Using GIS to measure geographical accessibility to primary health care in rural South Africa : research in action

We demonstrate the application of GIS to measure geographical accessibility to primary health care (PHC) and its potential as a tool to assist in planning and providing health services. Accessibility was defined by delineation of catchment areas for PHC clinics and their distance from homesteads. Asurvey showed that 96% of the catchment population in northern KwaZulu-Natal were using the nearest clinic, one-third of the people lived within 5 km of a clinic, and that clinic use declined with increasing distance. These results informedthe implementation of two new policies in the study area as part of the transformation of the South African health system along primary health care principles. The finding that most people made use of PHC facilities supported the decision by the health authorities to decentralize the vertically run Malaria Control Programme to PHC facilities as part of the district health system. The fact that only one-third of the population lived within 5 km of a clinic and that clinic use declined with increasing distance indicated to the authorities that there was a shortage of these health facilities. This finding supported the implementation of the Clinic Upgrading and Building programme, which provides additional primary health care clinics. GIS enabled us to show that geographical accessibility to primary health care was not adequate and that clinic use depended on distance from PHC facilities.