Geographic Access Modeling of Emergency Obstetric and Neonatal Care in Kigoma Region, Tanzania: Transportation Schemes and Programmatic Implications.

• Type of Material: Article
• Authors: Yi No Chen, Centers for Disease Control and Prevention; Michelle M Schmitz, Centers for Disease Control and Prevention; Florina Serbanescu, Centers for Disease Control and Prevention; Michelle M Dynes, Centers for Disease Control and Prevention; Godson Maro, Bloomberg Philanthropies; Michael Kramer, Emory University
• Language: English
• Date: 2017-09-27
• Publisher: Johns Hopkins University
• Publication Version: Final Published Version
• Copyright Statement: © Chen Y, Schmitz, et al.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.9745/GHSP-D-17-00110
• Title of Journal or Parent Work: Global Health: Science and Practice Journal
• ISSN: 2169-575X
• Volume: 5
• Issue: 3
• Start Page: 430
• End Page: 445
• Grant/Funding Information: The analysis was contained within the Reducing Maternal Mortality Project, supported by Bloomberg Philanthropy, the CDC, Vital Strategies, and Ministry of Health and Social Welfare of Tanzania.; These activities were conducted as part of the collaboration between the Tanzanian Ministry of Health and Social Welfare and the Division of Reproductive Health at CDC, with financial support from Bloomberg Philanthropies and Foundation H&B Agerup.
• Research Categories: Health Sciences, Epidemiology; Health Sciences, General

Abstract

BACKGROUND: Access to transportation is vital to reducing the travel time to emergency obstetric and neonatal care (EmONC) for managing complications and preventing adverse maternal and neonatal outcomes. This study examines the distribution of travel times to EmONC in Kigoma Region, Tanzania, using various transportation schemes, to estimate the proportion of live births (a proxy indicator of women needing delivery care) with poor geographic access to EmONC services. METHODS: The 2014 Reproductive Health Survey of Kigoma Region identified 4 primary means of transportation used to travel to health facilities: walking, cycling, motorcycle, and 4-wheeled motor vehicle. A raster-based travel time model was used to map the 2-hour travel time catchment for each mode of transportation. Live birth density distributions were aggregated by travel time catchments, and by administrative council, to estimate the proportion of births with poor access. RESULTS: Of all live births in Kigoma Region, 13% occurred in areas where women can reach EmONC facilities within 2 hours on foot, 33% in areas that can be reached within 2 hours only by motorized vehicles, and 32% where it is impossible to reach EmONC facilities within 2 hours. Over 50% of births in 3 of the 8 administrative councils had poor estimated access. In half the councils, births with poor access could be reduced to no higher than 12% if all female residents had access to motorized vehicles. CONCLUSION: Significant differences in geographic access to EmONC in Kigoma Region, Tanzania, were observed both by location and by primary transportation type. As most of the population may only have good EmONC access when using mechanized or motorized vehicles, bicycles and motorcycles should be incorporated into the health transportation strategy. Collaboration between private transportation sectors and obstetric service providers could improve access to EmONC services among most populations. In areas where residents may not access EmONC facilities within 2 hours regardless of the type of transportation used, upgrading EmONC capacity among nearby non-EmONC facilities may be required to improve accessibility.