It's a long, long walk: accessibility to hospitals, maternity and integrated health centers in Niger

Abstract

Background: Ease of access to health care is of great importance in any country but particularly in countries such as Niger where restricted access can put people at risk of mortality from diseases such as measles, meningitis, polio, pneumonia and malaria. This paper analyzes the physical access of populations to health facilities within Niger with an emphasis on the effect of seasonal conditions and the implications of these conditions in terms of availability of adequate health services, provision of drugs and vaccinations. The majority of the transport within Niger is pedestrian, thus the paper emphasizes access by those walking to facilities for care. Further analysis compared the change in accessibility for vehicular travel since public health workers do travel by vehicle when carrying out vaccination campaigns and related proactive health care activities.

Results: The majority of the roads in Niger are non-paved (90%). Six districts, mainly in the region of Tahoua lack medical facilities. Patient to health facility ratios were best in Agadez with 7000 people served per health facility. During the dry season 39% of the population was within 1-hours walk to a health center, with the percentage decreasing to 24% during the wet season. Further analyses revealed that vaccination rates were strongly correlated with distance. Children living in clusters within 1-hour of a health center had 1.88 times higher odds of complete vaccination by age 1-year compared to children living in clusters further from a health center (p < 0.05). Three key geographic areas were highlighted where access to health centers took greater than 4 h walk during the wet and dry season. Access for more than 730,000 people can be improved in these areas with the addition of 17 health facilities to the current total of 504 during the dry season (260,000 during the wet season).

Conclusions: This study highlights critical areas in Niger where health services/facilities are lacking. A second finding is that population served by health facilities will be severely overestimated if assessments are solely conducted during the dry season. Mapped outputs can be used for future decision making processes and analysis.

Figure 1

Geography of Niger. Map illustrating distribution of people and connectivity between departments. Population density by department is used to illustrate distribution of the population. Four road types are shown on the map and include Primary (paved), Secondary and Tertiary (non-paved, composed of sand and gravel), and Track (mainly through sandy desert). Permanent and fluctuating water sources are highlighted.

Figure 2

Change in accessibility to health facilities during the wet and dry season by foot and vehicular travel. A illustrates how accessible the health centers are when walking during the (A.1) dry season and (A.2) wet season. B illustrates how accessible the health centers are when using vehicular travel during the (B.1) dry season and (B.2) wet season.

Figure 3

Spatial distribution of settlements and accessibility to health facilities. The maps show the spatial distribution of settlements that are greater than 4 h walk (pink dots) and 12 h walk (black dots and crosses) from a health facility during the dry and wet season.

Figure 4

Proposed placement of new health facilities in population densities with the least access to a health facility. The maps show the most likely placement of proposed new health facilities within the densely populated regions using two different widths of hexagon. Proposed new health facilities were placed in the red hexagons (4.1).