Geospatial Access to Emergency Obstetric Surgery in Indonesia: Is Travel Time for Access Too Long?

Area of Science:

• Global Health
• Surgical Access
• Health Equity

Background:

• Timely access to safe and affordable surgery is vital for universal health coverage, as recommended by the Lancet Commission on Global Surgery (LCoGS).
• Assessing geographic accessibility to emergency obstetric and gynecological services is crucial for identifying healthcare disparities.

Purpose of the Study:

• To quantify the proportion of Indonesian women of reproductive age (WRA) with access to hospitals offering emergency obstetric and gynecological services within a 2-hour travel time.
• To identify specific populations and regions in Indonesia experiencing underserved access to these critical healthcare services.

Main Methods:

• Utilized databases from the Indonesian Society of Obstetricians and Gynecologists (ISOG) and the Ministry of Health to identify hospitals providing emergency obstetric care across 38 provinces.
• Conducted geospatial analysis using ArcGIS Pro, incorporating travel time (2-hour drive) and population data from high-resolution settlement layer maps to assess service area coverage.

Main Results:

• Out of 3,202 hospitals, 89.2% had an obstetric gynecologist (OBGYN); 91.6% of 5,305 OBGYNs were actively practicing.
• 94.5% of the WRA population lived within a 2-hour travel time to a facility offering these services.
• Significant geographic disparities were identified, with eight provinces demonstrating low timely access to essential obstetric surgical care.

Conclusions:

• While Indonesia has made strides in universal health coverage, substantial regional inequalities persist in accessing emergency obstetric surgical care.
• Geospatial mapping combined with survey data is an effective tool for evaluating surgical system capacity and pinpointing gaps in timely surgical care access.