Spatial accessibility assessment to health care servicesin Peri-urban Mbeya city, Tanzania.

This research assessed spatial accessibility to healthcare services in peri - urban Mbeya city Tanzania. Despite the tremendous improvement in quality and quantity of health sector globally, in developing countries healthcare provision is a serious problem (WHO 2014, David et al. 2008). Barriers to health services are availability, accessibility, affordability, acceptability and accommodation. The accessibility issues have been noted in peri-urban and measures to physical access to health services continue. This situation calls for effective planning using GIS. The primary components of accessibility: what, where, who when and how are conceptual terms of accessibility used in this study. Three objectives guided the study: to map the spatial distribution of health facilities and different population patterns; to evaluate the physical accessibility to healthcare facilities by the communities in peri-urban area; and to determine ways that GIS’ use can improve spatial access to healthcare facilities in peri-urban areas. A sample size of 110 was used in the study. Survey field observations and indepth interviews, document review, remote sensing & GIS Mapping were used as data collection techniques. Arc GIS & IBM SPSS Statistics software used to analyze the data. Findings revealed that out of 14,166 residents in the study area, 7,436 of them have no healthcare facilities available, and public and private transport are both inadequate. About 51% of the respondents get health service from public dispensary but the dispensary lack the capacity to handle complex health issues such as complicated pregnancies, chronic diseases and serious injuries among others. Findings from cluster analysis revealed that 96.9% of the total population (nearly 2,076 households) out of 2,143 households wereliving in disadvantaged locations, hotspot (low spatial accessibility) that is beyond 4kms, which is morethan recommendeddistance to access healthcare facilities. In addition, spatial accessibility index values and population countsindicate only 0.3% of the total population in the study area identified with high spatial accessibility. Furthermore, total travel (driving) distance to healthcare facilities range between 0.497kms to 5.98kms to public dispensary located in their respective wards, 13.57kms,and 19.263kms to Regional or Referral hospital located at urban area. The findings show that the residents pay more than Tshs 2,000 as fare and spend more than 2hours on a trip to healthcare facilities, which results in unnecessary deaths of women, especially those with complicated pregnancies, chronic diseases and delayed for other community development activities. The study concludes that there is poor spatial accessibility to healthcare facilities among resident in peri-urban Mbeya city attributed to variations in the spatial distribution of the population. Furthermore, Geographic Information Systems, Remote sensing technology, the use of Network analysis and Multicriteria evaluation approaches were invaluable in assessing spatial accessibility to healthcare facilities in the peri-urban areas. The study recommendsthat the government should rehabilitate and improve the existing roads. Also, improve health services by upgrading of some of the public health facilities to the status of health centers. The study also recommends allocating new healthcare facilities (location-allocation) to cover all wards peri-urban Mbeya city so that, residents can have access to these facilities and services within a minimum distance.