Abstract:
BACKGROUND: Little is known about the contribution of
community health posts and community health workers
(CHWs) to geographical accessibility of primary healthcare
(PHC) services at community level and strategies for
optimising geographical accessibility to these services.
METHODS: Using a complete georeferenced census of
community health posts and CHWs in Niger and other
high-resolution spatial datasets, we modelled travel times
to community health posts and CHWs between 2000 and
2013, accounting for training, commodities and maximum
population capacity. We estimated additional CHWs needed
to optimise geographical accessibility of the population
beyond the reach of the existing community health post
network. We assessed the efficiency of geographical
targeting of the existing community health post
network compared with networks designed to optimise
geographical targeting of the estimated population,
under-5 deaths and Plasmodium falciparum malaria cases.
RESULTS: The per cent of the population within 60-minute
walking to the nearest community health post with a
CHW increased from 0.0% to 17.5% between 2000 and
2013. An estimated 10.4 million people (58.5%) remained
beyond a 60-minute catchment of community health
posts. Optimal deployment of 7741 additional CHWs could
increase geographical coverage from 41.5% to 82.9%.
Geographical targeting of the existing community health
post network was inefficient but optimised networks
could improve efficiency by 32.3%–47.1%, depending on
targeting metric.
