Geo-spatial Information Science

ISSN: 1009-5020 (Print) 1993-5153 (Online) Journal homepage: https://www.tandfonline.com/loi/tgsi20

Modelling geographic accessibility to Primary

Health Care Facilities: combining open data and
geospatial analysis

Olanrewaju Lawal & Felix E. Anyiam

To cite this article: Olanrewaju Lawal & Felix E. Anyiam (2019) Modelling geographic accessibility
to Primary Health Care Facilities: combining open data and geospatial analysis, Geo-spatial
Information Science, 22:3, 174-184, DOI: 10.1080/10095020.2019.1645508

To link to this article: https://doi.org/10.1080/10095020.2019.1645508

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Francis Group.

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GEO-SPATIAL INFORMATION SCIENCE
2019, VOL. 22, NO. 3, 174–184
https://doi.org/10.1080/10095020.2019.1645508

Modelling geographic accessibility to Primary Health Care Facilities:

combining open data and geospatial analysis
a b
Olanrewaju Lawal and Felix E. Anyiam
a
Department of Geography and Environmental Management, Faculty of Social Sciences, University of Port Harcourt, Port Harcourt,
Nigeria; bCentre for Health and Development, University of Port Harcourt, Port Harcourt, Nigeria

ABSTRACT ARTICLE HISTORY

Ensuring healthy lives and promoting well-being for all ages is the 3rd Sustainable Received 9 December 2018
Development Goal (SDG). Inequality in access to health care remains one of the primary Accepted 23 June 2019
challenges in achieving the goal. With the ever-increasing expansion of urban areas and KEYWORDS
population growth, there is a need to regularly examine the pattern of accessibility of basic Spatial accessibility;
amenities across regions, States and urban areas. This study examined geographic access to geographic accessibility;
Primary Health Care Facilities (PHCF) in Nigeria using the combination of open data and Sustainable Development
geospatial analysis techniques. Thus, showcasing an approach can be replicated across Goal (SDG); Primary Health
different regions in Sub-Saharan Africa due to issues of information gap. Data on elevation, Care Facilities (PHCF); Niger
location of health care facilities, population and network data were utilised. The result shows Delta; geocomputation
that PHCF aggregate at certain locations, e.g. major urban agglomerations, and transit route
leading to these places. High concentrations are found in the capital city. The average travel
time to the nearest PHCF is about 14 min (Standard Deviation ±13.30 min) while the
maximum is about 2 hours. Pockets of low accessibility areas exist across the Akwa Ibom
State in the Niger Delta region of Nigeria. There is an indication that most places have good
geographic access. Across the 1787 settlements identified in our dataset, 98.3% are with good
access (<30 min), 27 settlements are located in the poor access class (31–60 min), while two
settlements are within the very poor access class (>60 min). Geographic access is not the
main limiting factor to health care access in the region. Therefore, computation of access to
health care should take into consideration other dimensions of accessibility, to create a robust
measure which will support effective and efficient health care planning and delivery.

