Applying Operations Research to Health Planning: Locating Health Centres in Zambia
BRYAN H. MASSAM, RAIS AKHTAR, IAN D. ASKEW
One of the main objectives of primary health care policies, particularly for countries with a large, dispersed rural population, is to increase the physical accessibility of the health care facilities provided by the state. This objective derives from the need to improve the availability of basic health services to rural dwellers, and to reduce the inequalities created by a centralized health system which tries to serve a widespread population. Planners often seek to meet this objective by decentralizing the existing health care system so as to provide essential services at the community level with referral to more specialized services through a hierarchy of health centres and hospitals.
However, even if a government does reallocate resources towards decentralizing and reorganizing a health care system to improve service availability at the community level, it will be impossible to provide every community with a primary health care centre; often it will be a matter of providing one centre to serve a number of communities. Moreover, in most countries some health care facilities already exist in rural areas, and these need to be integrated into a hierarchical system.
Thus, when considering the accessibility of primary health care facilities, policymakers and planners need to take into account not only the optimum location in terms of accessibility to a number of communities, but also the constraints imposed on the choice of location by existing facilities. Although relocation may increase accessibility to the users, it may also increase the costs to the provider. That is, the continued use of an existing facility may be perceived by planners as a saving and its relocation an unnecessary cost.
In this chapter we consider the problem of selecting possible locations for