Abstract:
Maternal mortality is a major problem in middle-income and low-income countries,
and the availability and accessibility of healthcare facilities offering safe delivery is
important in averting maternal deaths. Siaya County, in Kenya, has one of the
highest maternal mortality rates in the country—far more than the national average.
This study aimed to evaluate geographic access to health facilities offering delivery
services in Siaya County. A mixed-methods approach incorporating geographic information system analysis and individual data from semi-structured interviews was
used to derive travel time maps to facilities using different travel scenarios:
AccessMod5 and ArcGIS were used for these tasks. The derived maps were then
linked to georeferenced household survey data in a multilevel logistic regression
model in R to predict the probability of expectant women delivering in a health facility. Based on the derived travel times, 26 per cent (13,140) and 67 per cent
(32,074) of the estimated 46,332 pregnant women could reach any facility within
one and two hours, respectively, while walking with the percentage falling to seven
per cent (3,415) and 20 per cent (8,845) when considering referral facilities.
Motorised transport significantly increased coverage. The findings revealed that
the predicted probability of a pregnant woman delivering in a health facility ranged
between 0.14 and 0.86. Significant differences existed in access levels with
transportation-based interventions significantly increasing coverage. The derived
maps can help health policy planners identify underserved areas and monitor future
reductions in inequalities. This work has theoretical implications for conceptualising
healthcare accessibility besides advancing the literature on mixed methodologies.