1. Introduction consider distance to facilities, ease of travel, cost

and travel time (Pyrialakou, Gkritza, and Fricker
Ensuring healthy lives and promoting well-being for
2016). With the ever-increasing expansion of urban
all at all ages is the 3rd Sustainable Development Goal
areas and population growth, it is necessary to reg-
(SDG), one of the 17 global goals set by the United
ularly examine the pattern of accessibility of basic
Nations for transforming our world (United Nations
amenities across regions, States and urban areas.
Department of Economic and Social Affairs 2015).
This becomes much more important for a region
And inequalities in geographic access to health care
with huge population because the inadequate access
is one of the primary challenges in achieving the 3rd
to facilities may cause an epidemic outbreak – inade-
SDG, thereby resulting in unmet targets towards
quate care of one infected person living in close
reducing maternal and neonatal mortality, epidemics
contact with many people. A good example is the
of HIV/AIDS, Malaria, Hepatitis B and Tuberculosis
outbreak of Ebola (Heymann et al. 2015; Alexander
(Norheim et al. 2015; Stenberg et al. 2017).
et al. 2015). Thus, it is an accepted understanding
Adequate access to health is one of the defining
that everyone should have access to appropriate qual-
characteristics of a developed society because health
ity health care in a timely, acceptable and affordable
is a very important aspect of human life (Evans and
fashion, not just for the individual’s sake but for
Stoddart 1990). Availability is often prioritised over
everyone’s benefit. However, the reality is often far
accessibility by many politicians and other decision-
different (Tangcharoensathien, Mills, and Palu 2015).
makers in Sub-Saharan Africa (Wiseman et al. 2016),
The healthcare industry for many years has been
and especially in Nigeria (Iyioha and Nwabueze
generating large pools of data and especially in the
2016). The health sector in the country is categorised
book record keeping formats stored in hard copies
into public and private and the public facilities are
(Bollier and Firestone 2010). With the recent drive
further divided into primary, secondary and tertiary
and trend towards digitalization, it is necessary to
health care service facilities (Uzochukwu et al. 2016).
make these data available and open online in order
In measuring geographic access, it is important to

CONTACT Olanrewaju Lawal [email protected]

© 2019 Wuhan University. Published by Informa UK Limited, trading as Taylor & Francis Group.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits
unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
 GEO-SPATIAL INFORMATION SCIENCE 175

to enhance the potential to improve the quality of capability constraints (physical/biological limit). This
healthcare delivery. Furthermore, analysis of such approach is an improvement on the contour measure
data can reveal patterns and trends which has the approach with its consideration of additional constraint
potential to improve care, save lives and lower health- to accessibility other than just physical limitations.
care service cost (Raghupathi and Raghupathi 2014). Utility-based approach measures accessibility based on
Geographical or spatial accessibility refers to phy- the derived benefit from using the facility accessed.
sical access a user possesses to a location (McGrail Thus, a facility may be considered accessible if it offers
and Humphreys 2014). It captures the connection a higher level of benefit for the users. The last approach
between the location where the supply is and where discussed by Geurs and Van Wee (2004), is the network
the demand is, taking into cognisance existing trans- measure. For this, accessibility to a facility is based on
portation infrastructure and travel impedance (Wang the movement or access via the network and this is
et al. 2016). There are many dimensions to access, influenced by the topology and structure of the
and some of the concepts are complex to define and network.
are dependent on the population and the health care Geographic Information System (GIS) provides
systems itself (Aday and Andersen 1974). These a platform for which an assessment of the distribu-
dimensions could be spatial or non-spatial (Cressie tion of health care facilities (any other public ame-
2015). Thus, factors such as affordability, quality, and nities) can be carried out as well as the evaluation of
acceptability are non-spatial in nature while accessi- the effectiveness coverage in relation to the popula-
bility and availability are spatial attributes (Khan tion (Delamater et al. 2012). Mansour (2016) exam-
1992). ined the accessibility of health care facilities in the
In characterising the spatial dimension, vehicular Riyadh Governorate. The study focused on public
travel time/distance and Euclidean distance offers health care facilities across the study area. The results
a prospect for measuring spatial accessibility (Khan showed that the facilities are clustered in distribution,
1992). Geurs and Van Wee (2004) highlighted seven with central regions having a high density of facilities
different approaches to measuring spatial accessibil- and marginal regions having lower densities. Less
ity. Spatial-separation-based model for operationalis- than half the population are within 1-km distance of
ing accessibility is based on the infrastructure and Primary Health Care Facilities (PHCF), which pro-
uses the physical distance between infrastructure, vides valuable understanding for improving and plan-
e.g. Health Care Facilities (HCF) as input (Geurs ning for health care delivery in the study area.
and Van Wee 2004). This approach is more suitable Combining data from attitude survey and road dis-
when data on the network of transportation is not tance computation within GIS, Comber, Brunsdon,
available or incomplete since it only requires the and Radburn (2011) examined the difficulty of access
location of the facilities of interest. to General Practitioners (GPs) and hospitals using
Cumulative opportunity approach (isochrones) uses a logistic regression model. From the results, long
the element of travel time as well as a definition of the term illness, bad health and non-car ownership were
maximum desirable travel time. This approach captures found to be a significant predictor of difficulty of
the land use patterns and infrastructural constraints access to GPs and hospitals. Furthermore, the dis-
across the landscape (Geurs and Van Wee 2004). tance to a facility was found to be an insignificant
Gravity model approach seeks to overcome the rigidity predictor of difficulty of access to hospitals, but it was
or arbitrariness of the Isochrone approach, it treats a significant predictor for the difficulty in access to
opportunity differently along a time and distance con- GPs. From this, there is a clear indication that
tinuum. However, this approach is sensitive to the size depending on the area, the distance to a facility may
of the zone of interest, the configuration of this zone, not even be the most important factor in determining
choice of attractor variables and the values of travel accessibility, and the concept of accessibility needs to
impedance time. While being more accurate, this mea- be treated as a multi-dimensional construct. Dos
sure is often less legible. Competition measure approach Anjos Luis and Cabral (2016) examined geographic
is based on the separation-based approach but it con- accessibility of primary health care centres in
siders the presence of a competing facility (Van Wee, Mozambique using GIS to facilitate health care deliv-
Hagoort, and Annema 2001). For example, the accessi- ery planning. The result revealed that slightly over
bility to a health care facility is not only governed by the 90% of the country is underserved (>60 min walking
distance to travel to such facility but also by the amount distance to HCF) while 30% are in an underserved
of competition for such facility in the area – there is zone in the case of driving. However, when the
a certain number of bed spaces or range of services that population is considered, 67% of the population are
the facility can provide. Time-space approach considers in underserved areas (walking scenario) while for
the space-time constraints (Hägerstraand 1970) namely, driving only 6% are in underserved areas. Yerramilli
authority constraints (laws, rules, norms, time of opera- and Fonseca (2014) examined the disparity in geo-
tion, etc.), coupling constraints (social interaction), and graphic accessibility to various critical HCF
176 O. LAWAL AND F. E. ANYIAM

