Modelling the Allocation of Health Care Provision
Improved geographical accessibility to basic services for rural population is a goal of most governments. However, the formal methods for determining optimal locations have hardly been used as an aid to decision making. The three chapters in this part include case studies from the Third World in general and Zambia and Guatemala in particular. In Chapter 8 Gerard Rushton proposes various location-allocation models that could be used in improving geographical accessibility in Third World countries. He argues that research is needed to determine the appropriate objective functions, the role for modelling in the context of decentralized decision making and the efficiency of past processes of location decision making. James L. Mulvihill, in his chapter on Guatemala City, summarizes the results of two previous studies of Guatemalan health locations in both rural and urban environments. The main finding of these studies is that "access" does not simply mean providing health centers. Mulvihill states that questions must also be answered concerning "the position of individuals within their physical and social environments, and the attitudes they hold of public versus other health care types." Bryan H. Massam, Rais Akhtar, and Ian D. Askew, in Chapter 10, investigate the problem related to accessibility to health care facilities, particularly in rural areas with dispersed populations. The technique presented in the chapter should be useful in a prospective evaluation of alternative feasible locations. Two examples are taken from Zambia to illustrate how the approach could be used in choosing the most suitable location for upgrading a rural health center in a district.