ArticleBMJ global health2020
Geospatial evaluation of trade-offs between equity in physical access to healthcare and health systems efficiency.
Article in BMJ global health, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers.
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Who cites it
21 citing papers in PubMed.
- The Distribution, Accessibility, and Equity of Primary Care Facilities in China-A Nationwide Analysis Based on POI and High-Resolution Population Data.Healthcare (Basel, Switzerland) · 2026Article
- Modelling the coverage gap in percutaneous coronary intervention in LMIC: a geospatial analysis of cath lab coverage in Indonesia.Open heart · 2026Article
- Equity in health resource allocation in Guangdong Province, China, from 2013-2021: research based on the Dagum Gini coefficient and exploratory spatial data analysis.Cost effectiveness and resource allocation : C/E · 2026Article
- Geographic and Temporal Patterns of Screening for Breast, Cervical, and Colorectal Cancer in the US, 1997-2019.JAMA network open · 2025Article
- Harnessing Geospatial Artificial Intelligence (GeoAI) for Environmental Epidemiology: A Narrative Review.Current environmental health reports · 2025Review
- Analysis of equity in the distribution of human resources and hospital beds and its association with the COVID-19 mortality rate: a case of Iran.BMC health services research · 2025Article
- Equity and efficiency of health resource allocation in Sichuan Province, China.BMC health services research · 2024Article
- Article
- Equity and efficiency of health resource allocation in township health centers in Sichuan Province, China.PloS one · 2024Article
- The development and application of a two-step surveillance process for Healthy China Initiative based on wide coverage interagency data.Global health research and policy · 2023Article
- Association of Variation in US County-Level Rates of Liver Surgical Resection for Colorectal Liver Metastasis With Poverty Rates in 2010.JAMA network open · 2023Article
- Improving identification of symptomatic cancer at primary care clinics: A predictive modeling analysis in Botswana.International journal of cancer · 2022Article
- Cancer in sub-Saharan Africa: a Lancet Oncology Commission.The Lancet. Oncology · 2022Review
- Comparing absolute and relative distance and time travel measures of geographic access to healthcare facilities in rural Haiti.BMJ open · 2022Article
- Toward Equitable Access to Tertiary Cancer Care in Rwanda: A Geospatial Analysis.JCO global oncology · 2022Article
- What Geohistory Can Teach Us About Fundamental Causes of Health Inequities.Health equity · 2022Article
- Availability of essential diagnostics in ten low-income and middle-income countries: results from national health facility surveys.The Lancet. Global health · 2021Article
- Balancing Equity and Efficiency in the Allocation of Health Resources-Where Is the Middle Ground?Healthcare (Basel, Switzerland) · 2021Article
- Evaluating urban-rural access to pathology and laboratory medicine services in Tanzania.Health policy and planning · 2021Article
- Optimising passive surveillance of a neglected tropical disease in the era of elimination: A modelling study.PLoS neglected tropical diseases · 2021Article
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Authors and funding
7 authors.
Funding
Abstract
introductionDecisions regarding the geographical placement of healthcare services require consideration of trade-offs between equity and efficiency, but few empirical assessments are available. We applied a novel geospatial framework to study these trade-offs in four African countries.
methodsGeolocation data on population density (a surrogate for efficiency), health centres and cancer referral centres in Kenya, Malawi, Tanzania and Rwanda were obtained from online databases. Travel time to the closest facility (a surrogate for equity) was estimated with 1 km resolution using the Access Mod 5 least cost distance algorithm. We studied associations between district-level average population density and travel time to closest facility for each country using Pearson's correlation, and spatial autocorrelation using the Global Moran's I statistic. Geographical clusters of districts with inefficient resource allocation were identified using the bivariate local indicator of spatial autocorrelation.
resultsPopulation density was inversely associated with travel time for all countries and levels of the health system (Pearson's correlation range, health centres: -0.89 to -0.71; cancer referral centres: -0.92 to -0.43), favouring efficiency. For health centres, negative spatial autocorrelation (geographical clustering of dissimilar values of population density and travel time) was weaker in Rwanda (-0.310) and Tanzania (-0.292), countries with explicit policies supporting equitable access to rural healthcare, relative to Kenya (-0.579) and Malawi (-0.543). Stronger spatial autocorrelation was observed for cancer referral centres (Rwanda: -0.341; Tanzania: -0.259; Kenya: -0.595; Malawi: -0.666). Significant geographical clusters of sparsely populated districts with long travel times to care were identified across countries.
conclusionNegative spatial correlations suggested that the geographical distribution of health services favoured efficiency over equity, but spatial autocorrelation measures revealed more equitable geographical distribution of facilities in certain countries. These findings suggest that even when prioritising efficiency, thoughtful decisions regarding geographical allocation could increase equitable physical access to services.
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