Examining Spatial Patterns of Primary Health Care Utilization in Southern Honduras

Examining Spatial Patterns of Primary Health Care Utilization in Southern Honduras By Jonathan B. Baker Chairperson: Lin Liu, Ph.D. Primary health care utilization is poorly understood in many parts of the developing world. This is especially true in rural places, such as Santa Lucia, Intibuca, Honduras, where there are only three primary health care facilities servicing almost 12,000 people, where the people are poor, and generally speaking access to care is limited. This research project focuses on trying to understand primary health care utilization patterns in this part of southern Honduras. Specifically, this research project examines the utilization of three health clinics operating in and around Santa Lucia. The delivery of health care is dependent on many factors, including the availability, cost, and capacities of the providers; the needs, resources and decisions of the patients; and the characteristics of the region within which the patients live. This research focuses primarily on the patients, and tries to understand their health seeking behavior. A better understanding of utilization can be used by health service planners to improve primary health care delivery in this and similar locations. The findings of this research indicate that utilization patterns can be explained, to a large extent, by factors relating to walking [travel] time, economic status, and the combined affect of health service type and proximity to care. These findings are consistent with findings from prior research: Both travel time and economic status are important factors in determining primary health care utilization. In addition, a new variable is created to examine health decision-making. This new variable has not been considered in previous research, and is found to very significant determinant of health facility utilization in the study area. A modified gravity model is used to estimate the level of utilization, and is tested through the use of log linear transformation and multi-variate regression techniques. The results here, an Rsquare of .644 for a model combining three different health clinic service areas, clearly indicate a relationship between these independent variables and utilization. Acknowledgements I would like to gratefully acknowledge the following individuals for their contribution to my Doctor of Philosophy degree in Geography: Lin Liu, Ph.D., University of Cincinnati, Geography Department, for his teachings in economic geography; his support in the analysis and preparation of my dissertation and related papers; and his guidance through the process of completing my Ph.D. He has been my dissertation committee chair, and I am very grateful for his contribution to this research project and the development of a clear agenda for my future research. Howard Stafford, Ph.D., University of Cincinnati, Geography Department, for his teachings in Economic & Marketing Geography and support in the research, development and design of my dissertation. In addition, I would like to thank him for his many long discussions with me on various topics related to geography, and his support of me as a Teaching Assistant and Adjunct Instructor. Andrew Bazemore, M.D., University of Cincinnati, Department of Family Medicine, Institute for Health Policy and Health Services Research, for his teachings in the area of health services, and public health policy, and his enthusiasm and support in the development of this research project. Furthermore, I am very grateful for his support in helping me develop a niche in International Health research, and his contacts at Shoulder-to-Shoulder, Inc. and Hombro a Hombro, without which this research project would not have been possible. Nicholas Dunning, Ph.D., for his teachings in the History and Philosophy of Geography, his expertise in fieldwork in Latin America, and his support on my dissertation committee. Chris Carr, for his expert teachings in the area of GPS, and his assistance in data collection in Honduras and the development of methods for this project. Miguel Coello, for his experience and discussions related to primary health care delivery in Santa Lucia, Intibuca, Honduras. The following University of Cincinnati affiliates for their kind financial support of this project; The Graduate Student Governance Association (GSGA), The Institute for Global Studies and Affairs (IGSA), and the University Research Council (URC). La Secretaria de Estado en los Despachos de Recursos Naturales y Ambiente (SERNA), for making GIS and Honduran Census data files available for use in this project. Part of this material is based upon work supported by the National Science Foundation under Grant No. IIS-0081434. Any opinions, findings, and conclusions or recommendations expressed in this material are those of the author(s) and do not necessarily reflect the views of the National Science Foundation.