Comparing absolute and relative distance and time travel measures of geographic access to healthcare facilities in rural Haiti

• Published in: BMJ open Vol. 12; no. 5; p. e056123
• Main Authors: Bhangdia, Kayleigh Pavitra, Iyer, Hari S, Joseph, Jean Paul, Dorne, Rubin Lemec, Mukherjee, Joia, Fadelu, Temidayo
• Format: Journal Article
• Language: English
• Published: England British Medical Journal Publishing Group 24-05-2022; BMJ Publishing Group LTD; BMJ Publishing Group
• Series: Original research
• Subjects: Emergency medical care; Estimates; Geographic information systems; Haiti; health equity; Health Facilities; Health services; Health Services Accessibility; Health Services Research; healthcare accessibility; Hospitals; Humans; Land area; Population; Public health; Roads & highways; Rural areas; Rural Population; Topography; Travel; travel distance; travel time; Haiti; Haiti; geographic information systems; health equity; travel time; travel distance; healthcare accessibility
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2021-056123

IntroductionWhile travel distance and time are important proxies of physical access to health facilities, obtaining valid measures with an appropriate modelling method remains challenging in many settings. We compared five measures of geographic accessibility in Haiti, producing recommendations that consider available analytic resources and geospatial goals.MethodsEight public hospitals within the ministry of public health and population were included. We estimated distance and time between hospitals and geographic centroids of Haiti’s section communes and population-level accessibility. Geographic feature data were obtained from public administrative databases, academic research databases and government satellites. We used validated geographic information system methods to produce five geographic access measures: (1) Euclidean distance (ED), (2) network distance (ND), (3) network travel time (NTT), (4) AccessMod 5 (AM5) distance (AM5D) and (5) AM5 travel time (AM5TT). Relative ranking of section communes across the measures was assessed using Pearson correlation coefficients, while mean differences were assessed using analysis of variance (ANOVA) and pairwise t-tests.ResultsAll five geographic access measures were highly correlated (range: 0.78–0.99). Of the distance measures, ED values were consistently the shortest, followed by AM5D values, while ND values were the longest. ND values were as high as 2.3 times ED values. NTT models generally produced longer travel time estimates compared with AM5TT models. ED consistently overestimated population coverage within a given threshold compared with ND and AM5D. For example, population-level accessibility within 15 km of the nearest studied hospital in the Center department was estimated at 68% for ED, 50% for AM5D and 34% for ND.ConclusionWhile the access measures were highly correlated, there were significant differences in the absolute measures. Consideration of the benefits and limitations of each geospatial measure together with the intended purpose of the estimates, such as relative proximity of patients or service coverage, are key to guiding appropriate use.