Measuring the need for primary health care: an index of relative disadvantage

The prime objective of primary health care provision is the maintenance or improvement of the population's health. The equitable distribution of resources is paramount to this and measures of disadvantage are implemented to assess differential levels of need as a basis for calculating deprivation payments according to general practitioner workload. Despite research that highlights the benefits of measures of social disadvantage, indices have not been used to fundamentally shape resource allocation for health authorities. This paper uses the results from a patient survey into utilization behaviour to define and model the determinants of the need for health care based on components of relative need and accessibility. Proxy indicators are derived from routine sources of data to create an Index of Relative Disadvantage (IRD). A sensitivity analysis confirms the robustness of the index and shows that—although the index employs a wider range of variables than most previous deprivation indices—there is no gross data redundancy. Simplified versions of the index are also explored and evaluated. The IRD developed here is closely correlated with other indices of disadvantage, but its greater breadth and more logical construction mean that it may be more likely to be a more widely applicable instrument for health care planning of resource allocation.     

Exploiting available data sources: location/allocation modeling for health service planning in rural Ghana

The preconditions for applying GIS-based location-allocation analysis for health service planning in rural Ghana are examined in terms of data availability and quality. A population map is established from the latest available census using geo-coding methods and digital topographic sheets. A vector-based transport model of the region is established by merging data from several sources including GPS. It is suggested that a hybrid transport model is required. This model combines the possibilities for all-direction transportation inherent in the raster-based approach with the possibilities for road/path transportation inherent in the vector-based approach. All-direction movements are expected to take place close to the villages in order to reach a suitable linear transport corridor represented by a vector. Several scenarios for improving the accessibility aspects of the health service provision are examined in light of Ghana's current health service policy. Location-allocation modelling tools are used to select optimal locations and provide statistics on average distance to health centres and percentage of population covered.     

Pastoral mobility, sedentarization and accessibility of health services in the northeast Badia of Jordan

The World Health Organisation (WHO) has attempted to achieve ‘Health for All by the Year 2000’. However, this aim has been limited in its success and significant levels of poor health remain. The WHO concede this and have revised their slogan: ‘Health for All in the Twenty-First Century’. One of the central problems has been social and geographical inequity of development and, importantly, that health services are inaccessible to large segments of the population in many developing countries. To this end, the Jordanian government has attempted to improve accessibility in rural communities by providing an extensive network of basic rural health clinics. However, a significant factor impeding this goal has been that much of the population is dispersed and that many practise pastoral nomadism. This paper reviews the extent to which rural clinical services have been made accessible to the nomadic and sedentarizing population of the northeast Jordan Badia.     

Understanding usage and preference for health care therapies in a Ghanaian context: A pluralistic perspective

Studies of health care and health-care seeking behaviour in Ghana have mainly shown that many patients tend to use indigenous medicine to address their health care needs. These studies have cited affordability, acceptability, availability, and accessibility as major factors behind the predominant use of indigenous medicine. Nevertheless, in these studies, researchers often ignore the third health care option – self-care, usually subjugated under the indigenous medical system. Since the mid-1980s, both biomedical and indigenous health care systems have witnessed transformations that have shaped and changed their modes of operation, as well as the cost of treatment. In light of this, the author seeks to understand the motivations behind the preference for and use of self-care, professional biomedical care, and indigenous forms of care in the context of Ghana’s health care system. A qualitative, in-depth interview technique was used for data gathering. Findings from the study revealed that time and cost of treatment were major factors accounting for the predominant use of self-care. The author concludes that the findings challenge the long-held belief that biomedicine is not widely accepted by people in Ghana compared with indigenous medicine.     

