A composed index of critical accessibility (CICA) to healthcare services in a traditional African City

While empirical works that analyse rural–urban differentials in accessibility to health services are common in the developing countries, systematic studies focusing on intra-urban variations in accessibility to overall healthcare resources remain scant. Yet, many urban dwellers especially in the Sub-Saharan Africa have to travel long distances within the urban space to access basic health services. This study employs composed index of critical accessibility (CICA) to analyse differentials in access to health resources in Ibadan, a traditional African City. Data on healthcare centre location, ownership, doctors’ population were collected through field survey while spatial data on the administrative units and populated places were obtained from archival sources. Also, data on road networks was collected. Results show that the distribution of health facilities across local administrative units varies. In terms health facilities, Ibadan South West has 26 (36 %) of the total number while Ibadan South east has only 7 (9.8 %). The Doctor-Population Ratio also exhibits similar variations as Ibadan North has 20.5 as against 2.2, 1.9 and 0.3 for Ibadan SW, Ibadan NW and Ibadan NE respectively. The CICA analysis shows that 228,938 inhabitants are in high risk of negative accessibility while 49,234 are faced with condition of low risk of negative accessibility, which implies that a significant proportion of the population still finds it difficult to access basic health services as and when needed. The variations in the distribution of this deprived population are also noteworthy as the largest proportion of this group was localized in Ibadan NW. This has grave implication for the health and wellbeing of the population and raises once again the question of spatial equity in the delivery of urban public service. Curiously, these differences in the level of accessibility cut across administrative boundaries which brings to the fore the role of jurisdictional partitioning in ensuring equity in the delivery of urban public services. This opens a vista of research opportunity into the role jurisdictional partitioning in service provision in the urban centres.     

Changing levels of disparity in material well being: highlighting rural urban differentials in West Bengal,India

This study assesses the disparity in the level of material wellbeing between the rural and urban areas of various districts of West Bengal. To measure the level of material wellbeing three broad domains comprising of Housing index (HI), Basic Amenities Index (BAI) and Asset Index (AI) following which a composite index (Material Wellbeing Indexi.e. MWI) was computed for the urban and the rural areas for all the districts between the time frame of 2001–2011. A set of 14 sub-indicators were selected for the analysis. This paper takes into account the differentials between the urban and the rural areas of the state. The data was subjected to correlation analysis, ANOVA and PCA, intra-zonal analysis was also performed. The results show the presence of widespread levels of disparity between the various districts as well as within the districts. Over the course of the years this disparity has increased in case of the northern zone however intra and inter zonal disparity runs high. Among the different sub-indicators, BAI has recorded the highest decrease in the differentials whereas the AI has recorded the highest increase in the differentials. Among the districts eight of them have recorded a net increase in the differentials in MWI among which Maldah has recorded the highest decrease in the differentials whereas Dakshin Dinajpur has recorded the highest increase in the differentials.

     

Determinants of utilisation of health services by women in rural and urban areas in Ghana

The paper examines the factors that influence the utilisation of health services by women in the rural and urban areas in Ghana. The systematic sampling procedure was used to draw the sample from women aged 18 and above with diverse backgrounds from Ahafo-Ano South district, representing the rural districts and Kumasi metropolis, representing the urban districts. The research instruments used for data collection were the questionnaire and formal interviews. Multiple regression was the main tool for analysis. The research reveals that the key factors that impact significantly on the utilisation of health services by women in the Ahafo-Ano South district are, distance, income and family size (number of children) while for Kumasi metropolis they are education, distance and marital status. Whereas it is clear that distance is a common problem facing women in both rural and urban areas in Ghana in the utilisation of health services, marital status and number of children have emerged as contrasting factors influencing utilisation of health services by women in rural and urban Ghana. Recommendations to improve utilisation include the location of maternal and child health services within easy reach in the rural areas, intensification of family planning education in the rural areas, the empowerment of women through access to formal education and vocational training for income generation activities and the full implementation of the National Health Insurance Scheme (NHIS). A model of utilisation of health services by women in the rural and urban areas has emerged.     

