Accessibility to First-Mile health services: A time-cost model for rural Uganda

Roberto Moro Visconti, Alberto Larocca and Michele Marconi

Social Science & Medicine, 2020, vol. 265, issue C

Abstract: This study estimates the geographical disconnection in rural Low-Middle-Income Countries (LMIC) between First-Mile suppliers of healthcare services and end-users. This detachment is due to geographical barriers and to a shortage of technical, financial, and human resources that enable peripheral health facilities to perform effective and prompt diagnosis. End-users typically have easier access to cell-phones than hospitals, so mHealth can help to overcome such barriers, transforming inpatients/outpatients into home-patients, decongesting hospitals, especially during epidemics. This generates savings for patients and the healthcare system. The advantages of mHealth are well known, but there is a literature gap in the description of its economic returns. This study applies a geographical model to a typical LMIC, Uganda, quantifying the time-cost to reach an equipped medical center. Time-cost measures the disconnection between First-Mile hubs and end-users, the potential demand of mHealth by remote end-users, and the consequent savings. The results highlight an average time-cost of 75 min, well above the recommended thresholds, and estimate that mHealth leads to significant savings (1.5 monthly salaries and 21% of public health budget). Community health workers and private actors may re-engineer healthcare resources through Public-Private Partnerships (PPP), remunerated with results-based financing (RBF). These findings can contribute to improving healthcare resource allocation in LMIC.

Keywords: Barriers to care; Remote diagnosis; Geographic information systems; Home-patient; Results-based financing; Healthcare cost-effectiveness (search for similar items in EconPapers)
Date: 2020
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Citations: View citations in EconPapers (3)

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DOI: 10.1016/j.socscimed.2020.113410

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