Evaluating and improving the accessibility of primary health care services

Abstract

Investment in human resources is one of the key factors underlying the development of society. With human resource investment it is possible both to strengthen the development of a society and to increase its social equity. Primary health care is a critical investment in human capital that can bring about progressive societal change. Several factors, however, affect the provision of these health services in developing countries, including limited public funds available for providing services and a need for these services to target a population that is both poor and geographically dispersed. Since primary health care is an essential service, it is important to evaluate its provision to determine whether the service satisfies the needs of the target population and is distributed justly among the intended users.

This thesis examines the problem of evaluating and improving the potential accessibility of a target population to primary health care services. Towards this end, it develops a generic model of potential accessibility. It also examines how spatial aggregation of the target population can lead to errors in the evaluation of accessibility, and discusses methods of disaggregating population counts to a grid to reduce this spatial aggregation error.

Further, it develops a generic Accessibility Optimization Problem (AOP) that takes a facility-oriented approach to improve accessibility. Two subproblem formulations are also discussed for the AOP. The Facility Location Subproblem (FLS) adjusts the facility configuration to improve the efficiency and equity in the distribution of accessibility among the target population while the Resource Allocation Subproblem (RAS) modifies the allocation of resources to existing facilities. Specific accessibility optimization models for the minimum distance accessibility measure and the Joseph and Bantock [1982] accessibility measure are developed from the generic formulations. These accessibility measures are used to evaluate the current accessibility, and the optimization models are applied in two specific planning scenarios to examine potential strategies of improving accessibility to family planning services in the Central Valley of Costa Rica.