Optimising geographical accessibility to primary health care: a geospatial analysis of community health posts and community health workers in Niger.

Autor:	Oliphant NP; School of Public Health, University of the Western Cape, Bellville, South Africa npoliphant@gmail.com.; Technical Advice and Partnerships, The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland., Ray N; GeoHealth Group, Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland.; Institute for Environmental Sciences, University of Geneva, Geneva, Switzerland., Bensaid K; UNICEF Niger, Niamey, Niger., Ouedraogo A; UNICEF Niger, Niamey, Niger.; UNICEF Guinea, Conakry, Guinea., Gali AY; Pathfinder International, Niamey, Niger.; General Directorate of Reproductive Health (former), Government of Niger Ministry of Public Health, Niamey, Niger., Habi O; Inspection of Statistical Services, National Institute of Statistics, Niamey, Niger.; Directorate of Surveys and Censuses (former), National Institute of Statistics, Niamey, Niger., Maazou I; Directorate of Surveys and Censuses (former), National Institute of Statistics, Niamey, Niger., Panciera R; Health Section, UNICEF Headquarters, New York, New York, USA., Muñiz M; Eastern and Southern Africa Regional Office, UNICEF, Nairobi, Kenya., Sy Z; GeoHealth Group, Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland.; Institute for Environmental Sciences, University of Geneva, Geneva, Switzerland., Manda S; Biostatistics Unit, South African Medical Research Council, Pretoria, South Africa.; Department of Statistics, University of Pretoria, Hatfield, South Africa., Jackson D; School of Public Health, University of the Western Cape, Bellville, South Africa.; London School of Hygiene and Tropical Medicine Centre for Maternal, Adolescent, Reproductive and Child Health, London, UK., Doherty T; School of Public Health, University of the Western Cape, Bellville, South Africa.; Health Systems Research Unit, South African Medical Research Council, Tygerberg, South Africa.
Jazyk:	angličtina
Zdroj:	BMJ global health [BMJ Glob Health] 2021 Jun; Vol. 6 (6).
DOI:	10.1136/bmjgh-2021-005238
Abstrakt:	Background: Little is known about the contribution of community health posts and community health workers (CHWs) to geographical accessibility of primary healthcare (PHC) services at community level and strategies for optimising geographical accessibility to these services. Methods: Using a complete georeferenced census of community health posts and CHWs in Niger and other high-resolution spatial datasets, we modelled travel times to community health posts and CHWs between 2000 and 2013, accounting for training, commodities and maximum population capacity. We estimated additional CHWs needed to optimise geographical accessibility of the population beyond the reach of the existing community health post network. We assessed the efficiency of geographical targeting of the existing community health post network compared with networks designed to optimise geographical targeting of the estimated population, under-5 deaths and Plasmodium falciparum malaria cases. Results: The per cent of the population within 60-minute walking to the nearest community health post with a CHW increased from 0.0% to 17.5% between 2000 and 2013. An estimated 10.4 million people (58.5%) remained beyond a 60-minute catchment of community health posts. Optimal deployment of 7741 additional CHWs could increase geographical coverage from 41.5% to 82.9%. Geographical targeting of the existing community health post network was inefficient but optimised networks could improve efficiency by 32.3%-47.1%, depending on targeting metric. Interpretations: We provide the first estimates of geographical accessibility to community health posts and CHWs at national scale in Niger, highlighting improvements between 2000 and 2013, geographies where gaps remained and approaches for optimising geographical accessibility to PHC services at community level. Competing Interests: Competing interests: NPO reports grants (salary support) from Bill and Melinda Gates Foundation (BMGF), outside the submitted work. (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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