Towards a framework for delineating sub-districts for primary health care administration in rural Ghana: A case study using GIS

This paper examines the need to carry out primary health care administration, programming and planning beyond the established 110 districts in Ghana. The framework for delimiting the sub-districts is offered by the availability of digital data such as the district boundary, site location, road network and population. Using the specified travel distance from predetermined sites, network analysis generates approximate polygons around the health centres to create functional areas ? the health sub-districts. Additional sites are proposed based on a set of criteria which includes proximity, centrality, population and existing level of infrastructural development in an attempt to improve coverage and bring the total utilization of health facilities closer to 100% in the study area.     

广州市城中村农民工医疗行为及其空间特征——以新凤凰村为例

运用结构式访谈和深度访谈的调查方法,以城中村的农民工为研究对象,分析其医疗行为及空间特征,并探讨其形成原因。研究发现:城中村的农民工医疗保健水平低,医疗机构的使用率低;在医疗制度不完善的背景下,农民工能动地通过各种途径解决医疗需求,形成三种类型的医疗行为模式,即"自力更生"型、"社会资本"依赖型及"经济实力"型。结合医疗机构的空间分布,农民工医疗行为的空间特征符合距离衰减规律,同时表现出明显的波动性,表现为一个跳跃式五圈层结构。本研究试图为改善农民工的健康行为模式提供科学基础,并在一定程度上补充国内城市保健地理及行为地理的研究。     

Regional innovation systems,high-technology development,and governance in the periphery: The case of Northern Finland

The article examines high-technology development networks in peripheral areas using the case of Northern Finland (as defined by the EU under its Structural Funds programme). Few material and social resources and long distances between key development actors are challenging for research and the development of technologies targeted at global markets. The case study concerns the regional innovation system-based Multipolis network, which brings together technology-related actors in Northern Finland, located on both sides of the Arctic Circle, in an area of c.155,000 km² and with a population of 0.7 million. The results of the research, which used Q-methodology, reveal that networking is needed between technology development actors in the region and at various spatial levels. However, conflicting viewpoints on the development of Northern Finland exist, and indicate a mismatch between competitiveness policies to support high-technology development and regional policies to promote local employment. It is recommended that more attention should be paid to the governance of technology development in peripheral areas.     

特大城市医疗公共服务可达性的空间格局及其影响因素分析——以上海市为例

大城市通常是医疗资源最为丰富的地区,但普遍存在配置不均的问题。精准地衡量城市医疗公共服务的空间异质性、合理规划医疗公共空间,是实现城市稳定健康发展的重要保障。以上海市为例,运用改进两步移动搜索法,从乡镇（街道）尺度测算医疗服务设施的空间可达性,并结合基尼系数和空间自相关分析探究上海市医疗服务设施可达性的空间分异特征,探讨了影响上海市医疗服务资源可达性空间格局的主要因素。研究表明：上海市医疗公共服务可达性自中心城区向郊区逐渐递减;可达性高值区集中在外环线以内及其沿线地区,可达性低值区集中在远郊区。医疗资源呈现向心化集聚,满足了中心城区高密度的人口和体量庞大的老年人口就医需求;中心城区医疗服务资源配置相对均衡,可达性差异较小,而郊区医疗服务的可达性差异较大;上海市医疗服务可达性空间格局受人口密度和经济发展显著影响,上海市政府医疗财政支付对街道尺度的医疗服务设施空间可达性作用较小。在未来,在城市医疗卫生服务资源配置中注重人口集聚导向,建立医疗卫生人员双向流动的常态化机制是提升上海市医疗公共服务能力,优化城市医疗公共设施可达性的重要方向。     

基于空间句法的城市立体交通通达性模型及其应用——以石家庄市为例

当前通达性研究多单方面关注地面交通或地下轨道交通,缺少对地面、地下一体化立体交通通达性的研究。利用空间句法形态分析变量,分别表述地面和地下交通的通达性,并以地面公交站点通过的公交车数量作为权重因子,构建地下交通通达性向地面交通传递的纽带,最终建立城市立体交通空间通达性模型。研究表明,该模型可用于立体交通通达性的计算,定量描述结果更符合城市交通通达性现实状况,可作为城市科学布局与发展的依据。     

