• Non ci sono risultati.

Health System Planning. A Methodology to locate Social and Health Structures In Developing Countries

N/A
N/A
Protected

Academic year: 2021

Condividi "Health System Planning. A Methodology to locate Social and Health Structures In Developing Countries"

Copied!
12
0
0

Testo completo

(1)

Procedia Environmental Sciences 37 ( 2017 ) 222 – 233

1878-0296 © 2017 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Peer-review under responsibility of the organizing committee of GU 2016 doi: 10.1016/j.proenv.2017.03.037

ScienceDirect

,QWHUQDWLRQDO&RQIHUHQFH±*UHHQ8UEDQLVP*8

+HDOWK6\VWHP3ODQQLQJ$PHWKRGRORJ\WRORFDWH6RFLDODQG+HDOWK

6WUXFWXUHVLQ'HYHORSLQJ&RXQWULHV

'RPHQLFR&KL]]RQLWL

D



aPolitecnico di Milano, Piazza Leonardo da Vinci 32, Milan 20133, Italy

$EVWUDFW

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³VWUHVV´DUHDV WKDWUHTXLUHSULRULW\LQWHUYHQWLRQV )LQDOO\E\UHFRJQL]LQJDORQJWHUPVWUDWHJ\WKLVUHVHDUFKLGHQWLILHVDSUHFLVHFDVHVWXG\WRYHULI\WKLVH[SHULPHQWDOPHWKRG  ‹7KH$XWKRUV3XEOLVKHGE\(OVHYLHU%9 3HHUUHYLHZXQGHUUHVSRQVLELOLW\RIWKHRUJDQL]LQJFRPPLWWHHRI*8 Keywords:0HWKRGRORJ\VRFLDODQGKHDOWKVWUXFWXUHVV\VWHPSODQQLQJGHYHORSLQJFRXQWULHV ,QWURGXFWLRQ

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





&RUUHVSRQGLQJDXWKRU7HO

E-mail address:GRPHQLFRFKL]]RQLWL#SROLPLLW

© 2017 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

(2)

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x WKHSODQQLQJLVEDVHGRQDUELWUDU\SULRULWLHVZLWKOLWWOHIRUHVLJKWLQSURJUDPPLQJDQGWRWKHKHDOWKIDFLOLW\ PDQDJHPHQWPHWKRGV x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

x $ VHWWOHPHQW VWUDWHJ\ WKURXJK TXDQWLWDWLYH GDWD WR ORFDWH 3ULPDU\ +HDOWK &DUH IDFLOLWLHV RQ WKH UXUDO DUHDV RI GHYHORSLQJFRXQWULHV

,Q WKLV ILHOG LW LV LPSRUWDQW WR LGHQWLI\ WKH DUHD WR ZRUN RQ FROOHFW GDWD DERXW WKH GLVHDVH FKDUDFWHULVWLFV WKH SRSXODWLRQ GHQVLW\ WKH KHDOWK FDUH IDFLOLWLHV XQGHUVWDQG WKH HQYLURQPHQWDO VLWXDWLRQ HWF LQ RUGHU WR H[WUDFW TXDQWLWDWLYHGDWD

x $ORFDWLQJSURFHVVWKURXJKTXDOLWDWLYHFKRLFHV

7KHQXPHULFDOGDWDREWDLQHGVKRXOGEHFRQVLGHUHGIRUORFDWHWKHKHDOWKVWUXFWXUHVIURPDFULWLFDODSSURDFKWKDW HYDOXDWH WKH TXDQWLWDWLYH GDWD WKURXJK WKH TXDOLWDWLYH FKRLFHV SUR[LPLW\ RI WKH ULYHUV VHWWOHPHQWV IORRGV FKDUDFWHUVRIWKHVLWHDYDLODELOLW\RILQIUDVWUXFWXUHHWF



x 0HWKRGVWRLGHQWLI\WKHDFWLYLWLHVIXQFWLRQVDQGFXOWXUDOORFDOKDELWV

%HIRUHGHVFULEHWKHSURWRW\SHFRQVWUXFWLRQLWLVLPSRUWDQWWRGHILQHWKHFDWFKPHQWDUHDRIWKHKHDOWKIDFLOLW\IRU LGHQWLI\ WKH GLIIHUHQW DFWLYLWLHV WR EH SHUIRUPHG LQVLGH DFFRUGLQJ WR WKH SRSXODWLRQ WKDW UHYROYH DURXQG WR WKH KHDOWK SRVW :H VKRXOG DOVR XQGHUVWDQG ORFDO FXOWXUDO KDELWV WR ILJXUH RXW KRZ WR RUJDQL]H WKH LQWHUQDO DQG H[WHUQDOVSDFHVRIWKHFHQWUH

