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Accessibility to First-Mile health services: A time-cost model for rural Uganda

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  • Visconti, Roberto Moro
  • Larocca, Alberto
  • Marconi, Michele

Abstract

This study estimates the geographical disconnection in rural Low-Middle-Income Countries (LMIC) between First-Mile suppliers of healthcare services and end-users. This detachment is due to geographical barriers and to a shortage of technical, financial, and human resources that enable peripheral health facilities to perform effective and prompt diagnosis. End-users typically have easier access to cell-phones than hospitals, so mHealth can help to overcome such barriers, transforming inpatients/outpatients into home-patients, decongesting hospitals, especially during epidemics. This generates savings for patients and the healthcare system. The advantages of mHealth are well known, but there is a literature gap in the description of its economic returns. This study applies a geographical model to a typical LMIC, Uganda, quantifying the time-cost to reach an equipped medical center. Time-cost measures the disconnection between First-Mile hubs and end-users, the potential demand of mHealth by remote end-users, and the consequent savings. The results highlight an average time-cost of 75 min, well above the recommended thresholds, and estimate that mHealth leads to significant savings (1.5 monthly salaries and 21% of public health budget). Community health workers and private actors may re-engineer healthcare resources through Public-Private Partnerships (PPP), remunerated with results-based financing (RBF). These findings can contribute to improving healthcare resource allocation in LMIC.

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  • Visconti, Roberto Moro & Larocca, Alberto & Marconi, Michele, 2020. "Accessibility to First-Mile health services: A time-cost model for rural Uganda," Social Science & Medicine, Elsevier, vol. 265(C).
    • Handle: RePEc:eee:socmed:v:265:y:2020:i:c:s0277953620306298
    DOI: 10.1016/j.socscimed.2020.113410
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    References listed on IDEAS

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    3. Cao, Wen-Rui & Huang, Qiu-Ru & Zhang, Nan & Liang, Hui-Juan & Xian, Ben-Song & Gan, Xiao-Fang & Xu, Dong Roman & Lai, Ying-Si, 2022. "Mapping the travel modes and acceptable travel time to primary healthcare institutions: A case study in Inner Mongolia Autonomous Region, China," Journal of Transport Geography, Elsevier, vol. 102(C).

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