(paediatrics, obstetrician/gynaecologist, trauma/burn services. This endeavour is also geared toward show-
centres) in Mississippi (USA). The study was casing the use of open data in carrying out a rapid
designed to capture the accessibility to these facilities assessment, an aspect of health care delivery that will
for the specific population in need of these services, support planning and decision making towards uni-
using a GIS-based network data. Optimal travel time versal health coverage.
of between 20 min and 30 min (Obstetrician,
Paediatrics and Trauma centre) were used to model
service areas for the facilities under consideration. 2. Methodology
Contrary to the findings of Comber, Brunsdon, and
2.1. Study area
Radburn (2011), Yerramilli and Fonseca (2014) found
that distance and travel time were the most signifi- Akwa Ibom State is in the Niger Delta region of
cant factors affecting the health status and outcomes Nigeria (Figure 1), bordered by Rivers State and
of the population. Taking into consideration the age Abia State on the west, Cross River State on the east
and gender of the population in relation to cancer and the Atlantic Ocean on the south. It has four
risk, Zhang et al. (2018), evaluated access to HCFs ecological zones namely: mangrove forest/coastal
and concluded that based on ratio and shortest road vegetation, freshwater swamp forest, lowland rainfor-
distance the distribution and location of HCF in est, and derived savanna (Niger Delta Development
Hong Kong are reasonable. However, they reported Commission 2006). The State is projected to have
that cancer patient in rural/isolated or islands have approximately 4.5 million people in 2015 and
low accessibility, but this population represents 6.2 million people by 2020(UNDP 2006). The State
a small percentage of the total population. In the is divided into thirty-one Local Government Areas
same view, Loo and Lam (2012) examined the access (LGAs) with Uyo as the capital city. Akwa Ibom State
to HCF by the elderly across Hong Kong. The study Ministry of Health is responsible for the planning and
examined accessibility from major transit stops by implementation of health policies as well as the man-
walking for the elderly population of the Metropolis agement of HCF of the State.
(walkability assessment for accessibility) and con- It is estimated that about 51.5% of the popula-
cluded that there is a need for improvement in the tion in Akwa Ibom State are females (UNDP 2006).
walkability of the built environment surrounding the Niger Delta Environmental Survey of 2000, which
HCFs in Hong Kong. In their comparison of three was cited in UNDP (2006), reported that between
accessibility measures for HCFs in Austin, Texas, 20% and 24% of rural communities have access to
LaMondia, Blackmar, and Bhat (2010) reported that safe drinking water while across urban settlement
individual access to HCF via the Paratransit (on- about 45%–50% have access (the only exception is
demand transit) differ according to each of the three Cross River State) in the Niger Delta Region. In
measures of accessibility (cumulative, gravity and uti- addition to this, the Demographic and Baselines
lity-based). Each approach provides a different inter- Studies Sectoral Report by the Niger Delta
pretation from the others, and so there is a need for Development Commission, showed that when the
careful selection of measure by planners or policy- respondents from Akwa Ibom State were asked
makers in supporting their decision for health care which facilities should be provided or improved
delivery. In addition, they showed that while simple in their community, 89.8%, 9.6%, 0.1% and 0.5%
measures are easier to compute, they often provide an identified school, health facilities, road/waterways
extreme or skewed picture of accessibility. Therefore, and pipe-borne water, respectively (UNDP 2006).
accessibility measures that are more closely related to The sectoral report of the distribution of Small and
individuals’ perception and true access to activity Medium Enterprises (SMEs) showed that majority
opportunity are adequate for representing of the SMEs were in the tertiary services/mining/
accessibility. construction, manufacturing, and agriculture
It is therefore important that a definite effort is (41.3%, 35.7% and 22.2%, respectively) in Akwa
made at tracking inequalities in geographic access to Ibom State (Niger Delta Development
health care towards the achievement of the 3rd SDG, Commission 2006; UNDP 2006).
through the collection and analysis of relevant open According to the Nigeria Demographic and Health
data and GIS. To this end, it is important that acces- Survey (NDHS) of 2003 (National Population
sibility to health care facilities is measured thereby Commission and ORC Macro 2004), the Niger
identifying deprived areas and people. This study, Delta region has the highest incidence of risky sexual
therefore, explored the geographic accessibility of behaviour, thus resulting in the region having the
health care facilities across Akwa Ibom State, highest prevalence of HIV and AIDS in the country
Nigeria. This is intended to highlight the pattern of (UNDP 2006). Other factors responsible for this pre-
health care access across the State, thereby supporting valence include most sexually active people in the
the identification of areas with needs for such country, limited use of condom and the largest
 GEO-SPATIAL INFORMATION SCIENCE 177

