132 / 2019-11-05 13:43:51

The geographical distribution and spatial accessibility of health institutions in Nepal

Nepal,health institution,distribution,geographical accessibility,health equality

Background: Health equity has received worldwide attention, especially for low-income countries, such as Nepal. Geographical barrier is one important factor that lead to inequity of health sources. There are very few studies on spatial accessibility of health resources in Nepal.
Methods: Location data on different levels of health institutions in Nepal was collected from Kathmandu University School of Medical Sciences. The shortest path analysis method is used to study the geographical accessibility of different levels of health institutions under maximum-cost and least-cost mode, and high-spatial-resolution accessibility maps of health institutions was produced. Inequity analysis was conducted based on the access time and population to identify the less inequality areas of spatial accessibility of health sources in the country.
Results: High density of different levels of health institutions were found in the middle of the country, particularly around the capital area. The northern plateau areas had the worst accessibility, while the central mountainous and the southern Terai areas have the best accessibility. The least-cost mode of transportation could significantly increase the accessibility, especially in the remote plateau region. Overall, the population coverage is high (~90%) within the 90-minute time zone, except for the central-level institutions (22.01% only). The accessibility of central-level institutions show the less equality compared to the other levels of institutions.
Conclusions: This study present high-resolution accessibility maps of different levels of health institutions in Nepal and assess the corresponding inequality, which provides important information supporting evidence-based health planning and resource allocation in Nepal.