Examining the Spatial Mismatch in the Supply and Demand for Maternal and Child Health Services in Bangladesh
Over the past decades countries have made remarkable progress in improving population health. Yet gaps in service provision and differences in service utilization often result in within-country disparities in health outcomes. This poses a formidable challenge in the equitable delivery of health care for governments in developing countries. Poor availability of geographic data also attenuates the ability of researchers to examine equity in the spatial distribution of health facilities in relation to the population demand. This dissertation examines spatial equity in access to health services and in the utilization of maternal and reproductive health services in the context of Bangladesh. By examining the spatial distribution of public health facilities in Bangladesh, this research seeks to answer policy relevant questions on factors inﬂuencing differencing within regions, which in turn can help the government respond better to the challenges of disparities. This research consists of two components. The ﬁrst component examines spatial equity in the distribution of tertiary and secondary level health facilities using the lens of central place theory and urban hierarchy, while the second section examines mismatch in the supply and demand for primary health care services. In order to examine spatial equity in the distribution of tertiary and secondary public health services, this research uses geo-spatial data from the Government of Bangladesh in combination with the Demographic and Health Survey data from 2011 for Barisal and Sylhet Division of Bangladesh. Contrary to the assumption of urban hierarchy and central place theory which suggests market areas to be homogeneous for the same type of goods and services, this research ﬁnds substantial amount of within region variation in travel distance for the same type of health services. This research ﬁnds that inequality in access to public health facilities is inﬂuenced by the heterogeneous size of the administrative units to which they are linked. To test the spatial mismatch hypothesis, this dissertation used bivariate kernel density estimation technique to examine whether the distribution of the clinics followed population distribution. This analysis ﬁnds a greater concentration of clinics in rural areas than urban areas. This implies lower access to primary health care for the urban population. This methodology to assess spatial inequity can be useful in the context of developing countries where covariate data may not be reliable or available. This research provides recommendation to the Government of Bangladesh to capitalize on its vast distribution of primary health care facilities, with services aimed at improving the overall population health. Overall, it was found that with regard to hospital services, urban consumers in the city corporation had better access while communities living further from the city corporations and district centers were at a disadvantage; whereas in the case of primary health care, rural consumers had better access while urban consumers in the most densely populated places had limited access.