Quantification of accessibility to health facilities in rural areas

Abstract

The accessibility to medical facilities plays an important role in the overall health system of a country. Accessibility often refers to spatial or physical accessibility and is concerned with the complex relationship between the spatial separation of the population and the supply of health care facilities. There is a need to understand the current health care needs and also the existing practices. The traditional planning approach for rural transportation believes that building roads would ensure access to various infrastructure and services by motorized vehicles. However the impacts of such investments on rural development and also on health care have been found to be extremely mixed. Therefore an attempt has been made to quantify the impact of such investments on health sector. Prime Minister Gram Sadak Yojana (PMGSY) program, an Indian Government initiative is an example of one such investment. The accessibility to medical facilities of the villages connected by PMGSY roads is compared to villages which are not connected by any means, so that the effect on accessibility in the presence of a well constructed road can be determined. Quantifying accessibility in terms of health care contributes to a wider understanding of the performance of the health systems which in turn helps the policy decision maker(s) in identifying the deficiencies of the system so that remedial measures could be taken. However, it would be incomplete if the distance (or travel time), quality of service provided at the health care center and affordability of the users are not considered while quantifying accessibility. Therefore by integrating all the important factors influencing accessibility along with multi criteria decision making tools, a methodology is developed. This methodology includes three different multi-criteria decision making analysis tools: Simple Additive Weightage (SAW), Fuzzy aggregation method and Fuzzy preference decision analysis. Further these three methods are critically analyzed for their suitability to quantify accessibility to medical facilities.