The role of GIS in Healthcare Equity

No country has an even population distribution. Generally, locations with favourable and habitable conditions are more densely populated than those with challenging or hostile environments. Also, locations with more business opportunities and urbanization activities tend to attract migration. The locations where people live and work significantly affect their health. Migration can subsequently put pressure on the existing healthcare systems, leading to health inequity.Social determinants of health (SDH) play a significant role in influencing health as they can affect health in the long term.

SDH are the circumstances in which humans are born, develop, live, earn, and age. At a national level, it refers to the distribution of money, power, and resources that can shape these circumstances. Education, income level, employment status, ethnicity, and gender notably influence how healthy a person is. The lower an individual`s socio-economic position, the higher their risk of poor health.

Health inequities are systematic differences that prevent people from achieving optimal health which results in unfair and avoidable differences in health outcomes. Health inequities in a country are caused by unequal distribution of power, goods, income, and services. Health care is arguably the most well-known determinant of health.

Finding out and changing what makes people sick is as important as treating the sickness itself. Understanding individuals, families, and communities healthcare needs requires looking at health from a broader perspective. Social and economic factors contribute almost twice as much to health outcomes as clinical care. There is a likelihood that unequal access to medical services contributes to disparities in health status while rising costs of healthcare (including those insured) reduce disposable incomes with low-income households bearing most of the burden. Uneven distribution of population and healthcare providers can lead to geographic disparities in patient accessing care and varying workloads for healthcare workers. When patients cannot access care, it leads to inequality in people utilizing healthcare resources, subsequently affecting their health outcomes.

Varying workloads can also affect the stress level of healthcare professionals and impact the quality of care they deliver. Healthcare facilities and population interphase with each other and they represent the demand and supply sides of a health care system.

The map below shows some healthcare facilities in Kaduna state and where their registered patients are coming from (Figure 1).

While a large number of patients are coming from within the state, some are from the neighbouring states and some in states not so close. GIS can unmask health disparities. To attain efficiency and equality, where to set up new healthcare facilities and measuring its accessibility and proximity (the travel time to the nearest facilities for the communities) should be of utmost priority.

Deciding the capacities of the target healthcare facilities to minimize inequality in accessibility is also very key. The two most important criteria for the target population are proximity and availability. Using GIS network accessibility data will optimize healthcare delivery significantly. Rural-urban classification analysis is useful in evaluating the role of population composition and areas-based contextual factors that take rural-urban variation into account.

This classification will differentiate Kaduna city which is densely populated from its suburbs and from smaller or larger towns around it. Network optimization uses hospital Service areas and Hospital Referral Regions by maximizing the flow of patient-to-hospital within hospital service areas or hospital referral regions and ensuring minimal flow between them which will achieve optimized geographical units delineation. Geocoding of individual-level data can be limited to pre-defined area units and will require exploring the most relevant level of the neighbourhood and assessing if there is any link to underlying behaviours. This will shed more light on the socio-economic characteristics of the population and allow for proper planning of the specified resources required.

This will also significantly reduce the travel time of patients to another healthcare facility if they can get the required treatment close to them. The two-step floating catchment area accounts for proximity to service providers and their availability. This method takes into account the number of healthcare physicians needed in each Local Government Area (highlighting areas with excess workers and areas understaffed) and adjusts accordingly for overall maximal equity.

Figure 1: Patient distribution for Kaduna Health Facilities

GIS sheds light on patterns and trends and provides actionable insights. To achieve a balance in efficiency and equality, spatial optimization using location-allocation analysis is essential. The location set covering problem minimizes the number of facilities required to cover all demands while the maximum covering location problem maximizes the demand met within a preferred distance or time threshold by locating a specified number of facilities. The emphasis is on efficiency as it aims to minimize travel time and resources committed or maximize the population served. GIS enables healthcare organizations to identify where resources and interventions will have a considerable impact on communities in need.

The results from the identified gaps are critical in implementing programs and initiatives that will have the greatest impact on the outcomes of the community`s health and allow for a deeper understanding of ongoing patterns. Communicating this information will lead to tactical deployment and resource allocation with decision-makers while carrying the community along.GIS integrates diverse datasets from demographics to healthcare, providing a holistic view of network health by bringing patterns and trends to limelight. It identifies gaps and imbalances which enables strategic realignments. GIS provides insights into patients’ clusters and ensures maintenance and enhancement of health network.

GIS promotes health equity by supporting mapping care access, bringing to limelight disadvantaged communities, and customizing interventions to bridge identified gaps. Merging GIS with healthcare in a rapidly evolving healthcare sector is timely. The value of GIS in promoting health equity cannot be toned down.Aliogo, Rukevwe Akpevwe is an Abuja based GIS Specialist.