Empowering access: unveiling an overall composite spatial accessibility index to healthcare services in Southeastern Iran
Abstract Background Access to healthcare is critical for population health; however, geographic barriers persist especially in rural and deprived regions. This study aims to develop an overall composite potential spatial accessibility index to healthcare facilities and services in Sistan and Baluche...
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BMC
2025-02-01
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| Series: | International Journal for Equity in Health |
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| Online Access: | https://doi.org/10.1186/s12939-025-02399-1 |
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| author | Ahmad Raeesi Soheil Hashtarkhani Mahmood Tara Narjes Sargolzaei Behzad Kiani |
| author_facet | Ahmad Raeesi Soheil Hashtarkhani Mahmood Tara Narjes Sargolzaei Behzad Kiani |
| author_sort | Ahmad Raeesi |
| collection | DOAJ |
| description | Abstract Background Access to healthcare is critical for population health; however, geographic barriers persist especially in rural and deprived regions. This study aims to develop an overall composite potential spatial accessibility index to healthcare facilities and services in Sistan and Baluchestan Province in southeast Iran. Methods This study employed the enhanced two-step floating catchment area (E2SFCA) method to create an overall composite spatial accessibility index for healthcare facilities and services in Sistan and Baluchestan Province, southeast Iran. Spatial accessibility for general practitioners, nursing, dentistry, midwifery, pharmacy, medical laboratory, nutrition, public health, radiology, psychology, environmental health, rural health workers, inpatient hospital beds, and five medical specialty services were calculated. Spatial accessibility scores were normalized from 0 to 1 (no access = 0, low = 0.01 to 0.33, moderate = 0.331 to 0.66, high = 0.661 to 1) and aggregated into overall indices of primary, secondary, and overall healthcare accessibility for each district. Inequality was assessed using the Lorenz curve and Gini coefficient analysis. Results Low geographic accessibility was found across Sistan and Baluchestan Province, especially in rural areas. Almost 75% of the population had low/no access to overall primary care services within a 30-minute drive time. For secondary care, nearly 45% had low/no access to hospital inpatient beds within a 30-minute drive time, and around 40% had low/no access to specialists within a 60-minute drive time. Just 11.6% of the population had high overall healthcare access. The calculated Gini coefficient of 0.517 for the overall spatial accessibility index to healthcare services in Sistan and Baluchestan Province highlights a highly unequal distribution of healthcare services. Conclusions This study demonstrates a useful replicable methodology that combines individual service accessibility metrics into an overall spatial healthcare access index. Furthermore, this study provides evidence of major shortfalls in healthcare access across Sistan and Baluchestan Province. Targeted strategies are required to increase the availability and capacity of services in underserved communities. Improving geographic access is key for progressing towards universal coverage and better population health. |
| format | Article |
| id | doaj-art-73eb37f930d7489d98e68015c336c8ff |
| institution | Kabale University |
| issn | 1475-9276 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | BMC |
| record_format | Article |
| series | International Journal for Equity in Health |
| spelling | doaj-art-73eb37f930d7489d98e68015c336c8ff2025-02-09T12:26:13ZengBMCInternational Journal for Equity in Health1475-92762025-02-0124111710.1186/s12939-025-02399-1Empowering access: unveiling an overall composite spatial accessibility index to healthcare services in Southeastern IranAhmad Raeesi0Soheil Hashtarkhani1Mahmood Tara2Narjes Sargolzaei3Behzad Kiani4Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical SciencesCenter for Biomedical Informatics, Department of Pediatrics, University of Tennessee Health Science CenterCardiovascular Research Center, Rajaie Cardiovascular InstituteDepartment of Community Medicine, Faculty of Medicine, Zahedan University of Medical SciencesFaculty of Health, Medicine, and Behavioural Sciences, The University of Queensland Centre for Clinical ResearchAbstract Background Access to healthcare is critical for population health; however, geographic barriers persist especially in rural and deprived regions. This study aims to develop an overall composite potential spatial accessibility index to healthcare facilities and services in Sistan and Baluchestan Province in southeast Iran. Methods This study employed the enhanced two-step floating catchment area (E2SFCA) method to create an overall composite spatial accessibility index for healthcare facilities and services in Sistan and Baluchestan Province, southeast Iran. Spatial accessibility for general practitioners, nursing, dentistry, midwifery, pharmacy, medical laboratory, nutrition, public health, radiology, psychology, environmental health, rural health workers, inpatient hospital beds, and five medical specialty services were calculated. Spatial accessibility scores were normalized from 0 to 1 (no access = 0, low = 0.01 to 0.33, moderate = 0.331 to 0.66, high = 0.661 to 1) and aggregated into overall indices of primary, secondary, and overall healthcare accessibility for each district. Inequality was assessed using the Lorenz curve and Gini coefficient analysis. Results Low geographic accessibility was found across Sistan and Baluchestan Province, especially in rural areas. Almost 75% of the population had low/no access to overall primary care services within a 30-minute drive time. For secondary care, nearly 45% had low/no access to hospital inpatient beds within a 30-minute drive time, and around 40% had low/no access to specialists within a 60-minute drive time. Just 11.6% of the population had high overall healthcare access. The calculated Gini coefficient of 0.517 for the overall spatial accessibility index to healthcare services in Sistan and Baluchestan Province highlights a highly unequal distribution of healthcare services. Conclusions This study demonstrates a useful replicable methodology that combines individual service accessibility metrics into an overall spatial healthcare access index. Furthermore, this study provides evidence of major shortfalls in healthcare access across Sistan and Baluchestan Province. Targeted strategies are required to increase the availability and capacity of services in underserved communities. Improving geographic access is key for progressing towards universal coverage and better population health.https://doi.org/10.1186/s12939-025-02399-1Healthcare Access2SFCAEnhanced 2SFCAPrimary careSecondary careInequality |
| spellingShingle | Ahmad Raeesi Soheil Hashtarkhani Mahmood Tara Narjes Sargolzaei Behzad Kiani Empowering access: unveiling an overall composite spatial accessibility index to healthcare services in Southeastern Iran International Journal for Equity in Health Healthcare Access 2SFCA Enhanced 2SFCA Primary care Secondary care Inequality |
| title | Empowering access: unveiling an overall composite spatial accessibility index to healthcare services in Southeastern Iran |
| title_full | Empowering access: unveiling an overall composite spatial accessibility index to healthcare services in Southeastern Iran |
| title_fullStr | Empowering access: unveiling an overall composite spatial accessibility index to healthcare services in Southeastern Iran |
| title_full_unstemmed | Empowering access: unveiling an overall composite spatial accessibility index to healthcare services in Southeastern Iran |
| title_short | Empowering access: unveiling an overall composite spatial accessibility index to healthcare services in Southeastern Iran |
| title_sort | empowering access unveiling an overall composite spatial accessibility index to healthcare services in southeastern iran |
| topic | Healthcare Access 2SFCA Enhanced 2SFCA Primary care Secondary care Inequality |
| url | https://doi.org/10.1186/s12939-025-02399-1 |
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