(3)

x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

0HWKRG

:KHUHDV KRVSLWDOV DUH ORFDWHG LQWRZQV DQG PDLQO\ VHUYH XUEDQ VHWWOHPHQWV +HDOWK 3RVWV KDYH WR EH SODFHG LQ SHULSKHUDODUHDVDQGVHUYHSHDVDQWV%HIRUHDQDO\]LQJWKHIXQFWLRQDODVSHFWVRIWKHKHDOWKIDFLOLW\LWLVLPSRUWDQWWR FKRRVH WKH DUHD ZKHUH LW ZLOO EH SODFHG 7KH KHDOWK SODQQLQJ PHWKRGRORJ\ XVHG LQ WKLV UHVHDUFK WDNHV LQWR FRQVLGHUDWLRQWKHORFDOL]DWLRQPHWKRGRIWKHDUFKLWHFWXUDOWKHVLVRI(QULFR2URILQRSXEOLVKHGLQ>@7KHH[DFW SRVLWLRQRIWKHVWUXFWXUHPXVWQRWRQO\EHFKRVHQRQWKHEDVLVRISK\VLFDOIDFWRUV VXFKDVURDGDFFHVV EHFDXVHLWLV QRWDEOHWRYHULI\WKHDUHDVUHTXLULQJDSULRULW\LQWHUYHQWLRQ7KHNQRZOHGJHRIWKHDUHDFRQVLVWVRIWKHV\VWHPDWLF FROOHFWLRQRIGDWDDQGLQIRUPDWLRQUHODWLQJWRWKHUHVLGHQWSRSXODWLRQWKHRFFXSDWLRQRIWKHVRLOVDQGWKHLUXVHWKH FKDUDFWHULVWLFV RI WKH EXLOGLQJ DQG VHUYLFHV WR WKH SRSXODWLRQ SULPDU\ DQG VHFRQGDU\ LQIUDVWUXFWXUH  LQ WKH HODERUDWLRQRIWKHPDWLFPDSVWKDWVXPPDUL]HWKHFRQWHQWV>@

)LUVWWRGRWKLVLQDVKRUWWLPHZDVQHFHVVDU\WRFROOHFWGDWDSRSXODWLRQGHQVLW\ZDWHUVXSSO\KHDOWKIDFLOLWLHV FRYHUDJHDFFHVVWRKHDOWKFDUHIDFLOLWLHVDQGSULPDU\VFKRROV

7KH KHDOWK IDFLOLWLHV SODQQLQJ FDQ EH SHUIRUPHG ZHOO RQO\ ZKHQ WKH QHFHVVDU\ GDWD DUH DYDLODEOH WR FUHDWH WKH µORFDOPRGHO¶ZLWKUHDOLVWLFFULWHULD)RUHDFKRIIDFWRUVLVJLYHQDVFRUHWKHPLQLPXPVFRUHLVDWWULEXWHGWRWKHIDFWRU WKDWKDVWKHPD[LPXPYDOXH)RUH[DPSOHWKHZHOOVDUHGLYLGHGLQWRIXQFWLRQLQJ VFRUH WRUHVWRUH VFRUH WR EXLOG VFRUH   7R WKH IDFWRUV VXFK DV WKH SRSXODWLRQ GHQVLW\ LW LV QHFHVVDU\ WR GLYLGH LW LQWR  FODVVHV RI WKH SRSXODWLRQYHU\ORZ VFRUH ORZ VFRUH VFDUFH VFRUH KLJK VFRUH YHU\KLJK VFRUH 

%XWLQRUGHUWRH[DFWO\GHILQHWKHZHLJKWWREHJLYHQWRHDFKRIWKHVHIDFWRUVZHFDQGRLWRQVLWH LISRVVLEOH  LQWHUYLHZLQJ ORFDO SHRSOH WU\LQJ WR XQGHUVWDQG WKHLU QHHGV DQG WKHLU UHTXLUHPHQWV ,QWHUYLHZV FDQ DOVR EH PDGH SUHSDULQJTXHVWLRQQDLUHV WR DFFHOHUDWH GDWDFROOHFWLRQ DQGDVNLQJ WR ORFDO SHRSOH WRJLYH DYDOXH IURP  WR  IRU HDFKIDFWRU7KHZHLJKWLVWKHDYHUDJHMXGJPHQWIRUHDFKIDFWRU

