Physical access to primary health care in Andean Bolivia

Limited physical access to primary health care is a major factor contributi ng to the poor health of populations in developing countries, particularly in mountain areas with rugged topography, harsh climates and extensive soci oeconomic barriers. Assessing physical access to primary health care is an important exercise for health care planners and policy makers. The developm ent of geographic information system (GIS) technology has greatly improved this assessment process in industrialized countries where digital cartograp hic data are widely available. In developing countries - particularly in mo untain areas, however, detailed cartographic data, even in hardcopy form, a re nonexistent, inaccurate or severely lacking. This paper uses GIS technol ogy to assess physical access to primary health care in a remote and impove rished region of Andean Bolivia. In addition, it proposes an alternative mo del of health personnel distribution to maximize physical accessibility. Me thods involved extensive fieldwork in the region, utilizing GPS (global pos itioning system) technology in the development of the GIS and gathering oth er pertinent health data for the study. Satellite imagery also contributed to the development of the GIS and in the modeling process. The results indi cate significant variation in physical access to primary health care across the three study sites. More importantly, this paper highlights the use of GIS technology as a powerful tool in improving physical accessibility in mo untain areas of developing countries. (C) 2000 Elsevier Science Ltd. All ri ghts reserved.