A great number of deaths in children under 5 years of age were due to several common preventable causes, such as diarrhea, malaria, and poor prenatal care in Sub-Saharan Africa. The article suggests that poor physical access to health facilities was the most influential factor. Households with a greater distance from health facilities have higher rates of child mortality and malaria and are less likely to get treatment for fevers, although it was found that the relationships are heterogeneous and seem to be stronger in more rural areas. However, the connection between travel time to healthcare facilities and the actual travel behavior of a community is not certain, and the article suggests two different hypotheses. The first stems from a broad spatial analysis of Kenya that found a positive correlation between access to health facilities, frequency of travel, and wealth, suggesting that wealthier populations are able to travel more and travel to health facilities easier. The other hypothesis is contradictory; poor physical access creates greater travel difficulties for people to travel to health facilities, and people with poor access to health facilities may need to travel frequently and far.
The article discusses how human mobility is reflective of many components such as basic needs, social incentives, and economic constraints. With so many parts, it becomes hard to understand how measures of mobility, which are more than simply geographic location and infrastructure for travel, relate to accessible healthcare and health outcomes. With these difficulties, it becomes a challenge for policy makers to find effective solutions.
In relation to Sen’s definition of human development, this article is exploring the freedom of accessible healthcare. Healthcare is essential for all people, and having difficulty in traveling to facilities can influence other parts of a person’s life, such as economic freedom. The dimension of human development that is being addressed by the research is child and maternal mortality rates. The article used several methods of collecting data in Kenya to create geospatial datasets and understand certain aspects. They used mobile phone data to model the longitudinal travel behavior of people and thus understand the range and frequency of travel. By using information about the transportation network provided by the Kenyan National Bureau of Statistics, land cover data provided by africover.org, topography data provided by SRTM 90m DEM Digital Elevation Database, and locations of all the national health facilities provided by Noor, the authors were able to estimate travel times to the nearest health facility for Kenyans. The authors also collected data through the use of surveys from 5 districts in western Kenya. The human development process that the authors are investigating is the accessibility to healthcare. More specifically, they are trying to understand the problems and significance of each problem within the issue of poor accessibility to healthcare that has led to poor health outcomes.
This article focuses on the occurrence of stillbirths, defined by the World Health Organization as any third trimester foetal death or death of a newborn during childbirth. It was found that the rates of stillbirth in low-and-middle-income countries are ten times greater than that of high-income countries. This led to a global goal of reducing stillbirth rates to 12 or fewer stillbirths per 1000 births in all countries by 2030 after acknowledgement from the World Health Assembly-backed Every Newborn Action Plan that low-and middle-income countries needed to reduce their rates of stillbirth. The article highlights four components needed to prevent this issue: access to quality emergency obstetric and newborn care, having a skilled attendant at birth, adequate antenatal care, and efficient referral systems. In low-and middle-income countries, these can become hard to easily get to due to many of the people living in rural areas or urban slums where transportation options are poor. The authors of this article focus their attention on Nigeria, where there is a lot of data inaccuracy to support informed decision making. There are studies centered on stillbirths in Nigeria regarding a number of different related topics, but most are focused on southern Nigeria and more importantly, do not explore the relationship between geographic accessibility and stillbirths. In the capital of Gombe State, Gombe City, located in northeast Nigeria, there is only one major tertiary health facility.
The issue of stillbirths due to inadequate and various degrees of inaccessibility in healthcare facilities is related to the unfreedoms mentioned by Sen. He had discussed the many forms that unfreedom can be found in, including limited access to healthcare, which would lead to people struggling with a greater possibility of premature morbidity. The dimension of human development being addressed in the research is stillbirth rates. The geospatial datasets that were used were information collected through a questionnaire of Nigerian women that included data such as obstetric history, social, economic, and demographic characteristics, mode of transport to the hospital, and the path that they travelled to arrive at the hospital. Other geospatial datasets included the town address of participants and location of all government-run public health facilities in close proximity to the participants, provided by an open-source spatial database of health facilities managed by the public health sector in sub-Saharan Africa. Geospatial data science methods that were used include modelling the travel time of participants to their respective health facilities using AccessMod5.0, statistical analyses were performed with Statistical Package for the Social Sciences, figures were generated using ggplot2 in R and maps were created using ArcGIS software by Esri. The scientific question that the authors are seeking to answer is what the relationship between travel time to an adequate health facility and probability of stillbirths is in an urban city in northeast Nigeria.
