5.1 Transport considerations

A key element of health care management is an understanding of the way in which people physically access health services. Some health services are mobile or community-based so that, effectively, the service travels to the patient. Very often, however, health services are delivered from health facilities at fixed locations. In these cases, it is the patient or client who must travel in order to access the service. Consequently, the way in which people travel to access services is an important aspect of health care provision, and therefore of interest to health care planners and managers.

If health care managers want to use GIS to assess patient transport to health services, data are required on two different aspects. Firstly, data are required relating to the transport systems that patients may use. This might include data on the road network, public transport, or features of the landscape that affect journeys made on foot. Such data can be thought of as pertaining to potential transport and can be used, for example, to estimate travel times to health services or to identify under-served areas. Secondly, data are required on actual transport used by patients in accessing services. Such data record patients’ behaviour and experiences relating to the way they travel to access services. This ata on actual patient transport can be used investigate, for example, the proportion of patients using different transport options or to calibrate journey time models.

Data sources

The availability and reliability of data on both transport systems and travel behaviour varies widely, particularly between developing and developed countries.

In the UK, data on the transport network are available in various forms. The road and rail network has been mapped extensively and at a high level of precision by the Ordnance Survey (OS). They produce a range of spatial data products at different spatial resolutions that can be purchased and imported directly into a GIS for analysis. These include the Strategi® and MeridianTM data layers at 1:250,000 and 1:50,000 scales, respectively, and their flagship MasterMap® Integrated Transport NetworkTM layer which provides highly detailed data on the road network including traffic routing and road features (see references for URLs relating to these OS products).

A useful starting point for obtaining data relating to public transport networks are published timetables, since these illustrate theoretical journey times between different points. In the UK, timetabling data from different public transport services have been compiled into large databases and online tools exist that query these databases to allow optimum journey times and routes to be calculated. Such tools are useful for individual journey planning, and illustrate the potential of such data, but are of little practical use for strategic decision making. Health care researchers or managers require direct access to the underlying timetabling data in order to develop spatial models of public transport journeys to health services (Martin et al., 2002). With the Open Data movement making digital data more widely available in at least some countries, such data are becoming more widely available. In the UK, for example, the National Public Transport Access Node database (NaPTAN) is one such database that is now available for use. NaPTAN uniquely identifies all points of access to UK public transport, and contains coordinates of around 346,000 access points across the UK. These access points include bus stops, train stations, ferry terminals, and taxi ranks and are available in several formats, including as .csv (text files) that can readily be uploaded into ArcGIS.

Data on transport networks in developing countries is rarely as complete, contemporary, or reliable as that in developed countries. Individual countries may have undertaken exercises to create spatial databases of their major road or rail links, whilst research, management, or aid organisations may have collected such data for specific regions in support of their activities. Data is therefore often characterised by sporadic spatial extent and unknown quality, with often only major routes represented which limits the potential for assessing patient transport at the local level. Very little data is available on public transport networks in developing countries. Where much public transport is provided informally, published timetable are not likely to exist even in paper format. Some studies have attempted to reconstruct patients’ use of public transport via interviews (Tanser et al., 2006 ).

Because many journeys to access health care in developing countries are made on foot, spatial data may be required on features of the landscape that affect these journeys. In addition to data on road and footpath networks, spatial data on barriers such as rivers or swamps and on surface topography may be needed. Again, the availability of such data is sporadic, often only major features are included, and data quality is questionable. One potential source of data on these features is remotely sensed imagery which, if obtained at a fine spatial resolution, can be analysed in a GIS to pick out the features of interest.

---

---