Figure 1. Location of the study area.

number in the country to affirm to have had sex with services/poverty as the most limiting factor for their
prostitutes in the previous 12 months (UNDP 2006). access to health care (National average of 30.4%).
Centre for Population and Environmental Combining these characteristics, UNDP (2006)
Development of 2004, which was cited in UNDP computed the Human Development Index (HDI)
(2006), estimated that 71.2% of sickness in the region for the region and the results show that compared
can be traced to malaria. The NDHS of 2003 showed to the data of 1992, Akwa Ibom State recorded slight
reported that 30% of children sampled in the region improvement in HDI compared to Edo, Delta and
had fever/convulsion compared to 18% in the south- Bayelsa States (retrogressive trend). Among the nine
west, 23.6% in the south-east and 24.2% in the north States, Akwa Ibom State was ranked the 3rd for the
central region. Human Poverty Index (HPI), just behind Ondo and
The Niger Delta region has the largest proportion Bayelsa State. For Gender-related Development
of birth attended by traditional attendants (32.2%) Index (GDI), the State was ranked the last at 0.391,
across the nation and the high maternal mortality well below the Niger Delta average of 0.444. For
could be attributed to limited health facilities and Gender Empowerment Measure (GEM), the State
cost of services (UNDP 2006). The report also cited was ranked the 3rd at 0.385, below the regional
Nigeria Demographic and Health Survey (NDHS) of value of 0.399.
2003, reporting that birth attended by unskilled med-
ical personnel are higher in the urban area than that
2.2. Data and methods
in the rural area for the Niger Delta. They also
reported that 13.8% affirmed that they did not know The elevation data was extracted from the Shuttle
where to go for treatment (compared to the National Radar Topographic Mission (SRTM) 30m resolution
average of 13.7%). Furthermore, 34.8% of people dataset from the U.S. Geological Survey (USGS
from the Niger Delta region (the largest in the coun- 2015). The data for the study area was downloaded
try) identified the distance to HCF as a major impe- from the Earth Explorer website (http://earthex
diment to access to health care (National average of plorer.usgs.gov/). Prior to the computation of the
24.4%). Among women, 47.1% identified the cost of slope, sinks within the Digital Elevation Model
178 O. LAWAL AND F. E. ANYIAM

