As Liberia rebuilds a health care system decimated by the 2014 Ebola outbreak, understanding precisely how far citizens live from health facilities and its impact on seeking care can help shape new strategies to improve health care delivery and reduce geographic disparities.
A new examination of remoteness as a barrier to health care, published online June 29 in the Journal of Global Health, notes that most surveys and policy documents categorize families as living either in an urban or rural setting, and this dichotomy can mask disparities of the most remote families.
"It's no surprise that those who live in rural areas are less likely to seek essential care from a health care facility, but for those at the farthest distances the disparity in maternal and child services is staggering," says John Kraemer, JD, MPH, assistant professor in the health systems administration department at Georgetown University School of Nursing & Health Studies. "Our study illuminates new opportunities for the health system to close this gap."
Kraemer and his colleagues, including members of Last Mile Health, an organization focused on health in rural Liberia, suggest a number of strategies to better serve those in the most rural settings. These include shifting care to the lowest level provider possible; community health worker-based service delivery; training, formalization, or partnership with traditional or informal providers; mobile clinics and clinical outreach; or reimbursing families for health care seeking and/or transportation costs.
"It is critical that international partners continue supporting Liberia's government after headlines about Ebola fade, and that rural health systems be rebuilt," says Kraemer, also a Scholar with the O'Neill Institute for National and Global Health Law at Georgetown Law. "International human rights law and ethical norms oblige health ministries and their development partners to promote equal access to essential health services."