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The paper examines the factors that influence the utilisation of health services by women in the rural and urban areas in Ghana. The systematic sampling procedure was used to draw the sample from women aged 18 and above with diverse backgrounds from Ahafo-Ano South district, representing the rural districts and Kumasi metropolis, representing the urban districts. The research instruments used for data collection were the questionnaire and formal interviews. Multiple regression was the main tool for analysis. The research reveals that the key factors that impact significantly on the utilisation of health services by women in the Ahafo-Ano South district are, distance, income and family size (number of children) while for Kumasi metropolis they are education, distance and marital status. Whereas it is clear that distance is a common problem facing women in both rural and urban areas in Ghana in the utilisation of health services, marital status and number of children have emerged as contrasting factors influencing utilisation of health services by women in rural and urban Ghana. Recommendations to improve utilisation include the location of maternal and child health services within easy reach in the rural areas, intensification of family planning education in the rural areas, the empowerment of women through access to formal education and vocational training for income generation activities and the full implementation of the National Health Insurance Scheme (NHIS). A model of utilisation of health services by women in the rural and urban areas has emerged.     

Social justice and access to legal services: a geographical perspective

This paper discusses the theory, method and results of the Exeter Access to Justice in Rural Britain project which examined the question whether rural inhabitants are disadvantaged in terms of their access to legal services by comparison with people in urban areas. Analysis of the spatial distribution of solicitors in private practice in England and Wales revealed rural areas to be relatively well provided for. An interview survey of a random sample of solicitors in Devon and Cornwall showed some important differences between rural and urban solicitors, with the former being less specialized and more conservative in orientation. A parallel survey of managers of CABs, providing a limited legal service, also revealed some perceived differences between rural and urban bureaux and some spatial unevenness in distribution. Surveys of rural clients, supported by parallel studies elsewhere in Britain, suggest that remote rural communities harbour cases of considerable deprivation with respect to legal services.     

Breadth and depth in research on health disparities: commentary on the work of Nancy Krieger

Geocoding and spatial analysis of data describing populations and health events are important methods in health social science now carried out using GIS technology. This commentary considers Nancy Krieger’s work on health disparities in light of the various ways individuals and organizations use geocoded population and health data: analyzing spatial patterns of health and disease including health disparities, aggregating data spatially, assessing health status of individuals based on characteristics of aggregates, modeling neighborhood contextual factors affecting health, designing observation and intervention studies, and delivering health interventions and services. The extent to which her work addresses each of these purposes is considered. The strengths and limitations of the research including choice of spatial analytic units and techniques as reported in the published work are discussed. Krieger’s work, with her colleagues, has used standard methods of spatial analysis to raise the profile of GIS and spatial analysis in the public health community.     

Private non-degree practitioners and spatial access to out-patient care in rural India

Most rural areas in the developing countries lack access to qualified out-patient (OPD) care. The gap in health services provision arises, due to lack of qualified doctors and is oftentimes filled by unqualified doctors who are also known as private non-degree practitioners (PNDPs). Despite their dominance, their presence is often neglected in access to health care studies. This leaves a scenario which lacks informal, but predominant, care. This paper uses a mix-method approach, combining exhaustive quantitative census of all health care providers along with location details in Geographic Information System to address the accessibility to PNDP. Longitudinal quantitative as well as spatial surveys were conducted for 3 years (2010, 2012 and 2013) in districts of Pratapgarh and Kanpur Dehat in state of Uttar Pradesh and Vaishali in Bihar state. The results of this study show that PNDPs account for 25 % of the all health care providers active across the study areas. The PNDPs are active in a radius of 2–5 km and are main workforce for the OPD care. Considering all health care providers PNDPs provide best potential accessibility to OPD care. If the PNDPs are removed from the scenario; remote areas will be the most affected ones, leaving them with almost no OPD care.     

苏南地区城乡聚落空间演化过程及其格局特征

当前,城乡聚落空间正由自然和经济社会条件存在差异的等级体系转变为密切联系的网络化结构,城乡融合已经成为中国城乡聚落空间演化发展的重要方向。以苏南地区为例,对20世纪90年代以来的城乡聚落空间演化过程及其格局特征进行分析,发现2000年以后城镇聚落扩张强度远高于乡村聚落,城乡聚落空间结构可进一步归纳为集中、双心、多核和密集4种基本格局。该研究对乡村振兴背景下的城乡聚落空间优化布局具有一定指导作用。     

Soil sealing,population structure and the socioeconomic context: a local-scale assessment

