People across Africa have to travel long distances to reach hospitals. We calculated

Nearly half of all deaths and around a third of all disabilities in low- and middle-income countries could be avoided if people had access to health services. urgent CareIn Africa, the leading causes of emergencies are road traffic accidents, obstetric complications, serious illnesses and non-communicable diseases.

Over the past 18 years african federation of emergency medicineAdvocacy groups have been encouraging the development of emergency medical systems on the continent, which they have found have many shortcomings, including a lack of good transport and hospital services.

But addressing these challenges requires data on the number of hospitals, where they are located, and on marginalized populations. Most African countries don’t have this information. They lack a basic inventory of health care providers, including the number of hospitals.

our research To address this, the organization conducted the first-ever assessment of hospital services in sub-Saharan Africa to determine how well people are accessing health care.

The results, including how long it takes to get to a hospital, show where investments are needed to improve access to care. A variety of interventions are needed. These should include building new hospitals, improving outpatient care, constructing new roads, and repairing existing roads.

But the most urgent action is for countries to update their hospital lists, including assessing capacity and capability to provide emergency care and updating the private sector. Our research goes some way to helping them start this process. We have created a database that can be used to Free and used to assess service availability at a national level.

build database

The hospital list covers 48 countries and islands in sub-Saharan Africa.

To compile this list, we used a wide range of data sources, including ministries of health, health information systems, and national and international organizations for all countries and islands. In most cases, these sources can be found online, but we also relied on personal contacts to obtain hospital data for some countries.

Nearly 50% of the hospitals on the list did not have GPS coordinates and therefore could not be accurately located. To address this, we assigned them unique location attributes using online mapping tools such as Google Earth and OpenStreetMaps.

This audit located 4908 public hospitals with precise location attributes ( Figure 1 ).

Nigeria, which is home to nearly a fifth of sub-Saharan Africa’s population, has the highest number of hospitals, at 879. Other countries with a significant number of public hospitals are the Democratic Republic of the Congo (435), Kenya (399) and South Africa (337).

The lowest were in smaller countries such as Cape Verde, Zanzibar and Sao Tome and Principe. This information was used as a starting point to calculate the geographical accessibility of hospital services.

Timely access

We measure geographic accessibility by the travel time to the nearest public hospital. We do this by calculating road travel time for the main modes of transport in the area.

We collected road networks using Google Earth and OpenStreetMaps and assigned travel speeds along the roads. We then developed a model to calculate the time it would take a patient to travel to the nearest hospital from any 100-meter by 100-meter grid location.

More specifically, a significant proportion of women required hospital care during childbirth, and we determined how long it took them to reach the nearest hospital.

The results showed that less than a third (29%) of the general population and 28% of women of childbearing age lived more than two hours from the nearest hospital – a two-hour threshold widely used by the UK government. WHO and The Lancet Commission on Global Surgery The two most common definitions of obstetric and surgical care are:

The most surprising results are the huge disparities between countries. For example, more than 75% of the population of South Sudan lives outside the two-hour standard. Other poorly served countries include the Central African Republic, Chad, and Eritrea. More than half of the population in these countries lives outside the two-hour standard.

The best served countries are mostly island nations, such as Zanzibar, Comoros and Sao Tome and Principe. More than 95% of the population in these countries have access to a hospital within a two-hour drive. Large countries such as Kenya, South Africa and Nigeria also have good accessibility indices, with more than 90% of the population within a two-hour drive.

All 48 countries we surveyed have signed up to the Sustainable Development Goal of achieving universal health care by 2030, part of which involves hospital access. Our research can help countries determine what they need to do in terms of emergency care to achieve this goal. There is still a long way to go. Only 16 countries in our survey have achieved 80% coverage of hospital access within two hours.