Defining equity in physical access to clinical services using geographical information systems as part of malaria planning and monitoring in Kenya


Abdisalan Mohamed Noor, KEMRI/Wellcome Trust Collaborative Programme, PO Box 43640, 00100 GPO, Nairobi, Kenya. E-mail: (corresponding author).
Dr Dejan Zurovac, Médecins Sans Frontières–France, PO Box 39719, Nairobi, Kenya. E-mail:
Dr Simon I. Hay, Trypanosomiasis and Land-Use in Africa (TALA) Research Group, Department of Zoology, University of Oxford, South Parks Road, Oxford, OX1 3PS, UK. E-mail:
Dr Sam A. Ochola, Ministry of Health, Division of Malaria Control, PO Box 20750, Nairobi, Kenya. E-mail:
Professor Robert W. Snow, Centre for Tropical Medicine, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK. E-mail:


Distance is a crucial feature of health service use and yet its application and utility to health care planning have not been well explored, particularly in the light of large-scale international and national efforts such as Roll Back Malaria. We have developed a high-resolution map of population-to-service access in four districts of Kenya. Theoretical physical access, based upon national targets, developed as part of the Kenyan health sector reform agenda, was compared with actual health service usage data among 1668 paediatric patients attending 81 sampled government health facilities. Actual and theoretical use were highly correlated. Patients in the larger districts of Kwale and Makueni, where access to government health facilities was relatively poor, travelled greater mean distances than those in Greater Kisii and Bondo. More than 60% of the patients in the four districts attended health facilities within a 5-km range. Interpolated physical access surfaces across districts highlighted areas of poor access and large differences between urban and rural settings. Users from rural communities travelled greater distances to health facilities than those in urban communities. The implications of planning and monitoring equitable delivery of clinical services at national and international levels are discussed.