Use of a geographic information system to assess accessibility to health facilities providing emergency obstetric and newborn care in Bangladesh

Objective: To use a geographic information system (GIS) to determine accessibility to health facilities for emergency obstetric and newborn care (EmONC) and compare coverage with that stipulated by UN guidelines (5 EmONC facilities per 500000 individuals, 1 comprehensive). Methods: A cross-sectional study was undertaken of all public facilities providing EmONC in 24 districts of Bangladesh from March to October 2012. Accessibility to each facility was assessed by applying GIS to estimate the proportion of catchment population (comprehensive 500000; basic 100000) able to reach the nearest facility within 2hours and 1hour of travel time, respectively, by existing road networks. Results: The minimum number of public facilities providing comprehensive and basic EmONC services (1 and 5 per 500000 individuals, respectively) was reached in 16 and 3 districts, respectively. However, after applying GIS, in no district did 100% of the catchment population have access to these services. A minimum of 75% and 50% of the population had accessibility to comprehensive services in 11 and 5 districts, respectively. For basic services, accessibility was much lower. Conclusion: Assessing only the number of EmONC facilities does not ensure universal coverage; accessibility should be assessed when planning health systems.