AUTHOR=Moturi Angela K. , Suiyanka Laurissa , Mumo Eda , Snow Robert W. , Okiro Emelda A. , Macharia Peter M. 

TITLE=Geographic accessibility to public and private health facilities in Kenya in 2021: An updated geocoded inventory and spatial analysis

JOURNAL=Frontiers in Public Health

VOLUME=Volume 10 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2022.1002975

DOI=10.3389/fpubh.2022.1002975

ISSN=2296-2565

ABSTRACT=To achieve universal health coverage, adequate geographic access to quality healthcare services is vital and should be characterised periodically to support planning. However, in Kenya, previous assessments of geographic accessibility have relied on public health facility lists only, assembled several years ago. Here, for the first time we assemble a geocoded list of public and private health facilities in 2021 and make use of this updated list to interrogate geographical accessibility to all health providers.Existing health provider lists in Kenya were accessed, merged, cleaned, harmonised, and assigned a unique geospatial location. The resultant master list was combined with road network, land use, topography, travel barriers and healthcare-seeking behaviour within a geospatial framework to estimate travel time to the nearest i) private, ii) public, and iii) both (public and private-PP) health facilities through a travel scenario involving walking, bicycling and motorised transport. The proportion of the population within 1 hour and outside 2-hours was computed at 300x300 spatial resolution and aggregated at subnational units used for decision-making. Areas with a high disease prevalence for common infections that were outside 1-hour catchment (dual burden) were also identified to guide prioritisation. The combined database contained 13,579 health facilities, both in the public (55.5%) and private-for-profit sector (44.5%) in 2021. The private health facilities' distribution was skewed towards the urban counties. Nationally, average travel time to the nearest health facility was 130, 254 and 128 minutes while the population within 1-hour was 89.4%, 80.5% and 89.6% for the public, private and PP health facility, respectively. The population outside 2-hours were 6% for public and PP and 11% for the private sector. Mean travel time across counties was heterogeneous, while the population within 1-hour ranged between 38% and 100% in both the public sector and PP. Counties in northwest and southeast Kenya had a dual burden. Continuous updating and geocoding of health facilities will facilitate an improved understanding of healthcare gaps for planning. Heterogeneities in geographical access continue to persist, with some areas having a dual burden and should be prioritised towards reducing health inequities and attaining universal health coverage.