FACTORS AFFECTING ACCESS TO RURAL HEALTH SERVICES
A Case Study of Baringo Area of Kenya Using GIS
Benjamin Njore Mwasi
Ensuring equitable access to health services is a universal goal of governments. Achievement of this goal requires, among other things, the identification and removal of the many barriers that hinder access to health services. Broadly, these barriers can be grouped as physical, economic, social and cultural. Access to health services can arise due to one or different combinations of these four barrier types. Any attempt to improve access to health services requires the identification of area-specific prevailing barriers and their contributions to the overall condition.
This study sought to identify the major barriers to health service access for a special section of the Kenya community, namely, a rural community in a semi-arid environment, using Marigat Division of Baringo District within the Rift Valley as an example. Such environments are characterized by harsh weather conditions, sparsely distributed small settlements, poor road and other communication networks and low economic levels. The study used both primary and secondary socio-economic data, including health service attendance patterns, population and disease incidence distributions, as well as bio-physical data such as topography, weather and road networks to analyze health attendance patterns. The geographic information systems technology was used to integrate the socio-economic and physical data and analyze them while the statistical package for social scientists (SPSS) was used for statistical analyses.
The results show that about two-thirds of the population studied attend health facilities regularly, with the attendance patterns showing some variations across, sex, age, education marital status and type of occupation. Although not analysed in detail, ethnicity and religion did not seem to affect health facility attendance patterns. Distance, time and money were found to be the strongest barriers to health facility attendance in the study area, with distance being the single most important factor affecting the choice of the facility attended. There seems to be both spatial and temporal variations in disease incidence type and numbers, with more diseases occurring during the wet seasons.
Availability of facilities is generally low whether assessed in terms of density of facilities (< 0.01 facilities per square kilometre) or by population per facility, with each facility having more than 5000 people. Accessibility analysis by both Euclidean and slope-based friction surfaces show that very few people live within one kilometre from a health facility. In terms of road-network based accessibility only 6,050 people out of 69,450, representing less than 10% of the population were found to be within 5 kilometres from a health facility. Similarly, only 5,250 people lived within 15 minutes drive time to a health facility.
It was also shown that, a GIS can be used to identify the optimum facility to take a patient on the basis of both time (least time) or cost (shortest distance). Using pre-defined high need for a health facility criteria, namely, areas with a population density greater than 20 people per square kilometre and do not have a health facility within a 5 kilometre radius, the GIS was able to identify such areas. Similarly, the GIS identified areas with potential for private investment in health service provision using need for health services and ability to pay (using poverty index).
The study concludes that health service needs and barriers to health service access vary widely within and across geographic areas. Consequently, area specific analysis of needs and barriers can produce useful data for informing policy on improving accessibility to health services. Further, integrated analysis of socio-economic and bio-physical data using geographic information systems technology provides an objective means for making decisions on where to locate new facilities or which facilities to upgrade. The technology can also help decision makers solve problems of physical access by identifying where to construct new roads or upgrade existing ones to all weather standards.