In the most recent decades European urban regions underwent functional changes reflecting heterogeneous land-use patterns and specific urban footprints. Several mono-centric cities shifted towards a scattered development with impact on the socio-spatial structure. Discontinuous expansion determined, in some cases, a net increase in land consumption. Using a multivariate exploratory approach, the present study analyzes the spatial relationships between 14 morphological variables and 22 socioeconomic indicators in Rome’s province. The aim of this study was to identify the demographic and socioeconomic indicators most associated to the transition from a mono-centric and semi-compact morphology towards a more dispersed settlement structure based on different sealing profiles observed at the local scale. Four groups of socioeconomic indicators (population structure, job market, economic specialization and settlement characteristics) associated to different sealing profiles (low, medium and high imperviousness) were identified and local municipalities classified accordingly. Although the urban–rural axis maintains an important role in the spatial organization of Rome’s province, other variables were found associated to areas with moderately low imperviousness, evidencing a specific demographic structure and persisting socioeconomic disparities at the base of the settlement model observed at the regional scale.     

Women's migration and quality of life in Turkey

Turkey's urban growth has been unprecedented for the last two decades with women playing an increasingly substantial role in its development. In this context, we examine determinants of women's migration and quality of life in cities in 1990 (the most recent published census of Turkey) and onwards. Factor analysis of provincial data identified three quality of life dimensions: affluence, deprivation, and housing. Substantial disparities in quality of life indices exist between men and women, urban and rural milieu, and geographic regions. Migrants, especially women, still tend to move with their families but they prefer provinces with high scores on (relative) urban affluence and avoid deprived, rural provinces. Thus Istanbul, Ankara, and southern coastal provinces are preferred destinations. Policy implications for urban growth, regional development, and gender equality relative to migration are discussed.     

The determinants of primary health care utilization: a comparison of three rural clinics in Southern Honduras

Primary health care utilization is poorly understood in many parts of the developing world. This is especially true in rural places, such as Santa Lucia, Intibuca, Honduras, where there are only three primary health care facilities servicing almost 12,000 people, and generally speaking access to care is limited. This study examines the factors that can be used to explain primary health care utilization, and aims to improve the understanding of patient utilization behavior. A better understanding of utilization can be used by health service planners to improve primary health care delivery in this and similar locations. The findings of this research indicate that utilization can be explained, to a large extent, by factors relating to economic status and walking time to clinic. These findings are consistent with findings from prior research. In addition, a home territory variable is used to examine spatial variations of utilization behavior. This variable has not been considered in previous utilization research, and is found to be a very significant determinant of health facility utilization in the study area.     

Changing poverty distribution in Bolivia: the role of rural–urban migration and urban services

Bolivia is a country with high levels of poverty and inequality among its peoples and regions. For the nation and its urban and rural areas, trends in the social and spatial distribution of poverty (and extreme poverty) are identified from 1976 to 2003 using UBN data with minor support where appropriate from poverty lines. The main survey between 1992 and 2001 uses composite and selected UBN to track detailed poverty change for the country’s nine departments, its ten largest cities and a selection of other smaller urban and rural municipalities. Because of rising background increases in population in the various surveyed administrative units, many instances of relative reductions in poverty are accompanied by rising absolute increases. Marked spatial variations in poverty and development in the country over the last several decades are identified as the main driver for the country’s quickening pace of rural–urban migration. As a result, the paper concludes by assessing two different but closely related views. One investigation tests the notion that because more poor people have been living in Bolivia’s cities than in its rural areas since the mid to late 1990s, rapid rural–urban migration has simply shifted the locus of poverty from the countryside to the cities in a process called, the ‘urbanisation of poverty.’ A second, more challenging, investigation assesses the view that the flow of poor rural people to the better serviced urban areas of Bolivia has actually acted to alleviate national poverty levels.     

Accessibility, mobility and transport-related welfare: the case of rural wales

The welfare of rural communities depends to a large extent on standards of mobility and accessibility to (mainly urban) services. Probably the most valid measure is based on the needs and time/space budgets of specific population groups in specific villages (MOSELEY et al., 1977). For policy applications, there is a need for a way of evaluating ‘personal accessibility’ over a broader region rather than the detailed local case studies which such methods demand. A series of maps depicting aspects of accessibility and mobility is constructed for Rural Wales, at a parish level. The problem of weighting is potentially intractable, but it is argued that a simple points system is acceptable in combining these measures into a composite index.     