(DEM) were filled using the Wang and Liu (2006) Table 1. Speed model scenarios and conditions.
method. The dataset was also projected to the Speed Distance from Slope percent
Scenario (km/hr) road (m) (%)
Universal Transverse Mercator (Zone 32N) before
Road environment, 20 ≤ 10 ≤ 15
the computation of the percent slope. low slope
Population data for 2015 were sourced from Road environment, 10 ≤ 10 > 15
high slope
Worldpop Datasets (www.worldpop.org.uk) using Off-road, low slope 5 ≥ 10 ≤ 15
UN estimates and recent census data. This was com- Off-road, high slope 2 ≥ 10 > 15
puted using the method described by Stevens et al.
(2015).
Network data depicting the access by road across
accordingly. This is a broad assumption adopted for
the study area was captured from the OpenStreet
a rapid assessment and simplification of indicators.
Map (OSM) (OpenStreetMap contributors 2018).
However, many more scenarios could be accommo-
The dataset contains spatial information and attri-
dated within this framework to capture the speed of
butes, such as road network, water features (and
movement across the environment. This approach
waterways), building, point of interests, natural fea-
was adopted since the network data is incomplete,
tures, etc. The water feature, building and natural
and the analysis would not capture access to all the
features constitute obstacles which prevent direct
identified PHCF.
access to facilities in the computation of time to HCF.
Time from the nearest PHCF was calculated by
Data on the location of HCF was collated from the
PAT using the speed model generated from the sce-
Vaccination Tracking System (VTS), supporting
narios in Table 1. The output was reclassified into
Polio Eradication in Nigeria (http://vts.eocng.org/).
three classes to summarize the level of access across
This dataset is made up of all HCF (public and
the study area. In addition, the population across
private). However, all analyses were carried out
each of the zone was computed. The mean and
using only a portion of the dataset on PHCF. This
Standard Deviation (SD) of travel time from PHCFs
was done to capture the access to the most affordable
were also calculated for each LGA, to capture the
health facility to most of the populace in both urban
level of access at this level of administration.
and rural areas.
Using the population data, the total population per
LGA were computed and compared against the total
number of PHCF in each LGA. This was done to give 3. Results and discussion
a general view of the level of demand per PHCF.
3.1. Distribution, pattern and population
Distance to the road was calculated using the
OSM dataset taking into consideration obstacles From the total of 724 HCF identified from the VTS
(water or building/facilities or solid structures). This database, only 458 (63%) can be recognized as PHCF.
operation was carried out within ArcGIS (ESRI 2017) Therefore, most of the HCF across the State are in this
using the analytical tool – Predictive Analysis Tool category and Figure 2 shows that they are mostly con-
(PAT). PAT supports the building of models to pre- centrated around major intersections. These intersec-
dict the location of a moving or stationary object/ tions also coincide either major urban agglomerations
events based on conditions specified by the analyst. (Uyo, Abak, Eket, Oron Opobo, and Ikot Ekpene) or
The Speed Model Builder (within PAT) works like transit route leading to these places. Highest concen-
the raster-based proximity analysis. But constraints tration can be seen around Uyo (the capital city) fol-
to movement can be specified and travel time to lowed by Eket, Ikot Ekpene and Abak. As expected,
a destination can be computed in addition to dis- Uyo as the capital city is the most populated city and
tance. The speed model creates a condition (con- thus has a higher concentration of the PHCF.
straint) surface which specifies speed achievable on However, the ratio of the population to HCF
different surface and terrain across the area. The revealed a different picture (as shown in Figure 3).
result is essentially a surface showing travel time Using the population estimates in 2015, the lowest
(from all locations across the study area) to ratio (5363–8099 persons per PHCF) was recorded
a specified destination (in this case the PHCF). for 9 LGAs spread across different parts of the State.
A speed model was created for the study area based About 11 LGAs have between 10,700 and 15,230 per-
on the local understanding of the region. The con- sons depending on one PHCF. Uyo and Uruan LGAs
straints to movement across the study area are cap- are exceptionally high demand, with between
tured in Table 1. Thus, depending on the 15,240–23,880 persons potentially demanding ser-
characteristics on the location, the achievable speed vices from each PHCF. The high demand for services
across the study area for access to PHCF ranges from across Uruan LGAs could be attributed to the
2 km/hr to 20 km/hr. For places farther from roads increasing extent of Uyo as the capital city spreading
or with high slopes, the speed would be slower toward this LGA (eastward growth). With the
 GEO-SPATIAL INFORMATION SCIENCE 179

