A structured approach to promote equity in spatial accessibility to TB services during private sector engagement

We sought to quantify the potential impact of private sector engagement on the equity of spatial accessibility to TB services in Lima, Peru.

We used the enhanced two-step floating catchment area (E2SFCA) method to calculate census spatial accessibility indices for access to health facilities providing clinical evaluation, sputum testing, or chest radiography in two districts. We compared different hypothetical interventions of engaging private facilities to a baseline including only public facilities. We defined an equity-promoting intervention as one that improves the median spatial accessibility index while decreasing the interquartile range (IQR).

Our analysis included 22 public and 38 private facilities. For clinical evaluation and sputum testing, which are universally available in public facilities, neither broad nor targeted private sector engagement would have substantial impact on the IQR of the spatial accessibility index in either district. For radiography services, which are limited in public facilities, we identified equity-promoting private sector engagement interventions that would increase median spatial accessibility by 8%-28% while reducing the IQR by 1%-26%.

Targeted private sector engagement can sometimes promote equity in spatial accessibility to TB services. An E2SFCA analysis provides an objective approach to identifying equity-promoting engagement interventions.