A geospatial approach to assess health coverage and scaling-up of healthcare facilities

Oinam Bakimchandra, Joymati Oinam2 and RK Kajal
Contd from previous issue
Using a travel-time grid with maximum duration of 60 min, accessibility of the existing healthcare network to the local population was analysed for two districts in Manipur, viz Imphal West (valley district) and Ukhrul.
We found that large population of Imphal West district could access the existing health- care facilities within a travel-time duration of 60 min.
One of the reasons is the availability of a large number of private health facilities in this district, in addition to the government healthcare facilities.
In case of Ukhrul district, accessibility of healthcare centres by the population is rather limited within the travel-time duration of 60 min.
A time duration exceeding 60 min was necessary, except for the population residing within 10–15 km radial distance of the healthcare centres. This may be attributed to the rugged terrain configuration, non-uniform/sparse population density within the district, as well as poor road network connectivity between the existing healthcare centres and interior villages/population centres.
 This assessment on catchment area and accessibility to existing healthcare centres indicates the need for scaling- up of the existing healthcare facilities so that the entire population in each district of Manipur can be covered.
Scaling-up analysis of healthcare facilities
Using the generated population grid layer and the corresponding PCC studied for each type of health facility, scaling-up analysis was performed to assess the need for establishing new healthcare centres in different districts of Manipur.
It was found that there is need for establishing new healthcare centres in Ukhrul, Chandel, Senapati, Churachandpur and Tamenglong districts, regardless of their type.
For all the assessment years, it was found that Ukhrul district requires maximum scaling- up of healthcare facilities ranging from 7 in 2015 to 17 in 2020.
On the other hand, the valley districts of Manipur, ie Thoubal, Imphal West, Imphal East and Bishnupur need lesser scaling-up of healthcare facilities compared to the hilly districts.
There was no requirement for scaling up healthcare facilities in Imphal West district for 2015 and 2017, except for the projected year 2020, with requirement of just two more such facilities.
Scaling-up assessment provides us a clear understanding on the existing network of health facilities of the region and the need to provide new healthcare facilities in different districts of Manipur.
Assessment of the proposed healthcare  locations was carried out by checking for the presence of any existing healthcare centres within a buffer of 5 km from the proposed scaled-up facilities.
Referring to the spatial distribution of scaled-up locations for year 2017, most of the proposed scaled-up healthcare facilities are situated close to existing PHSCs and some of the new centres are situated near existing PHCs.
Since the assessment takes into account topographic factor, existing road network of the region, existing LULC distribution, population distribution and location of existing health facilities, the predicted results of the model will provide first-hand information for expansion of facilities in the region. Some of the locations predicted by the model have been cross-checked and verified on the ground using GPS.
Discussion
This study demonstrates the role of geospatial technology in the monitoring and assessment of distribution of the healthcare facilities network. It addresses the need for timely update of health geodatabase and monitoring the  spatial and temporal distribution of the existing health- care facilities.
It also addresses the need for scaling-up  healthcare facilities to increase population coverage in remote areas and inaccessible regions.
AccessMod (ver 5) was used to evaluate physical accessibility analysis of the existing healthcare facilities network, and geographic coverage and scaling-up analysis in Manipur.
The assessment of catchment area analysis and accessibility to existing healthcare centres in different districts  of Manipur indicates the need for scaling-up the existing healthcare facilities, so that the entire population in each district of Manipur can be covered.
It was observed that all the districts in the valley area of Manipur were well covered and connected with the existing healthcare facilities, while the population in the hilly regions/ districts, especially in the northeastern, northwestern and  southern parts of Manipur, and particularly the border areas were found to be insignificantly covered by the  existing catchment area of the healthcare network.
The  scaling-up analysis shows that there is need for establishing new healthcare centres in Ukhrul, Chandel, Senapati,  Churachandpur and Tamenglong districts.
Analysis on the financial budgeting and manpower requirements for the expansion and setting up of new healthcare centres in the region has not been done in the present study.
Under SPIP 2010–11, it is categorically mentioned regarding the financial as well as non-financial incentives for health personnel working in inaccessible and most difficult high-focus districts of Tamenglong, Churachandpur, Chandel and Ukhrul. This measure will ensure the presence of health personnel at their respective healthcare centres, which is critical to the success of  healthcare services.
As an extension of this study, socio- economic factors can be integrated within the model  framework to access the feasibility and cost–benefit analysis of setting up new healthcare centres.
Conclusion
This study addresses the need for geospatial-based assessment of the existing healthcare facilities at both spatial and temporal scales, which will provide a clear understanding towards addressing better health planning and policy development in Manipur.
The outcome from this type of study will help policy makers and planners to take effective decisions and allocate funds in a rational way for development of new healthcare facilities. This study also addresses one of the fundamental aspects of primary healthcare system, i.e. equity in the distribution  of healthcare facilities and their accessibility to all sections of the society.
Conflicts of interest
The authors declare no conflict of interest.
Ethical approval statements
‘This research does not involve any human subjects and only secondary data on health facilities and GPS locations data were utilized for mapping purpose.’- Not Required: Exemption from IEC Review (IEC-NIT MANIPUR).