 20 Jul 2019 00:36

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