Primary Health Care Accessibility in Zomba, Malawi: A Spatial Modelling Approach

Abstract. Access to primary health care (PHC), as the first point of care, is an essential factor in influencing the health status of a society. In Malawi, an individual is considered to have access to health care if they are within an 8 km radius to a health facility. Based on this, the Health Sector Strategic Plan (HSSP) II, 2017–2022 puts access to PHC in Malawi at 90 %. However, a Demographic Health Survey (DHS) reports that 56 % of women find distance as a major barrier. As such the aim of the study was to model spatial access to health of households in the district. The study used the 2 Step Floating Catchment Area (2FCSA) with Gaussian decay function method to model health care access and the greedy algorithm to find optimal locations for new facilities. The study found that 62% households have the potential of walking 60 minutes to the facility, a figure 28 % lower than the one reported by HSSP. With 2SFCA scores ranging from 0 to 0.19, the results show that 98 % and 57 % of the households scored between 0.031 to 0.046 for urban and rural areas respectively. These scores imply that urban households have better spatial accessibility than rural households. The results provide a spatially objective PHC accessibility data to inform policy direction.