基于GIS的县级市医疗机构空间可达性分析——以福建省石狮市为例

基于福建省石狮市行政区划及交通网络图,结合石狮市2008年末人口分布数据以及最近的医疗机构相关数据,运用最近就医距离模型、潜能模型及改进的潜能模型3个空间可达性模型,利用GIS技术和空间可达性指标评估医疗机构空间分布的合理性,详细分析了石狮市镇级以上医疗机构的空间布局.结果显示:石狮市医疗机构分布偏东西方向集中,南北分布的蚶江镇、永宁镇医疗资源缺少,总体分布不均衡.研究认为,利用改进的潜能模型,选择合适的阻抗系数能得出更加合理的空间可达性指标,突出空间可达性差异问题,可为医疗机构的空间格局优化提供参考,并为医疗卫生事业改革中设施规划和资源分配提供重要依据.     

城市新区教育设施可达性评价与空间优化——以深圳市坪山区为例

城市新区在发展过程中面临教育设施供给不足和不均衡的问题,可达性与空间优化方法能够为解决该问题提供科学依据。以深圳市坪山区为例,从供需关系出发,运用高斯两步移动搜寻法和改进的p-中位模型,探讨城市新区教育设施的可达性评价与空间优化,提出优化迫切度概念,分析得到教育设施优化区位和规模。结果表明:坪山区各层级教育设施可达性均存在明显空间差异;优化迫切度结果能够为设施配置的重点区域及优先次序提供依据;优化后各层级教育设施分布比较均衡,与人口分布较为契合;优化结果反映出相关规划标准存在不适用性,应注重规划标准差异化的研究。将城市教育设施空间布局评价和区位优化相结合,能为深圳市坪山区教育设施布局规划提供科学依据。     

社区生活圈基础教育设施空间可达性评价与布局优化研究

使用基于Rhino平台的UNA工具包,从住宅楼层面对大连市沙河口区幼儿园、小学和初中3类基础教育设施的空间可达性进行分析,并提出布局优化措施及新增选址方案。主要结论如下：① 各类基础教育设施空间分布不均,存在重复与缺失并存的现象;设施与住宅楼空间分布“错位”现象严重。② 各类基础教育设施均存在服务范围内住宅楼数量较少的问题,学区内的学生上下学需要耗费较长的路程与时间,若设施仅服务于规定服务范围内的居民,则部分设施会存在利用不足的情况。③ 在规定服务范围内,初中的可达比重最大,其次是小学和幼儿园。在规定服务范围外,幼儿园可达性为差及以下的比重最大,其次是初中和小学。④ 设施布局主要存在2个问题：设施供应不足和设施利用不足,对此提出相应的优化思路。并在考虑可达性和供需的情况下,提出2个新增设施参考选址方案,以改善设施可达性。其中方案一增加140所,方案二增加107所。     

教育公共服务设施可达性评价与规划——以江苏省仪征市高级中学为例

学校是公共服务设施的重要组成部分,其空间分布以及可达性的优劣,直接影响到受教育者接受教育的机会和方便程度。把可达性的概念引入到教育公共设施的规划中,利用Mapinfo公司的控件MapX和Borland公司的可视化编程语言Delphi,开发了基于时间最短的路径选择信息系统,生成了学校可达性的等时线图和学校服务范围图,通过该系统可直观地看到区域内任何一点到达学校所花费的最短时间以及通过的路径。以江苏省仪征市的高级中学为例,运用该系统对高级中学的可达性进行了评价,并提出了其规划方案。     

