New approaches to spatially analyse primary health care usage patterns in rural South Africa

OBJECTIVE To develop indices to quantitatively assess and understand the sp atial usage patterns of health facilities in the Hlabisa district of South Africa. METHODOLOGY We mapped and interviewed more than 23 000 homesteads (approxim ately 200 000 people) in Hlabisa district, South Africa and spatially analy sed their modal primary health usage patterns using a geographical informat ion system. We generated contour maps of health service use and quantified the relationship between clinic catchments and distance-defined catchments using inclusion and exclusion error. We propose the distance usage index (D UI) as an overall spatial measure of clinic usage. This index is the sum of the distances from clinic to all client homesteads divided by the sum of t he distances from clinic to all homesteads within its distance-defined catc hment. The index encompasses inclusion, exclusion, and strength of patient attraction for each clinic. RESULTS Eighty-seven per cent of homesteads use the nearest clinic. Residen ts of homesteads travel an average Euclidean distance of 4.72 kin to attend clinics. There is a significant logarithmic relationship between distance from clinic and their use by homesteads (r(2) = 0.774, P < 0.0001). The DUI values range between 31 and 198% (mean = 110%, SD = 43.7) for 12 clinics a nd highlight clinic usage patterns across the district. CONCLUSIONS The DUI is a powerful and informative composite measure of clin ic usage. The results of the study have important implications for health c are provision in developing countries.