Which households are most distant from health centers in rural China? Evidence from a GIS network analysis

In this paper we have two objectives—one empirical; one methodological. Although China’s leaders are beginning to pay attention to health care in rural China, there are still concerns about access to health services. To examine this issue, we use measures of travel distances to health services to examine the nature of coverage in Shaanxi Province, our case study. The mean distance by road to the nearest health center is still more than 6 km. When we use thresholds for access of 5 and 10 km we find that more than 40 (15) percent of the rural population lives outside of these 5 (10) kilometer service areas for health centers. The nature of the access differs by geographical region and demographic composition of the household. The methodological contribution of our paper originates from a key feature of our analysis in which we use Geographic Information System (GIS) network analysis methods to measure traveling distance along the road network. We compare these measures to straight-line distance measures. Road distances (produced by network analysis) produce measures (using means) that are nearly twice as great as straight-line distances. Moreover, the errors in the measures (that is, the difference between road distances and straight-line distances) are not random. Therefore, traditional econometric methods of ameliorating the effects of measurement errors, such as instrument variables regression, will not produce consistent results when used with straight-line distances.     

Identifying urban–rural differences in social vulnerability to natural hazards: a case study of China

Identifying and analyzing the urban–rural differences of social vulnerability to natural hazards is imperative to ensure that urbanization develops in a way that lessens the impacts of disasters and generate building resilient livelihoods in China. Using data from the 2000 and 2010 population censuses, this study conducted an assessment of the social vulnerability index (SVI) by applying the projection pursuit cluster model. The temporal and spatial changes of social vulnerability in urban and rural areas were then examined during China’s rapid urbanization period. An index of urban–rural differences in social vulnerability (SVI_D) was derived, and the global and local Moran’s I of the SVI_D were calculated to assess the spatial variation and association between the urban and rural SVI. In order to fully determine the impacts of urbanization in relation to social vulnerability, a spatial autoregressive model and Bivariate Moran’s I between urbanization and SVI were both calculated. The urban and rural SVI both displayed a steadily decreasing trend from 2000 to 2010, although the urban SVI was always larger than the rural SVI in the same year. In 17.5% of the prefectures, the rural SVI was larger than the urban SVI in 2000, but was smaller than the urban SVI in 2010. About 12.6% of the urban areas in the prefectures became less vulnerable than rural areas over the study period, while in more than 51.73% of the prefectures the urban–rural SVI gap decreased over the same period. The SVI_D values in all prefectures had a significantly positive spatial autocorrelation and spatial clusters were apparent. Over time, social vulnerability to natural hazards at the prefecture-level displayed a gathering–scattering pattern across China. Though a regional variation of social vulnerability developed during China’s rapid urbanization, the overall trend was for a steady reduction in social vulnerability in both urban and rural areas.

     

Water and power in Santiago de Chile: Socio-spatial segregation through network integration

The analysis of the history of the management and distribution of electricity, water and sanitation networks in Santiago de Chile throws light on a problem which is central to thinking on the relationship between urban services management and territorial splintering: what is the impact of urban policy, in particular housing policy and urban planning, on access to services and on the potential levels of social segregation and institutional splintering of metropolises?The Chilean example is eminently anchored in its political and institutional history. We shall see, for example, that the authoritarian urban policy of the military government, associated with early liberal reform, enabled the improvement of access to networks in every municipality of the Greater Santiago area. However, this success, leading to the integration by urban services of a large territory, does not signify that networks remained neutral as regards the process of spatial segregation. Inversely, we can defend the theory that the presence of an integrated service was a necessary condition and a reinforcing factor of the process of urban spread and residential segregation. This paradoxical argument is a result of the ambivalent liberal network and urban policies of the military government. Urban expansion was largely sustained by the development of integrated infrastructures and universal services. The processes of liberalising land and urban services were mutually sustaining and provided the necessary conditions for the birth of an extremely intense movement of urban sprawl and segregation between 1985 and 2000.     

