3.1 Health care locations

If we are to use GIS to investigate spatial aspects of a given health care system then a fundamental requirement is to know where different elements of that system are located. That is, the spatial characteristics of the system as a whole, or certain services within it, must be known. This object discusses the concept of location for different types of health services, and considers the availability of data on health care locations in different settings.

Defining health care locations

Many health services are provided from facilities with an obvious spatial location such as hospitals, clinics, or GP surgeries. In these cases, there is little conceptual difficulty in defining the location at which the service operates. However, it is important to note the distinction between the location of health facilities and the location of health services. Assessing the former requires information only on the physical location of facilities, whilst the latter requires also information on the types of services offered by each facility.

Some health services operate in such a way that their spatial location is difficult to define precisely. Community-based facilities where health workers visit patients in their own homes is an obvious example. Although these services have an inherent geographical location, it is less straightforward to define, and therefore collect data on, than services based at fixed locations. Mobile health services also have a potentially complex geography, with detailed data on their movements and schedule required to define fully their location. Telemedicine, where patients are consulted or diagnosed remotely (via phone or internet, for example) has an even less straightforward notion of location. However, telemedicine services must still be accessed at specific spatial locations such as people’s homes or workplaces and data can, in principle, be collected on these locations in order to define the spatial characteristics of the service.

Data sources

The availability and quality of data on health care locations varies widely. This variation is perhaps most pronounced between the relatively well resourced and administered health systems of the developed world and the more resource constrained systems of the developing world, although in neither case is health care location data necessarily easy to obtain or entirely reliable.

In developed countries, data on the location of different health facilities and services is likely to exist in some form, although a common limitation is that comprehensive data are not held on a single central database. In the UK, the increasing use of GIS in health care research and management has lead to numerous projects to develop spatial health system databases (Higgs et al, 2005). There have also been some qualitative studies of uptake of the technology (Joyce, 2009). However, these have been limited to regional or local areas within the UK, and no such project has been launched at the national scale. Regional health authorities generally maintain lists of health facilities which include detailed address data which can be used with products such as Ordnance Survey Address-Point® to derive latitude and longitude coordinates of health facilities. In the UK, the most comprehensive collection of data on the locations of primary health facilities such as GP surgeries, dentists, and pharmacies is provided by the Neighbourhood Statistics Service for England and Wales which allows interactive mapping of these facilities online.

In developing countries, reliable centralised databases on health care locations are extremely rare. Even basic lists of health facilities (i.e. without spatial information) are often unavailable at regional and national level. Where lists do exist they may be maintained by numerous organisations including national or local government, United Nations or World Health Organisation bodies, relief agencies, or private health care providers. Noor et al (2004) undertook an exercise to identify and georeference public health facilities in Kenya and found that existing lists of health facilities were generally incomplete, unreliable, and dispersed across several organisations. The need for improved data on health service locaton and availability is being recognised increasingly. Initiatives such as the AccessMod and Service Availability Mapping (SAM) programmes operated by the World Health Organisation represent current attempts to improve spatial data on health service provision and uptake.

---

 

---