Figure 2. Location and distribution of HCF across Akwa Ibom State.

attendant population growth, higher demand could Cross River State, coastline, around Opobo and
be expected as recorded in this analysis. along the border with Rivers State.
With the level of facilities and capacities of many of The analysis gave an indication that most of the
these PHCFs, it is highly debatable they are going to be locations across the study area have good spatial
able to cater for as many people as recorded from this access (in terms of travel time) to PHCFs as captured
analysis. It must also be noted that many of the popu- in the dataset.
lace may also not access these facilities due to beliefs, At the LGA level (Figure 5), the average travel time
culture and traditions, perception (past experiences or across Eastern Obolo, Ibeno, Uruan and Okobo LGAs
perceived benefit), and other socio-economic condi- is between 20.5 min (Eastern Obolo) and 28.8 min
tions. However, there is a need to determine how (Okobo) with SD ranging between 17.6 min and
many people are likely to require the services of PHCF 28.6 min. Eastern Obolo and Ibeno are coastal LGAs
to support planning for adequate health care delivery. while Okobo and Uruan are punctuated along the east-
ern border by a network of water bodies. This attribute
(remoteness) could further inhibit access to HCF for
3.2. Accessibility analysis
these LGAs (may likely be worse than captured by this
The combination of the attributes of the terrain and analysis). However, with characteristics of the terrain, it
the distance from the road network combined with is well with a reason to characterise these LGAs as
the known location of PHCF led to the creation of the having the worst access to PHCF.
results in Figure 4. This result was obtained by com- Fourteen LGAs have an average travel time ran-
bining the speed model created using conditions in ging between 10 min and 14.2 min, while thirteen
Table 1 for calculating the travel time from each LGA have an average travel time of less than 10 min.
PHCF. From this analysis, the maximum travel time As shown in Figure 5, it is evident that there are wide
to the nearest PHCF is slightly over 2 hours, while the variations across each LGA, the lowest variation was
average is around 14 min (SD ±13.30 min). There are recorded for Ikot Ekpene (one of the major metro-
pockets of low accessibility areas across the State, politan LGA) and the highest was recorded in Okobo.
with large tracks around the eastern border with This can be expected based on the variation in the
180 O. LAWAL AND F. E. ANYIAM

Figure 3. Distribution of population (at LGA level) per PHCF.

