Spatial accessibility of primary care services among rural population in Selangor, Malaysia
Disparities of access to health services in rural areas is a global health issue, especially in middle-income countries. Lack of access or delay in getting adequate treatment leads to poorer health outcomes. Recent method called enhanced two-step floating catchment area (E2SFCA) exhibits promisin...
| Main Author: | |
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| Format: | Thesis |
| Language: | English |
| Published: |
2022
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| Subjects: | |
| Online Access: | http://psasir.upm.edu.my/id/eprint/116457/ http://psasir.upm.edu.my/id/eprint/116457/1/116457.pdf |
| _version_ | 1848867008502824960 |
|---|---|
| author | Ab Hamid, Jabrullah |
| author_facet | Ab Hamid, Jabrullah |
| author_sort | Ab Hamid, Jabrullah |
| building | UPM Institutional Repository |
| collection | Online Access |
| description | Disparities of access to health services in rural areas is a global health issue,
especially in middle-income countries. Lack of access or delay in getting
adequate treatment leads to poorer health outcomes. Recent method called
enhanced two-step floating catchment area (E2SFCA) exhibits promising results
in quantifying spatial accessibility. Comprehensive understanding of current
extent of disparities of accessibility to primary healthcare in local context is
essential. This study is to determine the spatial accessibility score to primary
care services (clinics) across rural population in Selangor and its associated
ecological factors, as well as to propose solutions for primary care service
capacity upgrade.
This cross-sectional ecological study employed a geographical information
system (GIS) based approach to calculate the spatial accessibility, adapted from
E2SFCA method considering both public and private clinics. Public clinic refers
to health clinics (Klinik Kesihatan) and 1Malaysia mobile clinics govern by the
MOH that operated by at least one doctor. Private clinic refers to general
practitioner (GP) or private medical clinic. Other types of clinics, dental clinic or
primary care services that are provided at hospital is not included for the
calculation of spatial accessibility score. Population data was from Housing and
Population Census 2010. The spatial pattern of the E2SFCA scores was based
on geostatistical tests (Global Moran’s I and Getis-Ord Gi*) and the degree of
equality was based on Gini index. Associated ecological factors determined
using multiple linear regression. The location-allocation modelling performed to
identify optimal locations for public clinic service capacity upgrade, to improve
accessibility in low E2SFCA scores areas.
High E2SFCA scores areas mainly concentrated surrounding the urban
agglomeration at the centre of Selangor, largely contributed by the private sector.
Low E2SFCA scores areas predominantly at the northern and coastal regions.
Distribution of E2SFCA scores were equal but lower degree of equality observed
at the northern region. Rural areas, closer to urban area, higher road density and
higher proportion of vulnerable population were positively associated with higher
E2SFCA scores (p<0.05). In the location-allocation modelling, coastal areas
were prioritised for service capacity upgrade in order to optimise the increment
of E2SFCA scores.
The level and distribution of E2SFCA scores reflect the performance of primary
healthcare. This study provide insight for identifying disparities and areas that
need attention as well as potential solutions to resolve the issue. Identification of
the influencing factors elucidates the characteristics of the accessibility pertinent
to local context. This approach of utilising existing data combined with GIS-based
technology delivers great contribution for evidence-based in formulating policy
and healthcare planning related to accessibility and resource distribution, such
as projecting the health workforce distribution according to the population need.
