Strategies for enhancing PHC accessibility through mobile and capsule clinics: a spatial location allocation study in...

Shortages in the Primary Health Care (PHC) workforce, especially in remote areas, pose a major challenge to achieving universal health coverage. Traditional strategies focused solely on hiring village doctors face limitations due to recruitment challenges in these regions. This study proposes a multi-strategy approach to PHC workforce allocation to address spatial imbalances and improve healthcare accessibility and equity.

We developed a Multi-Strategy PHC Workforce Location Allocation model that integrates three strategies: hiring village doctors, deploying mobile clinics, and establishing capsule clinics. The model aims to minimize patient impedance while considering constraints such as service coverage, capacity, and budget. Using Beijing's suburban areas as a case study, we conducted empirical runs to compare two models. The first is a single-strategy model that relies solely on hiring village doctors. The second is a multi-strategy model that combines hiring village doctors with mobile and capsule clinics. Data were collected from 34 towns, 823 villages, and 894 medical facilities. We evaluated the models based on impedance, cost, accessibility, and Gini coefficients, which were calculated using methods such as the two-step floating catchment area approach.

Compared with the single-strategy approach, the multi-strategy model consistently achieves higher coverage, lower impedance, better accessibility, and improved equity under the same budget. For example, with a 10% budget parameter, it covers 19.23% more villages in deep mountainous areas and improves accessibility in the plains, near mountainous, and deep mountainous areas by 1.59%, 4.80%, and 4.44%, respectively, outperforming the single-strategy model. As government investment increases, the improvement in impedance shows a trend of diminishing marginal returns.

Integrating hiring village doctors with mobile and capsule clinics offers a flexible and effective solution for addressing PHC workforce shortages in remote areas. This multi-strategy approach not only improves healthcare accessibility and fairness but also achieves higher financial efficiency. We recommend that governments adopt this comprehensive strategy, especially in resource-constrained regions, to achieve universal PHC service coverage.