Spatio-Temporal Analysis of Spatial Accessibility to Primary Health Care in Bhutan

Geographic information systems (GIS) can be effectively utilized to carry out spatio-temporal analysis of spatial accessibility to primary healthcare services. Spatial accessibility to primary healthcare services is commonly measured using floating catchment area models which are generally defined with three variables; namely, an attractiveness component of the service centre, travel time or distance between the locations of the service centre and the population, and population demand for healthcare services. The nearest-neighbour modified two-step floating catchment area (NN-M2SFCA) model is proposed for computing spatial accessibility indices for the entire country. Accessibility values from 2010 to 2013 for Bhutan were analysed both spatially and temporally by producing accessibility ranking maps, plotting Lorenz curves, and conducting spatial clustering analysis. The spatial accessibility indices of the 205 sub-districts show great disparities in healthcare accessibility in the country. The mean-and median-based classification results indicate that, in 2013, 24 percent of Bhutan's population have poor access to primary healthcare services, 66 percent of the population have medium-level access, and 10 percent have good access.