terrain characteristics as well as the density of road populated urban area compared with rural areas, which
(per unit area) across these areas. is not different from what has been reported in other
To summarize the level of accessibility across the countries across the world (Mansour 2016). This dispro-
State, a cut-off point of 30 min to travel was selected portionate distribution is also evident from the LGA level
based on the works of Nicholl et al. (2007) and Ravelli aggregation where the urban LGAs have a higher propor-
et al. (2011). There is an increased risk of mortality tion of the total PHCF. However, despite this, it is highly
associated with the travel time of 20–30 min (trauma/ unlikely that these PHCF can meet the demand, with
emergencies care and obstetrician/gynaecologist). most of the urban LGAs having a very high population
The classification is presented in Table 2, and to HCF ratio. Because the population is projected to
from the results, there is a clear indication that increase in the future and most of the increase is likely
many places across the State fall within the to occur in the urban areas, there is a clear and pressing
30 min cut-off of good access. Across the 1,787 need to increase the number of HCF to support such
settlements identified in our dataset, 98.3% are population. It is necessary to include demand into the
with good access (Figure 6). 27 settlements are in characterisation of access in this region. NDHS of 2003
the poor access class, while 2 settlements (Akpamfri (National Population Commission, and ORC Macro
Ukim and Ine Moses) located in Uruan LGA are in 2004) identified distance as one of the impediments to
the very poor access class. access health care in the region. However, the current
Computation of the population in each class shows result shows that this may not be the case right now.
that about 96% of the population lives in the good The results identified terrain characteristics as one
access class areas and 4% in the poor and very poor of the major factors limiting access as many of the
access regions of the State. settlement with poor and very poor access have diffi-
From the foregoing, we can get a clear indication that cult terrain to navigate. The results also partially
there is good geographical access to PHCF in Akwa Ibom confirmed what was reported by the NDHS (2003)
State, at least for most of the populated areas of the State. in which women affirmed that poverty is the major
And there are more PHCF located in the highly limiting factors and not distance.
 GEO-SPATIAL INFORMATION SCIENCE 181

Figure 4. Drive time to nearest PHCF across the study area.

Figure 5. Mean and SD bars of travel time to PHCF per LGA.

4. Conclusions and recommendations evaluation of access, facilities (efficiency of service

provision) and planning for future demand. This
One of the tasks of the government in ensuring the
study partially confirmed previous studies which
achievement of the 3rd SDG is to provide more
show that geographic access is not the main limiting
robust access to an improved and equitable health-
factor to health care access in the region but the cost
care service. To do this, there is a need for regular
182 O. LAWAL AND F. E. ANYIAM

Table 2. Classes of the travel time to the PHCF. residents to healthcare services will improve their
PHCF access classes Time range (min) Access class visit and access to HCF. Innovative means of redu-
1 ≤30 Good cing geographic barrier or to circumvent them should
2 60 ≤ X > 30 Poor
3 >60 Very Poor be explored and the government should begin to
explore investing in low cost, easy to use, and inno-
vative delivery technologies for Information and
of procuring services (from transport to drugs) is the Communications Technology (ICT) infrastructure in
main limiting factor. Therefore, computation of the adoption of telehealth which is been practiced in
access to PHCF needs to take into consideration some countries (Wade et al. 2010; Steventon et al.
other dimensions of accessibility, to create a robust 2012). This will surely improve the quality of health
measure which will support effective and efficient information available to communities and their
health care planning and delivery. families in underserved rural areas, as this has proven
To bring the country closer achieving the SDG effective in its use for phone calls and the internet in
several issues must be addressed. Thus, ensuring Nigeria (Akinfaderin-Agarau et al. 2012; Odigie et al.
a more robust geographical access to an improved 2012). Momentum can be created for online patients
and equitable healthcare services will be through support and allow urban doctors access to rural doc-
investigation and efforts targeted towards tackling tors and nurses and decide on appropriate treatment
poor remote road network especially in rural areas (Beedasy 2010).
(inaccessibility), high travel costs as a result of dis- This study has shown that open data and spatial
tance, time, and expenses, high population to PHCF modelling can provide insights into the access to HCF
ratio in the urban areas, climate conditions and even and will help inform policy decisions, as larger datasets
cultural factors, which when tackled can enhance can be processed quickly, efficiently and consistently.
healthcare utilization. Ensuring effective public trans- With this framework, it is possible to regularly assess
portation means especially for those with low-income geographic accessibility to health care services. Such
can lead to enhanced utilization (Mattson 2011; regular measurement will identify poorly served loca-
Suzuki, Cervero, and Iuchi 2013). Methods that will tions due to population changes, thereby helping to
encourage travel expenses reimbursements for rural know where HCF can be located to improve access.

