Mapping physical access to health care for older adults in sub-Saharan Africa and implications for the COVID-19 response: a cross-sectional analysis | #healthcare | #elderly | #seniors
Evidence before this study
We searched MEDLINE from January, 1966, until May, 2020, for studies with variations of the keywords “physical access”, “distance”, “travel time”, “hospital”, AND “healthcare facility” in the title or abstract. To date, the only studies to systematically map physical access to health-care facilities in sub-Saharan Africa at a high resolution examined access to emergency hospital care (with a focus on women of childbearing age), access to care for children with fever, travel time to the nearest health-care facility for specific populations at risk of viral haemorrhagic fevers, and travel time to the nearest regional-level or district-level hospital.
Added value of this study
The added value of this study is threefold. First, we assembled a new dataset of geotagged health-care facilities, which combines two unique data sources for the geolocation of health-care facilities across sub-Saharan Africa: one-based on crowd-sourced data from OpenStreetMap and one based on information from ministries of health, health management information systems, government statistical agencies, and international organisations. Second, our study is the first to our knowledge to comprehensively map both hospitals and primary health-care facilities, including both public-sector and private-sector facilities, across sub-Saharan Africa. Third, because the COVID-19 pandemic causes a far higher need for hospital services among older than younger population groups, we focused on physical access to health care for adults aged 60 years and older—a population group that is rarely studied in investigations of health-care demand and supply in the region. As such, our maps can inform not only the health system response to COVID-19 but also, more generally, to conditions that are common among older adults in the region, particularly chronic non-communicable diseases and their sequelae.
Implications of all the available evidence
Low physical access to health care in sub-Saharan Africa will probably be a major barrier to receiving care for adults aged 60 years and older with COVID-19. However, there is a wide degree of variation in physical access to health-care facilities for older adults in the region, both between and within countries, which is likely to have an important bearing on the extent to which different population groups within countries are able to access care for COVID-19. Likewise, in areas with a long travel time to the nearest health-care facility of any type (which exist in most countries), symptomatic cases of COVID-19 are probably less likely to be reported to the health-care system.