This article discusses the influence of differences in distances from populations in rural areas to urban areas that lead to diminished resources, services, and opportunities for those populations in rural areas. The article explores how geography will influence and potentially significantly hinder a population’s access to healthcare, resources, and economic development. The article does not specifically focus on accessible healthcare, but instead suggests that a rural area’s accessibility to such resources, services, and opportunities as previously mentioned is closely linked to that rural area’s accessibility to more urbanized areas. The authors focused their research on Africa, which they explain that while there are existing spatially explicit population data, they are not recent and detailed enough to provide helpful information.
The connection between this article and Sen is that they both discuss the interconnections between different freedoms. For example, the article points out that level of poverty and economic development can be associated with quality of healthcare. The article also suggests that the implementation of a better transportation infrastructure will lead to improvements in the accessibility of healthcare, resources, and economic growth in rural areas of Africa. The authors used the global land cover dataset provided by GlobCover to understand the population distribution data of Africa. They also used data provided from the most recent censuses from each African country that provided information on human population census data, population sizes, and corresponding administrative unit boundaries. Lastly, the authors used a population density map of Namibia provided by Afripop. The geospatial data science methods used include a modelling method that differentiates urban and rural populations based on settlements and land cover-based weightings with support from the GRUMP urban extents. In regard to the scientific question of the article, the authors were seeking to understand and answer how and to what extent the accessibility of urbanized areas impacts the resources, services, and opportunities available to populations in rural areas.
This article discusses the significance of quality healthcare professionals in reducing maternal mortality. It’s noted by the authors that births outside of health facilities in low and middle-income countries are not as likely to have a skilled attendant present. The article states that “a skilled birth attendant has a broader team including nurses, midwives, anaesthetists, and specialized doctors such as obstetricians and paediatricians.” The article also mentions that the speed at which a woman must travel to a health facility when about to give birth is critical for limiting the potential for maternal mortality. The article goes on to explain that there is very little research that has been conducted on how both the distance and quality of healthcare available influence the usage of skilled birth attendants in low and middle-income countries. The location that the authors decided to focus their research on was Eastern Region, Ghana. This selection was due to the fact that there was available spatial data on the geographical locations of health facilities and communities in that area, as well as health management information systems data since the Eastern Region was mostly publicly funded. It is also mentioned that the authors believe the study was the first to illustrate childbirth-related patient flows to health facilities at a subnational level in Africa.
This article relates to Sen and his description of human development because of how the authors established the consequences of limited adequate skilled birth attendants as potentially increasing the possibility that a woman has a birth outside of any healthcare facility, and more importantly, increasing the rate of maternal mortality. The dimension of human development being addressed is the rate of maternal mortality. The article states that four secondary data sets were utilized, “namely health management information system records of hospital-based births; locations of health facilities reporting through the health management information system; a nationally representative sample survey of emergency obstetric and newborn care services at health facilities; and gridded estimated number of pregnancies.” This data was provided by Ghana’s District Health Information Systems 2 database, that additionally provided more specific information such as the mother’s place of residence, age, occupation, educational status, health insurance, parity, type of birth, and birth outcome. The use of “locational data sets from the Centre for Geographical Information Systems and Remote Sensing-University of Ghana, Google Maps and a Global Positioning System survey of settlements conducted by the Ghana Health Services” was also utilized. The geospatial data science methods involved include a spatial interaction model which provides a better understanding of the traveling tendencies of populations. A cross-sectional study design was also used to gain insight on how many women used public secondary healthcare facilities in the Eastern Region of Ghana. The scientific question that the authors attempted to answer was what the level of influence that distance and quality of healthcare had on women expecting to give birth in the Eastern Region of Ghana, and whether they would utilize healthcare facilities.
Considering that all my sources are focused on countries (Ghana, Kenya, and Nigeria) in Sub-Saharan Africa, aside from the Linard article that was more general but still made mention of Namibia, I believe that a strong option for the area of choice in my exploration of accessible healthcare would be in Sub-Saharan Africa. More specifically, I believe Nigeria, the most populated country in Africa, would be a good choice to investigate further. I had mixed emotions about this topic of accessible healthcare when reading my sources. On one hand, I was concerned about how many of the authors discussed inconsistent, inaccurate and outdated information on a range of topics, but on the other hand, intrigued by what new research will discover and how it will compare with the old data. I understand that accessible healthcare has become a fairly large issue in Sub-Saharan Africa, but as I recall Hans Rosling’s TedTalk, I wonder how much of what I understand is true and not misled by past experiences and media.