Figure 6. Access class and settlement point across the study area.
 GEO-SPATIAL INFORMATION SCIENCE 183

Thus, with proper engagement among stakeholders Africa?” PLoS Neglected Tropical Diseases 9 (6):
(policymakers, researchers, industry, health practi- e0003652. doi:10.1371/journal.pntd.0003652.
tioners, community workers, and residents, etc.) trans- Beedasy, J. 2010. “Rural Designations and Geographic
Access to Tertiary Healthcare in Idaho.” Online Journal
lating science and research into actionable policies and of Rural Research & Policy 5 (2): 1. doi:10.4148/ojrrp.
measures are possible in achieving SDGs. v5i2.191.
There is a need to measure accessibility with the Bollier, D., and C. M. Firestone. 2010. The Promise and
incorporation data on poverty, population structure Peril of Big Data. Washington, DC: Aspen Institute,
and capacity of HCFs monitor access to health care, Communications and Society Program.
Comber, A. J., C. Brunsdon, and R. Radburn. 2011.
therefore creating a more robust indicator to support
“A Spatial Analysis of Variations in Health Access:
planning for health delivery for the nation and con- Linking Geography, Socio-Economic Status and Access
sequently supporting the achievement of 3rd SDG. Perceptions.” International Journal of Health
Provision of more data from the Ministry of Health Geographics 10 (1): 44. doi:10.1186/1476-072X-10-44.
would further support this drive, allowing various Cressie, N. 2015. Statistics for Spatial Data. New York: John
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Delamater, P. L., J. P. Messina, A. M. Shortridge, and
S. C. Grady. 2012. “Measuring Geographic Access to
Notes on contributors Health Care: Raster and Network-Based Methods.”
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Olanrewaju Lawal is a senior lecturer at the University of doi:10.1186/1476-072X-11-15.
Port Harcourt. He is a fellow of the Royal Geographical Dos Anjos Luis, A., and P. Cabral. 2016. “Geographic
Society His works have leveraged the development in GIS, Accessibility to Primary Healthcare Centers in
remote sensing, information and communication technol- Mozambique.” International Journal for Equity in
ogy in addressing various issues in relation to sustainabil- Health 15 (1): 173. doi:10.1186/s12939-016-0455-0.
ity, disaster risk management and risk reduction. Current ESRI. 2017. ArcGIS Desktop 10.6. Environmental Systems
research interests include application of geocomputation, Research Institute, Redlands, CA.
modelling, geospatial intelligence, geosocial analysis for Evans, R. G., and G. L. Stoddart. 1990. “Producing Health,
addressing social, economic and environmental issues. Consuming Health Care.” Social Science & Medicine 31
(12): 1347–1363. doi:10.1016/0277-9536(90)90074-3.
Felix E. Anyiam is a trained Public Health Researcher, Geurs, K. T., and B. Van Wee. 2004. “Accessibility Evaluation
Research Data Management Expert and Biostatistician; of Land-Use and Transport Strategies: Review and Research
and presently employed as the Research Officer and Data Directions.” Journal of Transport Geography 12 (2):
Analyst (Scientist) for the Centre for Health and 127–140. doi:10.1016/j.jtrangeo.2003.10.005.
Development (CHD), University of Port Harcourt, Hägerstraand, T. 1970. “What about People in Regional
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