Geographic accessibility to public health facilities providing tuberculosis testing services at point-of-care in the upper east region, Ghana

Abstract

Background: In Ghana, limited evidence exists about the geographical accessibility to health facilities providing tuberculosis (TB) diagnostic services to facilitate early diagnosis and treatment. Therefore, we aimed to assess the geographic accessibility to public health facilities providing TB testing services at point-of-care (POC) in the Upper East Region (UER), Ghana. Methods: We assembled detailed spatial data on all 10 health facilities providing TB testing services at POC, and landscape features influencing journeys. These data were used in a geospatial model to estimate actual distance and travel time from the residential areas of the population to health facilities providing TB testing services. Maps displaying the distance values were produced using ArcGIS Desktop v10.4. Spatial distribution of the health facilities was done using spatial autocorrelation (Global Moran's Index) run in ArcMap 10.4.1. We also applied remote sensing through satellite imagery analysis to map out residential areas and identified locations for targeted improvement in the UER. Results: Of the 13 districts in the UER, 4 (31%) did not have any health facility providing TB testing services. In all, 10 public health facilities providing TB testing services at POC were available in the region representing an estimated population to health facility ratio of 125,000 people per facility. Majority (60%) of the health facilities providing TB testing services in the region were in districts with a total population greater than 100,000 people. Majority (62%) of the population resident in the region were located more than 10 km away from a health facility providing TB testing services. The mean distance ± standard deviation to the nearest public health facility providing TB testing services in UER was 33.2 km ± 13.5. Whilst the mean travel time using a motorized tricycle speed of 20 km/h to the nearest facility providing TB testing services in the UER was 99.6 min ± 41.6. The results of the satellite imagery analysis show that 51 additional health facilities providing TB testing services at POC are required to improve geographical accessibility. The results of the spatial autocorrelation analysis show that the spatial distribution of the health facilities was dispersed (z-score = - 2.3; p = 0.02). Conclusion: There is poor geographic accessibility to public health facilities providing TB testing services at POC in the UER of Ghana. Targeted improvement of rural PHC clinics in the UER to enable them provide TB testing services at POC is highly recommended.