7KHPHWKRGRORJ\LQYROYHVGLYLGLQJWKHPDSRIWKHLGHQWLILHGDUHDZLWKDJULG RIDSSURSULDWHVL]HUHODWLYHWRWKH VFDOH RI WKH PDS  )RU HDFK LQGLFDWRU PXVW EH PDGH D PDS ZKLFK VKRZV ZKHUH DUH ORFDWHG WKH DUHDV ZLWK PDMRU SUREOHPV UHODWHG WR WKDW VSHFLILF IDFWRU KLJKOLJKWLQJ WKH ³VTXDUHV´ RI WKH JULG ZLWK FRORUV RU GLIIHUHQW JUDSKLFV  $IWHUZDUGVFRPSDULQJWKHPDSVRIHDFKIDFWRUVKRXOGPDNHDTXDOLWDWLYHDQDO\VLV7KHUHVXOWVRIHDFKPDSPXVWEH FRPSDUHGDQGV\QWKHVL]HGLQWRDVXPPDU\WDEOH VHHWDEOH$ 

7DEOH$7RWDOVFRUHIRUHDFKVTXDUHLQWKHPDS

FACTORS RANK STRESS Ax RANK STRESSBy RANK STRESSCj RANK STRESSEz F... RANK STRESS

Population density ... ... ... ... ...

Water supply ... ... ... ... ...

Health facilities coverage ... ... ... ... ... Access to health facilities ... ... ... ... ...

... ... ... ... ... ...

(4)

(DFKUDQNVFRUHKDVWREHGLYLGHGLQWRFODVVHV DEFG DQGIRUHDFKFODVVVKRXOGEH LGHQWLILHGVRPHVTXDUHVZKHUHWKURXJKWKHSDUWLFLSDWRU\VXUYH\ZHFDQGHILQHWKHZHLJKWV6RWKHQH[WVWHSLVWR LGHQWLI\WKHUHODWLYHZHLJKWRIHDFKLQGLFDWRUWKURXJKDUDQNLQJGHSHQGLQJRQWKHFDVHVWXG\DQDO\]HG VHHWDEOH%  7DEOH%,GHQWLILFDWLRQRIWKH³VWUHVV´DUHD FACTORS RANKING WEIGHT Ax By Cj Ez F...

RANK STRESS RANK STRESS RANK STRESS RANK STRESS RANK STRESS

Population density ... ... ... ... ... ...

Water supply ... ... ... ... ... ...

Health facilities coverage ... ... ... ... ... ... Access to health facilities ... ... ... ... ... ...

... ... ... ... ... ... ... STRESS SCORE ... ... ... ... ... ...  %\PXOWLSO\LQJWKHUDQNLQJZHLJKWRIHDFKIDFWRUZLWKWKH6FRUHRIHDFKVTXDUHZHREWDLQWKHDUHDVZLWKWKHZRUVW VLWXDWLRQ ³VWUHVV´DUHDV 7KHILQDOVWHSLVWRUHSUHVHQWDODVWPDSWKURXJKWKHVWUHVVVFRUHREWDLQHGIRUHDFKVTXDUH 7KHVWUHVVVFRUHVKRXOGEHGLYLGHGLQWRJURXSVWKDWVKRZJUDSKLFDOO\WKHGLIIHUHQWOHYHOVRIVWUHVVDUHDVREWDLQHGLQ ZKLFK ZH PXVW DFW ,Q FRQFOXVLRQ WKLV PHWKRGRORJ\ DLPV WR ORFDWH WKH EDVLF KHDOWK XQLWV LQ WKH DUHDV ZLWK ZRUVW VLWXDWLRQV FORVH WR PDLQ UXUDO LQIUDVWUXFWXUH QHWZRUNV QRW IDU IURP YLOODJHV WR UHGXFH WKH LPSDFW RI WKH GLVWDQFH EHWZHHQWKHUHVLGHQFHDQGWKHSHULSKHUDOKHDOWKIDFLOLW\

,IWKHGLVWDQFHEHWZHHQYLOODJHVDQG+HDOWK3RVWVLQFUHDVHVWKHKHDOWKFDUHXWLOL]DWLRQGHFUHDVHVFRQVHTXHQWO\ DOVREHFDXVHLQGHYHORSLQJFRXQWULHVWKHPHDQVRIWUDQVSRUWDWLRQPRVWFRPPRQO\XVHGLVµZDONLQJ¶DQGURDGVDUH QRWSDYHGWKLV PDNHVLW PRUHGLIILFXOWWRUHDFKEDVLFKHDOWKIDFLOLWLHVE\LQFUHDVLQJWKH PRUWDOLW\UDWHRIWKHORFDO SRSXODWLRQ $ KHDOWK IDFLOLW\ DFWV DV D SROH QRW RQO\ IRU DWWUDFWLQJ SHRSOH EXW DOVR IRU LUUDGLDWLQJ VHUYLFHV RQ WKH WHUULWRU\

