Healthcare accessibility in preconflict Syria: a comparative spatial analysis.

Area of Science:

• Health Services Research
• Spatial Epidemiology
• Public Health Policy

Background:

• Scarce information exists on health resource allocation in Syria.
• Pre-existing health inequalities were exacerbated by the 2011 conflict, displacing over 50% of the population.
• A pre-conflict baseline is crucial for assessing the conflict's impact and guiding reconstruction.

Purpose of the Study:

• To analyze pre-conflict spatial inequalities in access to public hospitals in Syria using 2010 data.
• To compare the provider-to-population ratio (PPR) and the two-step floating catchment area (2SFCA) method for quantifying inpatient bed access.
• To establish a baseline for future health system impact assessments.

Main Methods:

• Compared PPR (governorate level) with population-weighted 2SFCA (2km x 2km resolution).
• Aggregated 2SFCA data to governorate level and tested various catchment sizes.
• Calculated the Gini coefficient to measure inequality within governorates.

Main Results:

• High inequality in public hospital access was found across and within governorates, particularly in northern and eastern regions.
• Western and southern governorates exhibited better spatial access and lower inequality.
• Even with a 125km catchment, 65% of Syria had below-average accessibility.

Conclusions:

• The two-step floating catchment area (2SFCA) method offers more nuanced insights into health accessibility than PPR, accounting for road networks and cross-boundary effects.
• Realistic health accessibility assessments are feasible even in data-scarce environments like Syria.
• This methodology can be adapted to evaluate health access inequalities in conflict and post-conflict settings.