How Geographically Accessible is Tertiary Care in Low- and Middle-income Countries: The Bangladesh Case

Receiving adequate, timely and effective medical care at the tertiary level hospitals can be a challenge because of the difficulty to reach these hospitals. Many of these facilities are located in central or certain geographic areas. This study describes the geographic distribution of tertiary care hospitals in Bangladesh and assesses their accessibility. Several data sources including the Directorate General of Health Services, National Population Census and Google Maps were used. Geographic inaccessibility ranking was calculated by a method that used data on population and area of the district, travel time and distance to the hospital. Among 35 hospitals, 16 are situated in Dhaka district comprising 10,424 beds, which is almost 41% of the total tertiary care beds. Among the 64 total districts, 46 do not have any such hospital. Around 6.4 million people need to travel more than 3 hours and another 25.4 million need between 2 and 3 hours to reach tertiary care hospitals. Geographic inaccessibility score was found to be high for 5 districts, moderate for 5 districts and low for 19 districts. High centrality of location and skewed distribution of these hospitals may have created health inequity and disparity for a large population segment in Bangladesh.