7KHUHIRUH LW KDV WR SURPRWH VHWWOHPHQWV LQFOXGLQJ DOO WKH DFWLYLWLHV QHHGHG E\ WKH SRSXODWLRQ VXFK DV KHDOWK IDFLOLWLHVVFKRROVPDUNHWVDQGZDWHUZHOOVLQRUGHUWRHQVXUHKHDOWKDQGK\JLHQHLQYLOODJHV )LJ 7KLVIDFWGRHV QRWRQO\LPSOLHVWKDWWKHORFDWLRQRIWKHFRQVWUXFWLRQXQLWVKRXOGEHEDU\FHQWULFZLWKUHVSHFWWRWKHFDWFKPHQWDUHD EXWLWDOVRLPSOLHVWKDWRQO\IHZVHUYLFHVZLOOEHORFDWHGLQWKHFHQWHU      )LJ1HWZRUNRIVHUYLFHVLPSOHPHQWDWLRQ

(5)

&DVHVWXG\

$PRQJ WKH ZD\V RI XQGHUVWDQGLQJ WKH 3ULPDU\ +HDOWK &DUH WKH FKRLFH KDV EHHQ WR IRFXV WKH DWWHQWLRQ RQ WKH VWUXFWXUHV RI KHDOWK IDFLOLW\ LQ WKH FRQWH[WV RI 6XE6DKDUDQ $IULFD WKDW FRXOG EH H[SRUWHG LQ RWKHU GHYHORSLQJ FRXQWU\,QSDUWLFXODUWKHFLW\RI&DLDLQ0R]DPELTXHZDVFKRVHQDVDFDVHVWXG\WRWHVWWKHKHDOWKV\VWHPSODQQLQJ H[SODLQHGLQWKHSUHYLRXVSDUDJUDSK7KHDUHDWREHFRQVLGHUHGDVDFDVHVWXG\FRQFHUQVWKHWHUULWRULHVRQWKHURDG D[LVDORQJWKHWUDMHFWRU\FDOOHG*D'H/L *DPED'HYH±/LFRPDQDPHG('(VWUDGD'LVWULWDOQƒ 7KH('UXQV HDVWZHVWSDUDOOHOWRWKHULYHU0HSX]H$ORQJWKHZD\LWFURVVHVLPSRUWDQWFHQWHUVVXFKDV1KDFXHFKD16RQDDQG &KDWDOD )LJ    )LJ8UEDQVHWWLQJRI&DLD0R]DPELTXH  7KHILUVWDSSURDFKLVWR&2//(&7'$7$DORQJWKHD[LV*DPED'HYH±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¶V DELOLW\ WR IDFHLWVPXOWLSOHKHDOWKFKDOOHQJHVLVDVWUXFWXUDORQH7KHSUREOHPLVWKDWDOOWKHKHDOWKFDUHV\VWHPVUHPDLQIRFXVHG RQDFXWHVKRUWWHUPWUHDWPHQWRQILJKWLQJWKHWUDGLWLRQDOEDWWOHVDJDLQVWLQIHFWLRXVDQGWURSLFDOGLVHDVHVGLDUUKHDDV ZHOO DV PDWHUQDO DQG FKLOG PRUWDOLW\ 7KH DSSURDFK WRZDUGV SULPDU\ KHDOWKFDUH LV FKDQJLQJ GXH WR WKH JURZLQJ DPRXQW RI FKURQLF FRQGLWLRQV DQG WKH LQFUHDVHG SRSXODWLRQV FRSLQJ ZLWK GLVHDVHV IRU ORQJHU SHULRGV +HQFH QHZ HPSKDVLV LV SXW RQ SUHVHUYLQJ JRRG KHDOWK LQVWHDG RI LQYHVWLQJ LQ ELJ DQG H[SHQVLYH QHZ VWUXFWXUHV ,Q PRVW GHYHORSLQJ FRXQWULHV WKH KHDOWK FDUH V\VWHP KDV WKH WDVN WR LQFUHDVH WKH FRPPXQLW\ DZDUHQHVV RI WKH FDXVHV XQGHUO\LQJGLVHDVHV$FFRUGLQJWRWKH+HDOWK6LWXDWLRQ$QDO\VLVLQWKH$IULFDQ5HJLRQ $WODVRI+HDOWK6WDWLVWLFV  E\ :RUOG +HDOWK 2UJDQL]DWLRQ  WKH GLVDELOLW\DGMXVWHG OLIH\HDU '$/<  SURYLGHV D FRQVLVWHQW DQG FRPSDUDWLYH GHVFULSWLRQ RI WKH EXUGHQ RI GLVHDVHV DQG LQMXULHV QHHGHG WR DVVHVV WKH FRPSDUDWLYH LPSRUWDQFH RI