Dwellers’ perception toward the Urban services of Panskura Municipality,India: an application of importance-performance models

The provision of urban service and citizens’ satisfaction is an important key issue in urban planning. Importance-performance analysis (IPA) is an effective and widely applicable technique to explore consumer’s satisfaction. IPA helps to prioritize the management strategies for urban services using the IPA. Purpose of the present study is to assess the performance of urban services and citizen’s satisfaction level of Panskura municipality using IPA models and improvement index. A total of 629 valid household responses are collected with the help of the door-to-door primary survey technique. The study reveals that all the selected seven urban services have significant importance-performance gap except water supply. Residents of the Panskura municipality are very much satisfied with the water supply service because of the very minimum improvement score. The combined result of IPA matrices and improvement index suggests residents are dissatisfied to a great extent with the performance of four urban services, i.e. health, economy, transportation and sanitation. These urban services require a problem-solving urgent action for restoration of the performance status. The improvement and prioritization of urban service are also required to fulfil the demand of target groups.

     

Spatial patterns and correlates of mortality due to selected non-communicable diseases among adults in South Africa, 2011

South Africa has a high prevalence of non-communicable diseases (NCDs) compared to other African countries. Government has predicted that NCDs will be a major threat of health in the country in the next 20–30 years and recommended a significant reduction in NCDs. This research studies spatial patterns of deaths resulting from chronic lower respiratory diseases (CLRD), malignant neoplasms of digestive organs (MNDO), diabetes mellitus (DM) and cerebrovascular diseases (CVD) among adults aged 15–69 years in 2011 at municipality level. The study uses secondary data from the civil registration system; population census; and supplementary information from the Business Register and a database of public health facilities. Moran’s Index, hot spot analysis and geographically weighted regression were applied to measure spatial autocorrelation of age-standardised death rates; to identify municipalities of high risk of deaths due to selected NCDs; and associated socio-economic and demographic factors. Clusters of high risk of deaths from selected NCDs were identified, with those for CLRD and MNDO mainly in the urban municipalities around the mid and western parts of the country while for DM and CVD they occurred mostly in the urban and rural north-eastern part, as well as in the urban municipalities of Northern Cape for CVD. Hot spots showed differential socio-economic and demographic risk factors in NCDs, which included sex, urbanisation, density of public hospitals; death occurrence in health facilities; smoking; asbestos roofing; mining and quarrying businesses. Findings highlight the importance of community-specific interventions and the need for a neighbourhood-based approach in tackling NCDs.     

Social provision and service delivery: Problems of equity,health, and health care in rural Australia

A neglected area of Australian geographical research relates to the issue of how to ensure an equitable provision of services to inhabitants of rural areas. Equity, however defined, is a procedural concept, requiring the implementation of rules about how to allocate and distribute scarce resources. Equity, as a distributional principle, is an important consideration both in determining the actual amount and nature of resources available and in deciding who will get how much of what is available. Compared with other social goods, there is a particular insistence on equity with respect to health care services. This article outlines the problems characterizing health care provision in rural Australia. It evaluates fiscal equalization as one means by which the Federal Government attempts to ensure at least some equity in the provision and distribution of health care resources to areas of dispersed population. The findings reveal that fiscal equalization alone is unable to ensure equity. This is because of problems of how to assess the needs for and costs associated with providing health care services in areas of dispersed population, confusion between equality and equity, problems related to the differentiation of government functions in a federal system, and inadequacies associated with using hospital services as the basis for resource allocation. This article concludes that equity is more likely to be achieved when policy is oriented to health care rather than medical care and when provision and distribution of resources relates more to service outcomes than to service inputs.     

Juggling through Ghanaian urbanisation: flood hazard mapping of Kumasi

More recently, driven by rapid and unguided urbanisation and climate change, Ghanaian cities are increasingly becoming hotspots for severe flood-related events. This paper reviews urbanisation dynamics in Ghanaian cities, and maps flood hazard zones and access to flood relief services in Kumasi, drawing insight from multi-criteria analysis and spatial network analysis using ArcGIS 10.2. Findings indicate that flood hazard zones in Kumasi have been created by natural (e.g., climate change) and anthropogenic (e.g., urbanisation) factors, and the interaction thereof. While one would have expected the natural factors to guide, direct and steer the patterns of urban development from flood hazard zones, the GIS analysis shows that anthropogenic factors, particularly urbanisation, are increasingly concentrating population and physical structures in areas liable to flooding in the urban environment. This situation is compounded by rapid land cover/use changes and widespread haphazard development across the city. Regrettably, findings show that urban residents living in flood hazard zones in Kumasi are also geographically disadvantaged in terms of access to emergency services compared to those living in well-planned neighbourhoods.