FOSS TECHNOLOGIES IN MODELLING SPATIAL ACCESSIBILITY OF PRIMARY HEALTH CARE IN MALAWI

The International Archives of the Photogrammetry, Remote Sensing and Spatial Information Sciences, Volume XLII-4/W14, 2019 FOSS4G 2019 – Academic Track, 26–30 August 2019, Bucharest, Romania FOSS TECHNOLOGIES IN MODELLING SPATIAL ACCESSIBILITY OF PRIMARY HEALTH CARE IN MALAWI Y. D. J. Phiri 1, K. G. Munthali 1, * 1 University of Malawi, Chancellor College, Computer Science Department, P.O. Box 280, Zomba, Malawi - (msc-inf-10-17, kmunthali)@cc.ac.mw Commission IV, WG IV/4 KEY WORDS: FOSS technologies, Spatial Accessibility Modelling, Primary health care, Relational spatial analysis, PostGIS ABSTRACT: Primary health care (PHC) is the first point of contact people have with a health system. As such access to PHC services is an important factor to ensure good health of a community. While the need to provide equal and easy access to PHC is well understood, the approaches informing the decision-making process to improve the access tend to face a number of challenges in the developing world. Use of conventional Information and Communication Technologies (ICTs) comes with requisite financial costs which Free and Open Source Software (FOSS) ICT technologies have the potential to help lower among other benefits. In this study, the confluence of spatial accessibility tools provided by FOSS technologies, specifically PostgreSQL/PostGIS and QGIS, was explored to inform decision making in PHC accessibility in Zomba, Malawi. The results show that the household population (P) that is within the threshold time was 8 , representing % of all households having access to health care. The mean accessibility score for the district was 0.010 and ranged from 0.00 to 0.231. While the findings provide, arguably, spatially objective PHC accessibility data to inform policy direction and also reveals accessibility to PHC in Malawi to be lower than reported, the study also reveals the usefulness of FOSS technologies, in the developing world. Use of FOSS facilitated incremental setup of the model thereby allowing to run the model with limited processing power. That notwithstanding, the study adds to the formal scientific research on the use of relational spatial analysis in the developing world. 1. INTRODUCTION 1.1 Background Primary health care (PHC) is the first point of contact people have with a health system. As such access to PHC services is an important factor to ensure good health of a community. It is, therefore, essential for governments to ensure the provision of equal and easy access to PHC services to all citizens. However, uneven distribution of population, health facilities and transport infrastructure has led to spatial inequalities in accessing PHC (Kaur Khakh, Fast, Shahid, 2019; Wang, Luo, 2005). This, in turn, results in disadvantaged locations and communities having poor accessibility to needed health care facilities While there are several definitions of access to health care, we define accessibility as an opportunity or ease with which consumers or communities can timely use appropriate services in proportion to their needs (Daniels, 1982; Peters, Garg, Bloom, Walker, Brieger, Rahman, 2008). In this context, it includes: availability, geographic accessibility, affordability, accommodation and acceptability of the health care services (Peters et al., 2008). These can be grouped into demand and supply where the former are factors influencing the ability to use health services while the latter cover aspects inherent in the health system that hinder service uptake at and by individuals, households or the community respectively (Jacobs, Bigdeli, Annear, Van Damme, 2011). Availability is the relationship between the volume and type of existing services (and resources) to the number of clients and types of needs (Penchansky, Thomas, 1981). Geographic accessibility, on the other hand, is the relationship between the location of supply of available services, the location of clients and the characteristics of the networks linking the two locations (Vickerman, 1974). A combination of these two is what forms spatial accessibility, whose models are essential in finding the relationship between the available (supply) health care services and population (population) targeted to access the services. Spatial accessibility modelling is, therefore, an important step in policy making and improved decision making. In this case, high availability of services does not guarantee high accessibility because it depends on how close the population is to those services. On other the hand, close proximity does not guarantee high accessibility because it depends on the size of the population competing for available services (McGrail, Humphreys, 2009). While the need to provide equal and easy access to PHC is well understood, the approaches informing the decision-making process to improve the access tend to face a number of challenges in the developing world. Attempts have been made to incorporate Information and Communication Technologies (ICTs) but the requisite financial costs, both direct and indirect, have been a constraint. The direct costs include buying or acquiring licences for the technology and the indirect include the requisite resources like availability of consistent power supply, and human capacity. * Corresponding author This contribution has been peer-reviewed. https://doi.org/10.5194/isprs-archives-XLII-4-W14-189-2019 | © Authors 2019. CC BY 4.0 License. 189 The International Archives of the Photogrammetry, Remote Sensing and Spatial Information Sciences, Volume XLII-4/W14, 2019 FOSS4G 2019 – Academic Track, 26–30 August 2019, Bucharest, Romania Free and Open Source Software (FOSS) ICT technologies have the potential to help lower the cost barrier by reducing the cost of software, which is an important component of ICT facilities, to almost negligible levels (Tong, 2004). FOSS is downloadable without any cost and no licensing fee for each user or computer, as is for proprietary software. Upgrades of FOSS can usually be obtained in a similar way. This is in sharp contrast with proprietary software upgrades, that, normally have to be paid for. Besides the cost benefits, there are numerous other advantages in using FOSS in health. To begin with FOSS is considered to have better reliability, performance and security. FOSS database management system of PostgreSQL/PostGIS and QGIS, used in this study, has assured high quality and compares very well with similarly proprietary applications. Pedagogically, the open philosophy of FOSS is consistent with academic freedom and the open dissemination of knowledge and information common in the academia. More importantly, the open nature of FOSS is such that it can be localized, because we have access to source code. Given the foregoing, FOSS technologies have been touted as the twentieth century's only true innovative concept in business (Sandred, 2002) largely because it presents a very different model for organisations with regard to innova (...truncated)