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. 2022 May;7(5):e008366.
doi: 10.1136/bmjgh-2021-008366.

Comparing modelled with self-reported travel time and the used versus the nearest facility: modelling geographic accessibility to family planning outlets in Kenya

Paul Bouanchaud  1 , Peter M Macharia  2   3 , Eden G Demise  4 , Doreen Nakimuli  5 ; CM4FP Group
Collaborators, Affiliations

Comparing modelled with self-reported travel time and the used versus the nearest facility: modelling geographic accessibility to family planning outlets in Kenya

Paul Bouanchaud et al. BMJ Glob Health. 2022 May.

Abstract

Introduction: Geographic access to family planning (FP) services has been characterised through a variety of proximity metrics. However, there is little evidence on the validity of women's self-reported compared with modelled travel time to an FP outlet, or between different distance measures.

Methods: We used data from four urban sites in Kenya. A longitudinal FP outlet census was directly linked with data from cross-sectional FP user surveys. We combined characteristics of outlet visited to obtain FP, transport mode, self-reported travel time and location of households and outlets with data on road networks, elevation, land use and travel barriers within a cost-distance algorithm to compute modelled travel time, route and Euclidean distance between households and outlets. We compared modelled and self-reported travel times, Euclidean and route distances and the use of visited versus nearest facility.

Results: 931 contraceptive users were directly linked to their FP source. Self-reported travel times were consistently and significantly higher than modelled times, with greater differences for those using vehicles rather than walking. Modelled and Euclidean distances were similar in the four geographies. 20% of women used their nearest FP outlet while 52% went to their nearest outlet when conditional on it offering their most recently used FP method.

Conclusion: In urban areas with high facility density and good road connectivity, over half of FP users visited their nearest outlet with their chosen method available. In these settings, Euclidean distances were sufficient to characterise geographic proximity; however, reported and modelled travel times differed across all sites.

Keywords: health policy; medical demography; other study design; public health.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Scatter plot showing correlation between modelled and self-reported travel times, by mode of transportation. FP, family planning.
See this image and copyright information in PMC

References

    1. Penchansky R, Thomas JW. The concept of access: definition and relationship to consumer satisfaction. Med Care 1981;19:127–40. 10.1097/00005650-198102000-00001 - DOI - PubMed
    1. Bertrand JT, Hardee K, Magnani RJ, et al. . Access, quality of care and medical barriers in family planning programs. Int Fam Plan Perspect 1995;21:64. 10.2307/2133525 - DOI
    1. UN Economic and Social Council . General Comment No. 14: the right to the highest attainable standard of health (art. 12 of the covenant). un Comm Econ soc cult rights, 2000. Available: https://www.refworld.org/docid/4538838d0.html [Accessed 22 Dec 2021].
    1. Choi Y, Safi S, Nobili J. Levels, trends, and patterns of contraceptive method availability: comparative analyses in eight sub-Saharan African countries. Reprod Health 2019.
    1. Alford-Teaster J, Lange JM, Hubbard RA, et al. . Is the closest facility the one actually used? an assessment of travel time estimation based on mammography facilities. Int J Health Geogr 2016;15:1–10. 10.1186/s12942-016-0039-7 - DOI - PMC - PubMed

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