National and subnational estimates of coverage and travel time to emergency obstetric care in Afghanistan: Modeling of spatial accessibility. (November 2020)

• Record Type: Journal Article
• Authors: Kim, Christine; Tappis, Hannah; McDaniel, Philip; Soroush, Mohammad Samim; Fried, Bruce; Weinberger, Morris; Trogdon, Justin G.; Kristen Hassmiller Lich, ; Delamater, Paul L.
• Is Part Of: Health & place. Volume 66(2020:Nov.)
• Publication Date: 2020-11
• Subjects: Access to healthcare -- Maternal healthcare -- Afghanistan -- Spatial analysis -- Geographic disparities; Health -- Social aspects -- Periodicals; Health services accessibility -- Periodicals; Public health -- Periodicals; Political planning -- Periodicals; Social medicine -- Periodicals; Epidemiology -- Periodicals; Health Policy -- Periodicals; Health Services Accessibility -- Periodicals; Public Health -- Periodicals; Public Policy -- Periodicals; Sociology, Medical -- Periodicals; Épidémiologie -- Périodiques; Politique sanitaire -- Périodiques; Santé, Services de -- Accessibilité -- Périodiques; Health services accessibility; Health -- Social aspects; Political planning; Public health; Social medicine; Periodicals; 613
• DOI: 10.1016/j.healthplace.2020.102452
• Languages: English
• ISSNs: 1353-8292

Abstract

Abstract: In Afghanistan, the risk of maternal death is among the highest in the world, with wide variation across the country. One explanation may be wide geographic disparities in access and use of maternal health care services. This study describes the spatial distribution of public facilities providing maternal health care in Afghanistan, specifically emergency obstetric care (EmOC), and the differences in travel time estimates using different transportation modes from 2010 to 2015 at the national and subnational levels. We conducted mapping and spatial analyses to measure the proportion of pregnant women able to access any EmOC health facility within 2 h by foot, animal, motor vehicle and a combination of transport modes. In 2015, adequate coverage of active public health facilities within 2 h of travel time was 36.6% by foot and 71.2% by a combination of transport modes. We found an 8.3% and 63.2% increase in access to EmOC facilities within 2 h of travel time by a combination of transport modes and by foot only, respectively, by 2015. Access to a combination of transportation options such as motor vehicles and animals may benefit pregnant women in reaching health facilities efficiently. Afghanistan made impressive gains in maternal healthcare access; despite these improvements, large disparities remain in geographic access by province and overall access to facilities is still poor. Highlights: Despite policies to increase services for pregnant women, geographic disparities remain. Increased access to emergency obstetric care suggest an expansion of services closer to communities. A combination of transportation modes may benefit pregnant women in reaching health facilities.