(6)

GLVHDVHV DQG LQMXULHV LQ FDXVLQJ SUHPDWXUH GHDWK ORVV RI KHDOWK DQG GLVDELOLW\ LQ GLIIHUHQW SRSXODWLRQV >@ 7KH '$/< H[WHQGV WKH FRQFHSW RI SRWHQWLDO \HDUV RI OLIH ORVW GXH WR SUHPDWXUH GHDWK WR LQFOXGH HTXLYDOHQW \HDUV RI µKHDOWK\¶OLIHORVWE\YLUWXHRIEHLQJLQVWDWHVRISRRUKHDOWKRUGLVDELOLW\7KHVHPD\LQFOXGHGRPHVWLFFDXVHVVXFKDV FRQWDPLQDWHG ZDWHU ODFN RI VHUYLFHV RU VHZHUDJH ZDVWH GLVSRVDO ODFN RI DWWHQWLRQ WR SHUVRQDO K\JLHQH DQG SUHVHUYDWLRQSURFHVVLQJDQGSUHSDUDWLRQRIIRRG

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x  YHU\KLJK PXG]L  x  KLJK PXG]L  x  VFDUFH PXG]L  x  ORZ PXG]L  x  YHU\ORZ PXG]L  7KHUHVXOWVKRZVZKHUHWKHUHDUHORFDWHGWKHPRVWSRSXODWHGDUHDVDQGZKLFKDUHQRW )LJ  )LJ'LVWULEXWLRQRISRSXODWLRQDORQJWKHD[LV 

:LWK DQ DUHD RI NP DQG D SRSXODWLRQ RI  LQKDELWDQWV   &DLD LV RQH RI WKH PRVW GHQVHO\ SRSXODWHGUXUDOGLVWULFWVRI0R]DPELTXH SHRSOHNP 7KHSRSXODWLRQRIWKHGLVWULFWLVPDLQO\\RXQJXQGHUWKH

(7)

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

4.2. Water supply

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x  IXQFWLRQLQJ x  WRUHVWRUH x  WREXLOG )LJ:DWHUVXSSO\DORQJWKHD[LV 

(8)

4.3. Health facilities coverage

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

)RU KHDOWK XQLWV WKH DUHD FRQFHUQHG KDV D VDWLVIDFWRU\ GLVWULEXWLRQ LQ WHUPV RI ORFDWLRQ DQG WKH SUHVHQFH RI IDFLOLWLHVLQWKHDUHD$ORQJWKHD[LVWKHUHDUHKHDOWKXQLWVDW*DPED'HYH5DQGLQKR&KDWDODDQG/LFRPD$PRQJ WKHVHWKHIDFLOLW\5DQGLQKRRQO\LVD3RVWRGH6DXGHZKLOHWKHRWKHUVDUH&HQWURGH6DXGH

7KHRQO\5XUDO'LVWULFW+RVSLWDOZKHUHWKHFRPSOLFDWHGELUWKVDQGVLFNHUSDWLHQWVDUHWUDQVIHUUHGLVWR&DLD7KH ZRUNSHUIRUPHGE\³'RFWRUVZLWK$IULFD±&8$00´LVSDUWLFXODUO\VLJQLILFDQWIRUWKH'LVWULFW+RVSLWDOLQ&DLDWKH ILUVW ,WDOLDQ RUJDQL]DWLRQ WKDW LQYHVWHG LQ WKH SURPRWLRQ DQG SURWHFWLRQ RI WKH KHDOWK RI $IULFDQ SRSXODWLRQV $OHVVDQGUD&DWWDQLDVXUJHRQRI&8$00ZRUNHGIRUWKHFRQVWUXFWLRQDQGODXQFKRIDQHZKRVSLWDOLQ&DLDDQGIRU VWDIIWUDLQLQJ1RZWKDQNVWR$OHVVDQGUD&DWWDQLWKHGLVWULFWKDVDUHDOKRVSLWDODQGQRWPHUHO\DKHDOWKFHQWHU 7KHUDQNLQJRIKHDOWKIDFLOLWLHVZDVGLYLGHGLQWRWKUHH )LJ   x  WKHH[LVWLQJIDFLOLWLHVRILQWHUPHGLDWHOHYHO &HQWURGH6DXGH  x  WKHH[LVWLQJVWUXFWXUHVRIEDVLFOHYHO 3RVWRGH6DXGH  x  KHDOWKIDFLOLWLHV\HWWREHEXLOW )LJ1HWZRUNRIKHDOWKIDFLOLWLHVDORQJWKHD[LV 

(9)

