# data[].attributes.headline
2023 LEAD Innovation Challenge - World Health Organization. Finalists

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2023 LEAD Innovation Challenge - World Health Organization. Finalists

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Driving Towards Equity is the proposal for WHO to scale up the AMORE Project in member states by supporting the adoption of participatory approaches to predict and measure accessibility with open data that accounts for traffic congestion, with an equity perspective. The approach involves multistakeholder and intersectoral collaboration to assess and improve accessibility when traffic congestion exacerbates health inequities. This idea was among the ten finalists from a pool of fifty-three ideas. Finalists participated in a Boot-Camp and two pitches assessed by an international panel of WHO judges.

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III Simposio de Gestión de datos: ciudades inteligentes. 

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III Simposio de Gestión de datos: ciudades inteligentes. 

# data[].attributes.body
Medición de accesibilidad espacial a servicios prioritarios de salud, una perspectiva de equidad territorial partiendo de datos públicamente disponibles. Conferencista: Ciro Jaramillo Molina

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Las ciudades y territorios inteligentes son aquellos que ofrecen una mejor calidad de vida a sus habitantes al integrar tecnologías digitales en sus servicios, redes de conexión e infraestructuras, logrando así una mayor eficiencia.

El objetivo principal de estas ciudades y territorios, basados en datos, es utilizar la información y el conocimiento obtenidos para mejorar la planificación urbana, la movilidad, la sostenibilidad ambiental, la seguridad ciudadana y la eficiencia de los servicios públicos.

Estas ciudades también pueden fomentar la participación ciudadana al proporcionar acceso a los datos recopilados, lo que permite a los habitantes, industria, academia y gobierno, tomar decisiones informadas y colaborar en la mejora de su entorno, aprovechando al máximo las nuevas tecnologías.

La Escuela Colombiana de Ingeniería Julio Garavito, junto con DAMA Colombia (Data Management Colombia Chapter) y la Asociación Colombiana de Informática, Sistemas y Tecnologías Afines (ACIS), lo invitan a disfrutar de una semana en la que explorará las tendencias de innovación y gestión de datos para obtener su mayor valor.

Regístrese aquí

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III Simposio Gestión de Datos: Ciudades Inteligentes

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La Escuela Colombiana de Ingeniería, de la mano de Dama (Data Management Association) Colombia y la Asociación Colombiana de Ingenieros de Sistemas (Acis) lo invitan a una semana donde explorará las tendencias en innovación y gestión de datos en el marco de las ciudades inteligentes.

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Brief submitted as finalists to the WHO Judges 

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2023 WHO LEAD Innovation Challenge - Finalist's brief 

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2023 WHO LEAD Innovation Challenge - Finalist's brief 

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International Forum on Quality and Safety in Healthcare 2023, Copenhagen.

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International Forum on Quality and Safety in Healthcare 2023, Copenhagen.

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L1: A dynamic, interactive platform for assessing urban health services accessibility and equity. Luis Gabriel Cuervo, representing the AMORE Project Collaboration.

Doctoral Candidate, Universitat Autònoma de Barcelona. 12:30-13:00 May 16, 2023
Slides with notes: https://internationalforum.bmj.com/copenhagen/wp-content/uploads/sites/18/2023/05/L2-additional-20230516-AMORE_Project_IFQSH_Notes-Luis-Gabriel-Cuervo.pdf

Handout: https://internationalforum.bmj.com/copenhagen/wp-content/uploads/sites/18/2023/05/20230509-Infographic-2-and-maps-haemodialysis-July-2020.pdf

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International Forum | International Forum on Quality and Safety in Healthcare site

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Speaker handouts and presentations from Copenhagen 2023 | International Forum

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See all available speaker slides from the 2023 International Forum on Quality and Safety in Copenhagen.

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@Proyecto_AMORE liderado por investigadores de @UABBarcelona @eicg_univalle @SaludPublicaUV @UdeA @i_quartil utilizan macrodatos para abordar problemática de acceso a la salud en Cali, que afecta principalmente a los barrios con menor accesibilidad  
👉Lee https://t.co/BuXmQZzkEH

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El costo de transitar la ciudad enfermo: modelos de datos le apuntan a solucionar esta problemática

# data[].attributes.wish_content.attachment_props.original_text
@Proyecto_AMORE liderado por investigadores de @UABBarcelona @eicg_univalle @SaludPublicaUV @UdeA @i_quartil utilizan macrodatos para abordar problemática de acceso a la salud en Cali, que afecta principalmente a los barrios con menor accesibilidad  
👉Lee https://t.co/BuXmQZzkEH https://t.co/8hrghgw1Pr

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@Proyecto_AMORE liderado por investigadores de @UABBarcelona @eicg_univalle @SaludPublicaUV @UdeA @i_quartil utilizan macrodatos para abordar problemática de acceso a la salud en Cali, que afecta principalmente a los barrios con menor accesibilidad
👉Lee https://t.co/BuXmQZzkEH pic.twitter.com/8hrghgw1Pr
— Facultad de Ingeniería Univalle (@ingenieriauv) May 29, 2024