广东省医疗与养老设施空间格局、适老化与均等性——基于空间可达性的评价

以广东省为例,采用改进两步移动搜索法测算医疗与养老设施可达性,然后采用自相关分析法、基尼系数分析医疗与养老设施的适老化及均等性,最后运用Spearman相关系数对医疗与养老设施可达性及均等性的影响因素进行分析。结果表明：1）改进两步移动搜索法更能准确反映医疗与养老设施可达性,珠三角地区老年人医疗、养老设施可达性相对较好,东、西部沿海经济区相对较差;但珠三角地区养老设施医疗可达性在四大区域中最差。2）广佛都市区、梅州市北部等地区的医疗与养老设施适老化不足,广东省医疗与养老设施可达性存在较大的不均等。3）路网密度、人口密度、人均GDP、公共财政支出与广东省医疗、养老设施可达性显著相关,平均海拔、生态环境状况指数、面积、路网密度、人口密度、人均GDP、公共财政支出与广东省老年人医疗、养老设施可达性的均等性显著相关。     

Geographic Variation in Services under Different Providers: The Case of Formal Child Care in Ontario

This study concerns geographic variation in levels of formal child care provision in the province of Ontario, Canada. The historical development of the decentralized service system is described, highlighting the emergence of public nonprofit, private nonprofit, and private proprietary service providers. Several policy measures in the recent past have attempted to restrict development of proprietary services, and this study examines in detail the geographic distribution of services prior to a number of these initiatives. Correlation analysis shows that service levels are related to measures of socioeconomic status, service need, and size and distribution of area populations. A regression model accounting for service levels in terms of socioeconomic status, single-parent families, and regional effects is described. Results differ by provider sector. Private nonprofit service levels are related to all three factors. Private proprietary services respond to socioeconomic status and to regional effects, but not to need measures. Service levels in the public nonprofit sector are not related to the model of service provision described here.     

基于学籍地址和地理编码的乡村小学教育资源空间可达性分析

基于“学籍信息中的家庭地址承载了学生空间位置”这一假设,通过学籍信息收集了湖南省株洲县小学生的家庭地址,借助高德开放平台提供的地理编码和POI搜索服务,获得到了株洲县小学生的空间位置和分布,并基于最短路径分析和高斯型两步移动搜索法分析了株洲县小学教育资源的空间可达性及其特征,尝试为区域教育资源的空间均衡性分析与规划配置提供新的数据源和方法借鉴。结果表明：① 基于学籍地址和地理编码技术能够较准确地获取株洲县小学生的空间分布。② 株洲县小学生就近入学距离的最大值、平均值和中位数分别为11.83 km、2.10 km和1.81 km,就近入学距离小于2.0 km的学生仅占55.46%,为株洲县兼顾公平和效率的教育资源配置工作带来了挑战。③ 株洲县北部城镇地区因学校数量较多,平均就近入学距离较小,教育资源的空间可达性普遍较高,且空间差异小,均衡性好;而东南部的乡村地区,平均就近入学距离较大,教育资源的空间可达性普遍较低,且空间差异大。④ 基于情景分析,在不造成局地生源稳定性问题的前提下,新增3所学校后,东南部地区的平均就近入学距离和教育资源的空间可达性有很大的改善,龙潭镇和龙门镇的平均入学距离由3784 m和3520 m降低到3116 m和2636 m,教育资源的空间可达性分别由0.0492和0.0982提高到0.0762和0.1496。     

气候增暖背景下的冬小麦种植北界研究——以辽宁省为例

本文以辽宁省 1 991～ 1 999年冬小麦地理播种试验观测资料和现代气象观测资料为基础 ,系统研究了辽宁省冬小麦的种植北界问题。根据试验观测资料 ,利用灰色关联分析方法 ,揭示出越冬前积温、越冬前降水、越冬期负积温以及 5～ 6月份降水是影响冬麦种植的 4个关键性影响因子。通过对逐年越冬前活动积温所作的分析 ,得到了气候保证率在80 %以上的北界 ,并利用负地积温指标对所确定的北界进行了验证。结论是辽宁省冬麦可北移至本溪—抚顺—法库—彰武—阜新—北票—朝阳一线 (约 42 .5°N)     

