The predictive power of health system environments: a novel approach for explaining inequalities in access to maternal healthcare

BMJ Global Health
Laura Sochas

Abstract

The growing use of Geographic Information Systems (GIS) to link population-level data to health facility data is key for the inclusion of health system environments in analyses of health disparities. However, such approaches commonly focus on just a couple of aspects of the health system environment and only report on the average and independent effect of each dimension. Using GIS to link Demographic and Health Survey data on births (2008-13/14) to Service Availability and Readiness Assessment data on health facilities (2010) in Zambia, this paper rigorously measures the multiple dimensions of an accessible health system environment. Using multilevel Bayesian methods (multilevel analysis of individual heterogeneity and discriminatory accuracy), it investigates whether multidimensional health system environments defined with reference to both geographic and social location cut across individual-level and community-level heterogeneity to reliably predict facility delivery. Random intercepts representing different health system environments have an intraclass correlation coefficient of 25%, which demonstrates high levels of discriminatory accuracy. Health system environments with four or more access barriers are particularly likel...Continue Reading

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Citations

Dec 10, 2020·Bulletin of the World Health Organization·Anna D GageSanam Roder-DeWan

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