In addition, using existing data routinely collected by the government ease
replication for continuous monitoring, as well as can be applied in other health
care services. |
| first_indexed | 2025-11-15T14:29:40Z |
| format | Thesis |
| id | upm-116457 |
| institution | Universiti Putra Malaysia |
| institution_category | Local University |
| language | English |
| last_indexed | 2025-11-15T14:29:40Z |
| publishDate | 2022 |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | upm-1164572025-05-19T03:16:31Z http://psasir.upm.edu.my/id/eprint/116457/ Spatial accessibility of primary care services among rural population in Selangor, Malaysia Ab Hamid, Jabrullah Disparities of access to health services in rural areas is a global health issue, especially in middle-income countries. Lack of access or delay in getting adequate treatment leads to poorer health outcomes. Recent method called enhanced two-step floating catchment area (E2SFCA) exhibits promising results in quantifying spatial accessibility. Comprehensive understanding of current extent of disparities of accessibility to primary healthcare in local context is essential. This study is to determine the spatial accessibility score to primary care services (clinics) across rural population in Selangor and its associated ecological factors, as well as to propose solutions for primary care service capacity upgrade. This cross-sectional ecological study employed a geographical information system (GIS) based approach to calculate the spatial accessibility, adapted from E2SFCA method considering both public and private clinics. Public clinic refers to health clinics (Klinik Kesihatan) and 1Malaysia mobile clinics govern by the MOH that operated by at least one doctor. Private clinic refers to general practitioner (GP) or private medical clinic. Other types of clinics, dental clinic or primary care services that are provided at hospital is not included for the calculation of spatial accessibility score. Population data was from Housing and Population Census 2010. The spatial pattern of the E2SFCA scores was based on geostatistical tests (Global Moran’s I and Getis-Ord Gi*) and the degree of equality was based on Gini index. Associated ecological factors determined using multiple linear regression. The location-allocation modelling performed to identify optimal locations for public clinic service capacity upgrade, to improve accessibility in low E2SFCA scores areas. High E2SFCA scores areas mainly concentrated surrounding the urban agglomeration at the centre of Selangor, largely contributed by the private sector. Low E2SFCA scores areas predominantly at the northern and coastal regions. Distribution of E2SFCA scores were equal but lower degree of equality observed at the northern region. Rural areas, closer to urban area, higher road density and higher proportion of vulnerable population were positively associated with higher E2SFCA scores (p<0.05). In the location-allocation modelling, coastal areas were prioritised for service capacity upgrade in order to optimise the increment of E2SFCA scores. The level and distribution of E2SFCA scores reflect the performance of primary healthcare. This study provide insight for identifying disparities and areas that need attention as well as potential solutions to resolve the issue. Identification of the influencing factors elucidates the characteristics of the accessibility pertinent to local context. This approach of utilising existing data combined with GIS-based technology delivers great contribution for evidence-based in formulating policy and healthcare planning related to accessibility and resource distribution, such as projecting the health workforce distribution according to the population need. In addition, using existing data routinely collected by the government ease replication for continuous monitoring, as well as can be applied in other health care services. 2022-06 Thesis NonPeerReviewed text en http://psasir.upm.edu.my/id/eprint/116457/1/116457.pdf Ab Hamid, Jabrullah (2022) Spatial accessibility of primary care services among rural population in Selangor, Malaysia. Doctoral thesis, Universiti Putra Malaysia. http://ethesis.upm.edu.my/id/eprint/18276 Rural Health Services Health Services Accessibility Spatial Analysis |
| spellingShingle | Rural Health Services Health Services Accessibility Spatial Analysis Ab Hamid, Jabrullah Spatial accessibility of primary care services among rural population in Selangor, Malaysia |
| title | Spatial accessibility of primary care services among rural population in Selangor, Malaysia |
| title_full | Spatial accessibility of primary care services among rural population in Selangor, Malaysia |
| title_fullStr | Spatial accessibility of primary care services among rural population in Selangor, Malaysia |
| title_full_unstemmed | Spatial accessibility of primary care services among rural population in Selangor, Malaysia |
| title_short | Spatial accessibility of primary care services among rural population in Selangor, Malaysia |
| title_sort | spatial accessibility of primary care services among rural population in selangor, malaysia |
| topic | Rural Health Services Health Services Accessibility Spatial Analysis |
| url | http://psasir.upm.edu.my/id/eprint/116457/ http://psasir.upm.edu.my/id/eprint/116457/ http://psasir.upm.edu.my/id/eprint/116457/1/116457.pdf |