$ORQJWKHD[LVWKHUHDUH

x &HQWUR GH 6DXGH RI *DPED'HYH LV FRQVLGHUHG SDUW RI WKH D[LV &DLD6HQD EXW DOVR IDPLOLHV RI 1KDFXDFKD &RQJH DQG 5DQGLQKR DOVR JUDYLWDWH WR WKLV FHQWHU ZKLFK LV FXUUHQWO\ RQH RI WKH EHVW HTXLSSHG RI WKH DUHD DOWKRXJKWKHUHLVQRDOORFDWHGKHDOWKVWDIIEXWRQO\RQHKRVSLWDODVVLVWDQW

x 3RVWR GH 6DXGH RI 5DQGLQKR LV D KHDOWK IDFLOLW\ VXSSRUW QR VWDII LV FRQVWDQWO\ SUHVHQW QHLWKHU KHDOWK QRU DWWHQGDQW

x &HQWUR GH 6DXGH RI &KDWDOD LV WKH UHIHUUDO IDFLOLW\ IRU WKH ZLGH DUHD WKDW LQFOXGHV 5DQGLQKR 1¶6RQD &KDWDOD 1KDFKLODXD DQG DOVR IRU VRPH IDPLOLHV OLYLQJ DFURVV WKH ULYHU 0HSX]H ,W ZDV EXLOW UHFHQWO\ DQG LV TXLWH ZHOO HTXLSSHG+HUHDQXUVHDQGDQDWWHQGDQWZRUN

x &HQWURGH6DXGHRI/LFRPDLVWKHRUHWLFDOO\DFRQVWUXFWLRQOLNHWKDWRI&KDWDODEXWDVLQ'HYHQRKHDOWKVWDIILV DOORFDWHG+RZHYHUWKHUHLVDQDWWHQGDQW

7KHSRSXODWLRQ WKDW LV GLVWULEXWHG LQ WKH &HQWUR GH6DXGH RI*DPED'HYH DQG WKH &HQWUR GH6DXGH RI &KDWDOD DPRXQWVWRDSSUR[RIWKHSRSXODWLRQRQWKHD[LV*D'H/LZKLOHLQWKH3RVWRGH6DXGHRI5DQGLQKRDQGWKH &HQWURGH6DXGHRI/LFRPDLVDURXQG 3'78 

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

4.4. Access to the health facilities

7KH DFFHVV WR WKH KHDOWK IDFLOLWLHV VKRXOG EH HVWLPDWHG DFFRUGLQJ WR WKH WLPH WR UHDFK WKHP 7KH WLPH SHRSOH VKRXOGVSHQGLQUHDFKLQJDKHDOWKFDUHLVGLYLGHGLQILYHFODVVHV x  UHDFKWKHKHDOWKIDFLOLW\ZLWKLQNP x  ZLWKLQNP x  ZLWKLQNP x  ZLWKLQNP x  ZLWKLQNP )RURWKHUIDFWRUV SULPDU\VFKRROVFRYHUDJHDFFHVVWRSULPDU\VFKRROVORFDOPDUNHWVFRYHUDJHDFFHVVWRORFDO PDUNHWV PLOOV FRYHUDJH DQG WKH DFFHVV RI PLOOV  WKH PHWKRGRORJ\ XVHG ZDV WKH VDPH WKDW ZDV DSSOLHG WR KHDOWK IDFLOLWLHV VHHDOOWKHPDSVDWWDFKHGDWWKHHQGRIWKHSDSHU ,WWULHGWRJLYHDQXQLIRUPDVVHVVPHQWIRUDOOIDFWRUVWR GHILQHDUHOLDEOHPRGHO7KHWHQPDSVZHUHFRPSDUHGDQGLWZDVLGHQWLILHGDUDQNVFRUHIRUHDFKIDFWRU7KHUDQN VFRUHUDQJHZDVGLYLGHGLQWRFODVVHV x D  x E  x F  x G  DQGIRUHDFKFODVVVRPHVTXDUHVKDYHEHHQLGHQWLILHGZKHUHLWZDVSRVVLEOHWRGHILQHWKHZHLJKWV %\PXOWLSO\LQJWKHUDQNLQJZHLJKWZLWKWKHVFRUHRIHDFKVTXDUHZHREWDLQWKH³VWUHVV´DUHDV7KHUHVXOWRIWKH FRPSDULVRQ EHWZHHQ WKH PDSV LV VXPPDUL]HG LQ WKH IROORZLQJ WDEOH & WKH IXOO WDEOH LV DWWDFKHG DW WKH HQGRI WKH SDSHU 

(10)

