Some people must travel over 5 hours to access healthcare in rural Madagascar

Many people living in Infanadiana, rural Madagascar, have to travel more than an hour to receive healthcare, and some as long as 5 hours. Researchers mapped local terrains and locations of healthcare services in this area, to help authorities improve access to healthcare. 

In rural areas, there is a lack of development and transport, and so access to healthcare is impacted. There is also not enough geographical information about how long it takes people to access healthcare. 

In this study therefore, researchers wanted to make accurate estimates of how long it took people to get these essential services, so that access can be improved.

They mapped out the Ifanadiana area in Madagascar by focusing on the natural features of the land. They mapped over 100 000 buildings, 23 000 km of footpaths, and 4 925 residential areas. 

They then recorded the time it would take residents to get to healthcare services on foot, and in different types of weather. They also calculated the shortest distance to the nearest healthcare service. 

They found that more than 75% of the Ifanadiana community lived more than an hour away from healthcare sites. The northern and eastern part of Ifanadiana, in particular, were problematic areas. In some instances, people were more than five hours away from decent health services. 

This geographical information is available electronically to the residents and healthcare workers. 

Researchers unfortunately didn’t survey the amount of people living in the area, which may skew their results.They also did not consider the use of transport in the travel time. 

They say more work is needed in this field, which is called “geographical accessibility modelling”. In other words, more studies should use computer modelling and geographical data to map access to health services.

The study was done in Madagascar, and the authors were from Madagascar and France. 

Abstract

Background

Geographical accessibility to health facilities remains one of the main barriers to access care in rural areas of the developing world. Although methods and tools exist to model geographic accessibility, the lack of basic geographic information prevents their widespread use at the local level for targeted program implementation. The aim of this study was to develop very precise, context-specific estimates of geographic accessibility to care in a rural district of Madagascar to help with the design and implementation of interventions that improve access for remote populations.

Methods

We used a participatory approach to map all the paths, residential areas, buildings and rice fields on OpenStreetMap (OSM). We estimated shortest routes from every household in the District to the nearest primary healthcare center (PHC) and community health site (CHS) with the Open Source Routing Machine (OSMR) tool. Then, we used remote sensing methods to obtain a high resolution land cover map, a digital elevation model and rainfall data to model travel speed. Travel speed models were calibrated with field data obtained by GPS tracking in a sample of 168 walking routes. Model results were used to predict travel time to seek care at PHCs and CHSs for all the shortest routes estimated earlier. Finally, we integrated geographical accessibility results into an e-health platform developed with R Shiny.

Results

We mapped over 100,000 buildings, 23,000 km of footpaths, and 4925 residential areas throughout Ifanadiana district; these data are freely available on OSM. We found that over three quarters of the population lived more than one hour away from a PHC, and 10–15% lived more than 1 h away from a CHS. Moreover, we identified areas in the North and East of the district where the nearest PHC was further than 5 h away, and vulnerable populations across the district with poor geographical access (> 1 h) to both PHCs and CHSs.

Conclusion

Our study demonstrates how to improve geographical accessibility modeling so that results can be context-specific and operationally actionable by local health actors. The importance of such approaches is paramount for achieving universal health coverage (UHC) in rural areas throughout the world.]

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