Analyzing spatial disparities in access to health care: A methodology with application in Bangladesh

This paper develops a methodology for analyzing spatial disparities in access to health care in situations where the data base is limited, and applies it in the context of Bangladesh. The proposed indirect measures of inpatient and outpatient service utilization, and of quality of available services, seem to provide reasonably accurate, consistent, and interpretable results; these indices are combined into a composite index of relative access to health care. The form of the composite index and its components permits the incorporation of Sopher's disparity index into the methodology for measuring urban-rural disparities in relative access to health care. The empirical analysis based on subdivision level data revealed that Bangladesh's health care delivery system is, in general, characterized by extremely low level of access and a high degree of disparity in favor of urban areas, especially in terms of inpatient services. Spatial patterns of relative access and urban/rural disparity were perused through cartographic and statistical analyses; although clear-cut regional patterns did not emerge, the considerable spatial variations could be explained largely with reference to urbanization and density of population. Assuming improved level of access and minimal urban/rural disparity as basic policy goals a method to prioritize spatial units for future allocation of health sector resources is recommended.The author gratefully acknowledges the helpful comments on an earlier draft of this paper by Dr. S. M. Bhardwaj, Professor of Geography, Kent State University.