7DEOH&,GHQWLILFDWLRQRIWKH³VWUHVV´DUHDV

FACTORS RANKING

WEIGHT

A5 A6 A7 A8 B3

RANK STRESS RANK STRESS RANK STRESS RANK STRESS RANK STRESS

Population density 13 4 52 5 65 5 65 5 65 4 52

Water supply 18 1 18 5 90 5 90 5 90 5 90

Health facilities coverage 15 5 75 5 75 5 75 5 75 5 75 Access to health facilities 20 3 60 2 40 3 60 4 80 4 80 Primary schools coverage 8 5 40 5 40 5 40 1 8 5 40 Access to primary schools 8 4 32 3 24 2 16 1 8 4 32 Local markets coverage 5 5 25 5 25 5 25 5 25 5 25 Access to local markets 5 4 20 3 15 2 10 2 10 4 20 Mills coverage 4 5 20 5 20 5 20 1 4 5 20 Access to mills 4 4 16 3 12 2 8 1 4 3 12

STRESS SCORE 100 40 358 41 406 39 409 30 369 44 446



7KH VWUHVV DUHDV DUH VKRZHG LQ WKH ODVW VXPPDU\ PDS 7KH PDS LGHQWLILHV WKHGLIIHUHQW OHYHOVRI VWUHVV DQG WKH DUHDVLQZKLFKWRDFW )LJ  x 7KHVFRUHVDUHGLYLGHGLQVL[FODVVHV x 9HU\KLJKULVN PRUHWKDQ x +LJKULVN  x 0HGLXPULVN  x 6FDUFHULVN  x /RZULVN  x :LWKRXWULVN VFRUHOHVVWKDQ )LJ(QYLURQPHQW6WUHVV0DS

(11)

5HVXOWV

7KHDUHDVLQZKLFKWKHVHUYLFHVDUHORFDWHGDUHWKHUHVXOWRIDVHULHVRIIDFWRUVWKDWRYHUODSSLQJWRJHWKHU)RUDOO WKHVHIDFWRUVDVVKRZQLQ)LJXUHWKHJUHDWHVWFRQFHQWUDWLRQRIVHUYLFHVDUHSODFHVLQ1KDFXHFKD*DPED'HYH 16RQD  &KDWDOD DQG /LFRPD 6FRUH OHVV WKDQ  DQG EHWZHHQ   /LFRPD UHYHDOV D JRRG DPRXQW RI IDFLOLWLHVWZRVFKRROVKHDOWKFHQWHUPLOOVDQXPEHURISURWHFWHGZHOOV&KDWDOD1¶6RQDZRUNLQFRPSOHPHQWDU\ ZD\LQ&KDWDODWKHUHDUHWKHODUJHVWQXPEHURIVHUYLFHVDQGLQ16RQDWKHUHLVWKHJUHDWHUDQGWKHEHWWHUVFKRRORQ WKHD[LV

7KHFOXVWHU1KDFXHFKD*DPED'HYHLVFKDUDFWHUL]HGE\WKHSUHVHQFHRIERWKFRPPHUFLDODFWLYLWLHVDQGIRUWKH SUHVHQFHRISXEOLFVHUYLFHV7KLVFOXVWHUDWWKHVDPHWLPHUHVWRQWKHD[LV*DPED'HYH/LFRPDWKDWRQWKHPDMRU D[LV &DLD  6HQD DQG LW JDWKHUV DURXQG KLP WZR VFKRROV DQG D KHDOWK FHQWHU 7KH WKUHH FOXVWHUV RI 1KDFXHFKD  *DPED'HYH16RQD&KDWDODDQG/LFRPDDUHZHOOORFDWHGLIFRPSDUHGWRWKHSUHVHQFHRIWKHSRSXODWLRQ

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

7KHSUREOHPRIZDWHUVXSSO\LVWKHPRVWFULWLFDO$FFHVVWRFOHDQZDWHULVLQIDFWRQHRIWKHEDVLFHPHUJHQFLHVLQ WKHVHDUHDV,WLVJOREDOO\PRUHWKDQRQHWKLUGRIKRXVHKROGVFXUUHQWO\OLYLQJDZD\IURPSURWHFWHGVRXUFHVDQGDERYH DOOWKHUHDUHODUJHDUHDVOLNH1KDFKLODXDDQG5DQGLQKRZKHUHDFFHVVLVFRPSOHWHO\IRUELGGHQ+HUHWKHNH\LVVXHLV WR LQFUHDVH WKH QXPEHU RI VRXUFHV DQG GLVWULEXWH WKHP LQ WKH WHUULWRULHV LQ RUGHU WR HQVXUH DFFHVV WR WKH JUHDWHVW QXPEHURISHRSOH

