Geographic accessibility to public healthcare facilities and spatial clustering during the wet and dry seasons in Côte d’Ivoire
Authors: Sehi Gaëlle T. , Houngbedji Clarisse A. , Parker Daniel M. , Macharia Peter M. 
Published: November 2023

AbstractIntroductionGeographic accessibility to healthcare is a key determinant of health outcomes. Yet, globally, over 4.5 billion people lack access to healthcare, majority of which are located in low and middle-income countries. While metrics of spatial access should consider variation in seasonality, studies in Côte d’Ivoire have overlooked seasonality impacts and how such metrics are spatially clustered. Here, we assessed geographical accessibility to public health care in Côte d’Ivoire across wet and dry seasons while assessing clustering and identifying marginalized populations.MethodsWe assembled spatial data on the location of public healthcare facilities, factors that affect travel, population distribution, and healthcare-seeking behaviour. Using these datasets, plausible travel scenarios reflecting seasonality were combined within a cost-distance algorithm in AccessMod (version 5) to model travel time to the nearest facility at 1km resolution for dry and wet seasons. We determined the proportion of the population within 2 hours’ travel time at the district level. We assessed marginalization (≥4 hours from the nearest facility) and spatial autocorrelation using Moran’s I indices.ResultsAt the national level, mean travel time to the nearest public healthcare facility was 1.8h during the dry season and 3.4h during the wet season. The travel times were heterogeneous and varied between 23min – 6h and 38min - 10h during both seasons. About 73% (7 to 98%) of the population was within 2h of the nearest public healthcare facility in the dry season and 55% (2 – 97%) during the wet season at the district level. Poor access clusters were in the north and better access clusters in the south-central area of the country during both seasons.ConclusionHealthcare access inequalities in Côte d’Ivoire persist, with inadequate access clusters in the north and better access in the south-central region. There is a need for seasonal-based targeted interventions to improve access.Key SummaryWhat is already known on this topicAdequate geographic access to healthcare is crucial for timely diagnosis and life-saving interventions, especially in low- and middle-income countries where individuals face physical barriers to accessing essential and routine healthcare.Healthcare access in Côte d’Ivoire has been examined without considering weather seasonality or spatial clustering, yet these play a critical in healthcare accessibility.What this study addsIn the dry season, the mean travel time to the nearest healthcare facility at the national level is approximately 1.8 hours, whereas in the wet season, it increases to 3.4 hours.Over 80% of the population can reach a healthcare facility within 2 hours during the dry season, but only 66% can do so during the wet season.How this study might affect research, practice or policy.Policymakers can use this study to develop policies that address seasonal variations in accessibility, ensuring that healthcare services remain accessible even during adverse weather conditions.