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Improving accessibility to rural health services: The maximal covering network improvement problem


  • Murawski, Lisa
  • Church, Richard L.


Accessibility to health facilities is a critical factor in effective health treatment for people in rural areas of lesser-developed countries. In many areas accessibility is diminished by the lack of all-weather roads, making access subject to weather conditions. Location-allocation models have been used to prescribe optimal configurations of health facilities in order to maximize accessibility, but these models are based on the assumption that the underlying transport network is static and always available. Essentially, past work has ignored the potential impacts of improvements to the transport system in modeling access. In this paper we propose a model that treats the opposite side of the location/transport equation; that is, a model that treats existing facility locations as fixed and improves health service accessibility by upgrading links of the transport network to all-weather roads. This new model, called the Maximal Covering Network Improvement Problem (MC-NIP) is formulated as an integer-linear programming problem. An application of the MC-NIP model to the Suhum District of Ghana is presented, which shows that even a modest level of road improvement can lead to substantial increases in all-season access to health service.

Suggested Citation

  • Murawski, Lisa & Church, Richard L., 2009. "Improving accessibility to rural health services: The maximal covering network improvement problem," Socio-Economic Planning Sciences, Elsevier, vol. 43(2), pages 102-110, June.
  • Handle: RePEc:eee:soceps:v:43:y:2009:i:2:p:102-110

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    References listed on IDEAS

    1. Current, J. R. & Re Velle, C. S. & Cohon, J. L., 1985. "The maximum covering/shortest path problem: A multiobjective network design and routing formulation," European Journal of Operational Research, Elsevier, vol. 21(2), pages 189-199, August.
    2. Marianne Fay & Danny Leipziger & Quentin Wodon & Tito Yepes, 2003. "Achieving the Millennium Development Goals : The role of infrastructure," Policy Research Working Paper Series 3163, The World Bank.
    3. Okafor, Francis C., 1990. "The spatial dimensions of accessibility to general hospitals in rural Nigeria," Socio-Economic Planning Sciences, Elsevier, vol. 24(4), pages 295-306.
    4. Stock, Robert, 1983. "Distance and the utilization of health facilities in rural Nigeria," Social Science & Medicine, Elsevier, vol. 17(9), pages 563-570, January.
    5. Matisziw, Timothy C. & Murray, Alan T. & Kim, Changjoo, 2006. "Strategic route extension in transit networks," European Journal of Operational Research, Elsevier, vol. 171(2), pages 661-673, June.
    6. Oppong, Joseph R., 1996. "Accommodating the rainy season in Third World location-allocation applications," Socio-Economic Planning Sciences, Elsevier, vol. 30(2), pages 121-137, June.
    7. Perry, Baker & Gesler, Wil, 2000. "Physical access to primary health care in Andean Bolivia," Social Science & Medicine, Elsevier, vol. 50(9), pages 1177-1188, May.
    8. Barnes-Josiah, Debora & Myntti, Cynthia & Augustin, Antoine, 1998. "The "three delays" as a framework for examining maternal mortality in Haiti," Social Science & Medicine, Elsevier, vol. 46(8), pages 981-993, April.
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    Cited by:

    1. Contreras, Ivan & Fernández, Elena, 2012. "General network design: A unified view of combined location and network design problems," European Journal of Operational Research, Elsevier, vol. 219(3), pages 680-697.
    2. Amber Kunkel & Elizabeth Itallie & Duo Wu, 2014. "Optimal distribution of medical backpacks and health surveillance assistants in Malawi," Health Care Management Science, Springer, vol. 17(3), pages 230-244, September.
    3. Alassane DRABO & Christian EBEKE, 2010. "Remittances, Public Health Spending and Foreign Aid in the Access to Health Care Services in Developing Countries," Working Papers 201004, CERDI.
    4. Contreras, Ivan & Fernández, Elena & Reinelt, Gerhard, 2012. "Minimizing the maximum travel time in a combined model of facility location and network design," Omega, Elsevier, vol. 40(6), pages 847-860.
    5. López-de-los-Mozos, M.C. & Mesa, Juan A. & Schöbel, Anita, 2017. "A general approach for the location of transfer points on a network with a trip covering criterion and mixed distances," European Journal of Operational Research, Elsevier, vol. 260(1), pages 108-121.
    6. Maya Duque, Pablo A. & Coene, Sofie & Goos, Peter & Sörensen, Kenneth & Spieksma, Frits, 2013. "The accessibility arc upgrading problem," European Journal of Operational Research, Elsevier, vol. 224(3), pages 458-465.
    7. Tong, Lu & Zhou, Xuesong & Miller, Harvey J., 2015. "Transportation network design for maximizing space–time accessibility," Transportation Research Part B: Methodological, Elsevier, vol. 81(P2), pages 555-576.


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