7KHGLVWULEXWLRQRIVHUYLFHVOHDYHVVRPHRIWKHSRSXODWHGDUHDVGLVFRYHULHV7KHIDPLOLHVRIWKHVHDUHDVKDYHWR WUDYHOLQWKHIDUWKHVWIDFLOLWLHVEXWRIWHQWKH\KDYHWRUHVRUWWRWKHXVHRIDOWHUQDWLYHVHUYLFHV DVLQWKHFDVHRIWKHXVH RIWUDGLWLRQDOPHGLFLQHLQWKHWRWDOODFNRISXEOLFKHDOWKVHUYLFHV RUJLYHLWXS DVLQWKHFDVHRIVFKRROOHDYLQJ >@

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



(12)

5HIHUHQFHV

:RUOG+HDOWK2UJDQL]DWLRQAtlas of Health Statistics of the African Region 2014%UD]]DYLOOH5HSXEOLFRI&RQJR5HJLRQDO2IILFHIRU$IULFD $)52/LEUDU\&DWDORJXLQJLQ3XEOLFDWLRQ'DWD

 &KL]]RQLWL ' &DWWDQL / 0RVFDWHOOL 0 3UHLV / 3ULPDU\ +HDOWK &DUH 6WUXFWXUHV )RU 7KH 'HYHORSLQJ &RXQWULHV ,Q $5&+'(6,*1  '$.$0 (DVWHUQ0HGLWHUUDQHDQ$FDGHPLF5HVHDUFK&HQWHU Current Trends And Methodologies On Architectural Design,VWDQEXO S±

 )HLNLQ '5 1JX\HQ /0 $GD]X . 2PERN 0 $XGL $ 6OXWVNHU / /LQGEODGH .$ The impact of distance of residence from a peripheral health facility on pediatric health utilization in rural western Kenya7URSLFDO0HGLFLQHDQG,QWHUQDWLRQDO+HDOWK  S±  .OHF]NRZVNL %0 3LERXOHDX 5 Approaches to planning and design of Health Care Fa-cilities in Developing Areas *HQHYD 'LYLVLRQ RI

6WUHQJWKHQLQJRI+HDOWK6HUYLFHV:RUOG+HDOWK2UJDQL]DWLRQ  S±

.OHF]NRZVNL%01LOVVRQ12+HDOWKFDUHIDFLOLW\SURMHFWVLQGHYHORSLQJDUHDVPlanning, implementation, and operation*HQHYD:RUOG +HDOWK2UJDQL]DWLRQS±

0LQHUYLQL&Abecedario del cooperanteWorld in Progress7RULQR3ROLWHFQLFRGL7RULQR

2URILQR(Primary Health Care Centres Under Conditions of Limited Resources: A methodology for an integrated planning7RULQR(GL]LRQL &/87

 5DKPDQ 6 Health Facility Planning and Design: Priorities of the profession and Urgen-cies of Local Needs 6LQJDSRUH 5HJLRQDOLVP $UFKLWHFWXUH&RQFHSW0HGLD$JD.KDQIRU$UFKLWHFWXUHS±

5DPD, %HUWROD3'LDPDQWLQL& Sviluppo Rurale e Assetto del Territorio in Contesti in Via di Sviluppo: un Pro-getto Attuativo del Plano de Uso da Terra in un Distretto Rurale del Mozambico7UHQWR8QLYHUVLWjGHJOLVWXGLGL7UHQWR'LSDUWLPHQWRGL,QJHJQHULD&LYLOH$PELHQWDOH H0HFFDQLFD$<

 

Riferimenti

Documenti correlati

Tanto Leonardo si sofferma nella descrizione delle sue circonvoluzioni, da porre egli stesso all’origine di tale interesse un ricor- do personale risultato poi degno dell’analisi

Finally, future strategies finalized to improve the technological properties of bakery products made from ancient wheat’s are related to the assessment of suitability and

This geo-database was used to produce maps (e.g. susceptibility, ground deformation velocities, damage assessment, risk zonation) which today are constantly used by the Civil

Rosenzweig analizza lo sviluppo del pensiero hegeliano comparando infine, nella conclusione della seconda parte, la tesi della teoria dello Stato di Hegel, soprattutto così

This may suggest that the charging process does not depend only on the grain size but also on the grain composition; (c) there is a very strong and fast feedback between sand /

Since the Buchberger algorithm implemented with MAPLE turns out to be more efficient when running by usual term orders, the use of global procedures PolyMilnor and PolyTyurina has to

Our analysis of fossil system scaling relations is distinguished from previous studies through several updates including the fitting of the largest assembled fossil system data

sviluppato da Burdett (1982) ed è stato usato per determinare le forze sulla caviglia durante la fase di appoggio nella corsa: egli ha analizzato la posizione dei muscoli che