Geographic accessibility to public health facilities providing tuberculosis testing services at point-of-care in the upper east region, Ghana
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Date
2019-05-27
Journal Title
Journal ISSN
Volume Title
Publisher
BMC Public Health
Abstract
Background: In Ghana, limited evidence exists about the geographical accessibility to health facilities providing
tuberculosis (TB) diagnostic services to facilitate early diagnosis and treatment. Therefore, we aimed to assess the
geographic accessibility to public health facilities providing TB testing services at point-of-care (POC) in the Upper
East Region (UER), Ghana.
Methods: We assembled detailed spatial data on all 10 health facilities providing TB testing services at POC, and
landscape features influencing journeys. These data were used in a geospatial model to estimate actual distance
and travel time from the residential areas of the population to health facilities providing TB testing services. Maps
displaying the distance values were produced using ArcGIS Desktop v10.4. Spatial distribution of the health facilities
was done using spatial autocorrelation (Global Moran’s Index) run in ArcMap 10.4.1. We also applied remote sensing
through satellite imagery analysis to map out residential areas and identified locations for targeted improvement in
the UER.
Results: Of the 13 districts in the UER, 4 (31%) did not have any health facility providing TB testing services. In all,
10 public health facilities providing TB testing services at POC were available in the region representing an
estimated population to health facility ratio of 125,000 people per facility. Majority (60%) of the health facilities
providing TB testing services in the region were in districts with a total population greater than 100,000 people.
Majority (62%) of the population resident in the region were located more than 10 km away from a health facility
providing TB testing services. The mean distance ± standard deviation to the nearest public health facility providing
TB testing services in UER was 33.2 km ± 13.5. Whilst the mean travel time using a motorized tricycle speed of 20
km/h to the nearest facility providing TB testing services in the UER was 99.6 min ± 41.6. The results of the satellite
imagery analysis show that 51 additional health facilities providing TB testing services at POC are required to
improve geographical accessibility. The results of the spatial autocorrelation analysis show that the spatial
distribution of the health facilities was dispersed (z-score = − 2.3; p = 0.02).Conclusion: There is poor geographic accessibility to public health facilities providing TB testing services at POC in
the UER of Ghana. Targeted improvement of rural PHC clinics in the UER to enable them provide TB testing services
at POC is highly recommended.
Description
Research Article
Keywords
Geographic, Distribution, Accessibility, Health facilities, Tuberculosis, Point-of-care testing, Upper east region,, Ghana