Rural Local Economic Development and Land Restitution in South Africa: The Case of Schmidtsdrift,Northern Cape

Local Economic Development is (LED) an activity of increasing importance in the developing world as globalisation produces new roles for local governments. As compared to a growing number of urban initiatives for LED, rural LED initiatives are relatively undeveloped. In this paper, the focus is upon South Africa, where the post‐apartheid government has sought to encourage both urban and rural LED initiatives. Programmes of land reform and restitution in South Africa result in the resettlement or return to the land of communities formerly dispossessed under apartheid. A critical element of planning for successful resettlement is the implementation of LED programmes. Schmidtsdrift in Northern Cape is examined as an example of participatory LED in a developing rural context. Rural LED in South Africa is distinguished by its focus upon poverty alleviation in the context of addressing the legacies of apartheid.     

中国北方草原沙漠化发展过程及其成因分析——以内蒙古苏尼特左旗为例

利用遥感监测和实地调查研究相结合的办法,研究分析了中国北方草原沙漠化动态变化趋势和发展原因。结果表明:苏尼特左旗沙漠化形势非常严峻,包括北部广阔草原地区的沙漠化和南部沙丘活化两大类型。苏尼特左旗在过去30余年里,沙漠化土地总面积在增加,而沙漠化指数（ADI）在2000—2005年间略有减小,反映出2000—2005年间研究区沙漠化程度略有恢复。研究区两大类沙漠化土地发展变化趋势并不相同,草原沙漠化在过去30余年里一直在发展,由斑块状向片状发展;而沙丘活化则在1973—1987年间强烈发展,在1987年以后则呈现出恢复逆转的态势,沙丘活化对气候变化表现出较高的响应,揭示出苏尼特左旗南部沙漠化的发展受人类活动影响较小,主要与气候变化有关。北部大面积的草原沙漠化与气候变化趋势不完全一致,主要随着人类过渡放牧活动或者大规模保护恢复活动,而发生沙漠化严重程度的加剧或减缓。苏尼特左旗的沙漠化发展状况表明,中国北方草原沙漠化发展以人类活动占主导地位,且以斑块状向连片发展为主要形式,其中围绕居民点和水源的沙漠化发展最为突出。实践表明,科学管理人类活动完全可以减缓甚至恢复中国北方草原区的沙漠化土地。     

基于EPIC模型的黄淮海夏玉米旱灾风险评价

玉米是中国最主要的粮食作物之一,因其较高的需水量,受气候影响,极易遭受旱灾。因此,以黄淮海夏播玉米区为例,从风险的角度进行玉米旱灾评价,对于农业旱灾预警和保障国家粮食安全具有重要的现实和指导意义。在全面收集研究区气象、土壤、土地利用、农气观测等资料的基础上,基于农业旱灾风险评价的概念框架“致灾因子危险性H评价(Hazard)-承灾体脆弱性曲线Vc 评价(Vulnerability Curve)-作物减产风险性R评价(Risk)”,引入基于物理过程的作物模型EPIC (Erosion Productivity Impact Calulator),采用作物模型模拟和数字制图等技术,分别从全生育期和分生育期角度,对黄淮海夏播玉米区玉米旱灾风险的时空分布进行了定量评价。结果表明：在2、5、10 和20 年一遇致灾水平下,黄淮海夏播玉米区玉米旱灾减产风险总体呈现出从西北向东南方向递减的趋势,这主要由气候环境和下垫面的地形地貌条件所决定。20 年一遇水平时,产量损失风险的高值区(R ≥ 0.5) 集中分布在冀北高原山地和山东省中南部地区,占黄淮海夏播玉米区玉米总面积的7.63%。黄淮海夏播玉米区成灾风险较高的生育期：拔节期-抽雄期、抽雄期-乳熟期、乳熟期-成熟期应加强防范。研究可为高风险区和高风险时段的玉米旱灾风险防范提供理论依据和科技支撑。