Percent of population living within two hours travel time from nearest facility offering a specific reproductive health service

The percent of the population in a given geographical area that resides within two hours travel to the nearest service delivery site offering a specific type of reproductive health (RH) service (e.g., antenatal care, voluntary counseling and testing, male sterilization)

The time (measured in minutes) is contextually-based and depends on what the most common form of transportation is.  For example, at one site, traveling may be primarily on foot whereas at another site it may be by motorbike and vehicle.

This indicator is calculated as:

(Number of respondents living within two hours travel time to nearest facility providing a specific RH service / Total number of people surveyed) x 100

Information on the location of the respondents in relation to the service delivery point in question

One can map the routes between a given community and an individual service delivery point and can (preferably) obtain measures of travel time. 

Self-reports of respondents or key informants is another way to determine travel time.

Data from facility-based surveys analyzed in relation to data from household surveys (e.g., in the context of a DHS survey); special surveys

Ideally, the researcher will determine the distance between the home of an average citizen in country X and the nearest facility providing a specific RH service and with that information, determine the time it takes to cover that distance by the most common mode(s) of transportation. In the past, researchers often relied on self-report of survey respondents or of community informants, both of which tended to be highly unreliable. In recent years, researchers have attempted to link the DHS household surveys with surveys of the facilities in the surrounding area in selected countries. In linking the data from the household and facility-based surveys, researchers and evaluators are able to accurately measure distance between these communities and service delivery points (Akin et al., 1998; Seiber and Bertrand, 2001).

There are, however, several caveats to measuring access using this linking technique. First, many DHS household surveys do not include a facility-based survey, or the facility-based survey is not linked to the household survey. Second, the human and financial resources needed to carry out a DHS with both the household and the facility-based components are considerable. Thus, in the best of cases, the linked surveys are conducted only once every 3-5 years. Third, this linking of the two surveys allows for a much more precise measurement of the time and distance between the household of the average respondent and the nearest service delivery point. However, research has shown that clients often elect to use services at some more distant point to preserve their privacy; to obtain a range of services (e.g., specific contraceptive method, or special lab procedures) not available at a facility closer to their home; or to obtain higher quality services (e.g., better client-provider communication).

To date, evaluators have studied physical access as a determinant of service utilization and use, but program managers have not routinely used it for the day-to-day monitoring of program performance, because of the time and expense associated with the above-mentioned linking procedure.

access, health system strengthening (HSS), safe motherhood (SM)

Distance to the nearest RH facility represents, on one hand, the commitment and resources of government to provide universal access to health care. It is an important variable to consider in terms of women's ability to obtain obstetrical services-- maternal and child health care and family planning-- particularly in areas where transportation is difficult. Distance to needed obstetrical services and lack of transport to reach a facility offering such services are key variables contributing to maternal deaths. Advocates for safe motherhood argue that these preventable deaths indicate that policy makers undervalue women's lives. Advocates employ human rights conventions to hold governments accountable for providing appropriate and accessible health services (Rosenfield, 2001). On the other hand, when women travel outside of their communities to obtain care at a remote service site, they may do so because some service facilities fail to adequately observe privacy and confidentiality, and women fear the consequences. For example, women who feel they must obtain contraceptives covertly because of perceived disapproval on the part of the husband or extended family may fear retribution if confidentiality is violated. Many small local service outlets have no potential for offering women visual privacy as they wait in line for services. However, even these facilities can observe policies and procedures to protect the woman's confidentiality in RH choices and services obtained.

Akin J.S., D.K. Guilkey, P.L. Hutchinson, and M.T. McIntosh. 1998. "Price Elasticities of Demand for Curative Health Care with Control for Sample Selectivity on Endogenous Illness: An Analysis for Sri Lanka." Health Economics 7, 509-531.

Rosenfield A, 2001. "Maternal Mortality as a Human Rights and Gender Issue". In: Reproductive Health, Gender and Human Rights: a dialogue. Edited by Elaine Murphy and Karin Ringheim. Washington D.C.: Program for Appropriate Technology in Health [PATH].

Seiber, E. and J.T. Bertrand. 2001. "Access as a Factor in Differential Contraceptive Use between Mayans and Ladinos in Guatemala." MEASURE Evaluation Project Working Paper Series. University of North Carolina, Chapel Hill, NC: Carolina Population Center.