Improving accessibility to radiotherapy services in Cali, Colombia: cross-sectional equity analyses using open data and big data travel times from 2020
Authors: Cuervo Luis Gabriel , Villamizar Carmen Juliana , Cuervo Daniel , Zapata Pablo , Ospina Maria B. , Valencia Sara Marcela , Polo Alfredo , Suárez Ángela , Bula Maria O. , Miranda J. Jaime , Millan Gynna , Cuervo Diana Elizabeth , Owens Nancy J. , Piquero Felipe , Hatcher-Roberts Janet , Paredes Gabriel Dario , Navarro María Fernanda , Minotta Ingrid Liliana , Palta Carmen , Martínez-Herrera Eliana , Jaramillo Ciro ,   on behalf of the AMORE Project Collaboration, Agredo Lemos Freddy Enrique , Arboleda Juan Camilo , Avila Rodriguez German , Concha-Eastman Alberto , Faber Ingrid , Franco Oscar H. , Garcia Altamirano Crhistian Camilo , Guerrero Velasco Rodrigo , Itriago Déborah , Martin Edith Alejandra , Martinez Arambula Fernando Rafael , Merino Juarez Maria Fernanda , Murillo-Hoyos Jackeline , Ortigoza Ana , Osorio Lyda , Paredes-Zapata David , Pinilla Luis Fernando , Rojas Rentería Oscar , Rosero Hernández Myriam , Tobar-Blandón María Fernanda 
Published: August 2024

In this study, we evaluated and forecasted the cumulative opportunities for residents to access radiotherapy services in Cali, Colombia, while accounting for traffic congestion, using a new people-centred methodology with an equity focus. Furthermore, we identified 1–2 optimal locations where new services would maximise accessibility. We utilised open data and publicly available big data. Cali is one of South America's cities most impacted by traffic congestion.

Methodology: Using a people-centred approach, we tested a web-based digital platform developed through an iterative participatory design. The platform integrates open data, including the location of radiotherapy services, the disaggregated sociodemographic microdata for the population and places of residence, and big data for travel times from Google Distance Matrix API. We used genetic algorithms to identify optimal locations for new services. We predicted accessibility cumulative opportunities (ACO) for traffic ranging from peak congestion to free-flow conditions with hourly assessments for 6–12 July 2020 and 23–29 November 2020. The interactive digital platform is openly available.

Primary and secondary outcomes: We present descriptive statistics and population distribution heatmaps based on 20-min accessibility cumulative opportunities (ACO) isochrones for car journeys. There is no set national or international standard for these travel time thresholds. Most key informants found the 20-min threshold reasonable. These isochrones connect the population-weighted centroid of the traffic analysis zone at the place of residence to the corresponding zone of the radiotherapy service with the shortest travel time under varying traffic conditions ranging from free-flow to peak-traffic congestion levels. Additionally, we conducted a time-series bivariate analysis to assess geographical accessibility based on economic stratum. We identify 1–2 optimal locations where new services would maximize the 20-min ACO during peak-traffic congestion.

Results: Traffic congestion significantly diminished accessibility to radiotherapy services, particularly affecting vulnerable populations. For instance, urban 20-min ACO by car dropped from 91% of Cali’s urban population within a 20-min journey to the service during free-flow traffic to 31% during peak traffic for the week of 6–12 July 2020. Percentages represent the population within a 20-min journey by car from their residence to a radiotherapy service. Specific ethnic groups, individuals with lower educational attainment, and residents on the outskirts of Cali experienced disproportionate effects, with accessibility decreasing to 11% during peak traffic compared to 81% during free-flow traffic for low-income households. We predict that strategically adding sufficient services in 1–2 locations in eastern Cali would notably enhance accessibility and reduce inequities. The recommended locations for new services remained consistent in both of our measurements.

These findings underscore the significance of prioritising equity and comprehensive care in healthcare accessibility. They also offer a practical approach to optimising service locations to mitigate disparities. Expanding this approach to encompass other transportation modes, services, and cities, or updating measurements, is feasible and affordable. The new approach and data are particularly relevant for planning authorities and urban development actors.