Improving accessibility to rural health services: The maximal covering network improvement problem

Accessibility to health facilities is a critical factor in effective health treatment for people in rural areas of lesser-developed countries. In many areas accessibility is diminished by the lack of all-weather roads, making access subject to weather conditions. Location–allocation models have been used to prescribe optimal configurations of health facilities in order to maximize accessibility, but these models are based on the assumption that the underlying transport network is static and always available. Essentially, past work has ignored the potential impacts of improvements to the transport system in modeling access. In this paper we propose a model that treats the opposite side of the location/transport equation; that is, a model that treats existing facility locations as fixed and improves health service accessibility by upgrading links of the transport network to all-weather roads. This new model, called the Maximal Covering Network Improvement Problem (MC-NIP) is formulated as an integer-linear programming problem. An application of the MC-NIP model to the Suhum District of Ghana is presented, which shows that even a modest level of road improvement can lead to substantial increases in all-season access to health service.