# data[].attributes.attachment_link.metadata.attachment_props_source.data.entities.urls[].title
El costo de transitar la ciudad enfermo: modelos de datos le apuntan a solucionar esta problemática

# data[].attributes.attachment_link.metadata.attachment_props_source.data.text
@Proyecto_AMORE liderado por investigadores de @UABBarcelona @eicg_univalle @SaludPublicaUV @UdeA @i_quartil utilizan macrodatos para abordar problemática de acceso a la salud en Cali, que afecta principalmente a los barrios con menor accesibilidad  
👉Lee https://t.co/BuXmQZzkEH https://t.co/8hrghgw1Pr

# data[].attributes.attachment_link.metadata.attachment_props.original_text
@Proyecto_AMORE liderado por investigadores de @UABBarcelona @eicg_univalle @SaludPublicaUV @UdeA @i_quartil utilizan macrodatos para abordar problemática de acceso a la salud en Cali, que afecta principalmente a los barrios con menor accesibilidad  
👉Lee https://t.co/BuXmQZzkEH https://t.co/8hrghgw1Pr

# data[].attributes.attachment_link.metadata.attachment_props.text
@Proyecto_AMORE liderado por investigadores de @UABBarcelona @eicg_univalle @SaludPublicaUV @UdeA @i_quartil utilizan macrodatos para abordar problemática de acceso a la salud en Cali, que afecta principalmente a los barrios con menor accesibilidad  
👉Lee https://t.co/BuXmQZzkEH

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El costo de transitar la ciudad enfermo: modelos de datos le apuntan a solucionar esta problemática

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Blog Ingeniería Informa 2024-05-29 El costo de transitar la ciudad enfermo: modelos de datos le apuntan a solucionar esta problemática. [The cost of driving in the city sick: data models aim to solve this problem]

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Blog Ingeniería Informa 2024-05-29 El costo de transitar la ciudad enfermo: modelos de datos le apuntan a solucionar esta problemática. [The cost of driving in the city sick: data models aim to solve this problem]

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Español: https://ingenieriainforma.blogspot.com/2024/05/el-costo-de-transitar-la-ciudad-enfermo.html

English: https://ingenieriainforma.blogspot.com/2024/05/the-cost-of-driving-in-city-sick-data.html

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El costo de transitar la ciudad enfermo: modelos de datos le apuntan a solucionar esta problemática

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Ciro Jaramillo Molina, investigador, profesor de la Escuela de Ingeniería Civil y Geomática y codirector de la tesis doctoral que dio como r…

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Seminario IPPS (Iniciativa de Política Pública y Salud) 7 de febrero de 2023.

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Midiendo la accesibilidad urbana a los servicios de salud con perspectiva de equidad.  Seminario de la Escuela de Gobierno y Transformación Pública - Tecnológico de Monterrey.

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Midiendo la accesibilidad urbana a los servicios de salud con perspectiva de equidad.  Seminario de la Escuela de Gobierno y Transformación Pública - Tecnológico de Monterrey.

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Midiendo la accesibilidad urbana a los servicios de salud con perspectiva de equidad. Seminario IPPS (Iniciativa de Política Pública y Salud). Ciudad de México: Escuela de Gobierno y Transformación Pública, TEC de Monterrey, 2023. https://youtu.be/j1t321lVX7U?t=41.

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Escuela de Gobierno y Transformación Pública

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Seminario IPPS (Iniciativa de Política Pública y Salud)

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La misión diplomática colombiana en Dinamarca atendió  destaca la presentación del Proyecto AMORE en el Foro Internacional de Calidad y Seguridad en la Atención en Salud, en Copenhagen.  Destacaron que ofrece soluciones para mejorar la accesibilidad ciudadana a servicios esenciales en ciudades congestionadas, con una mirada de equidad. 

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La misión diplomática colombiana en Dinamarca atendió  destaca la presentación del Proyecto AMORE en el Foro Internacional de Calidad y Seguridad en la Atención en Salud, en Copenhagen.  Destacaron que ofrece soluciones para mejorar la accesibilidad ciudadana a servicios esenciales en ciudades congestionadas, con una mirada de equidad. 

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Bella Center, Copenhagen, 16 de mayo de 2023. De izquierda a derecha: Silvia Calderón (Primera secretaria de la Embajada), Luis Gabriel Cuervo, María Fernanda Merino (Proyecto AMORE) y Duván Ocampo (Encargado de negocios de la Embajada)

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COLOMBIA PRESENTA MÉTODO EFICIENTE PARA ACCESO A LA SALUD EN FORO MÉDICO INTERNACIONAL EN COPENHAGUE | Embajada de Colombia

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III Simposio Internacional de Doctorandos en Desarrollo Urbano Sustentable de Latinoamérica y el Caribe – 2023. Área 03 Accesibilidad y Movilidad

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III Simposio Internacional de Doctorandos en Desarrollo Urbano Sustentable de Latinoamérica y el Caribe – 2023. Área 03 Accesibilidad y Movilidad

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Mediciones de accesibilidad a servicios de salud y predicciones de impacto agregando nuevos servicios: una perspectiva de equidad, partiendo de datos públicamente disponibles

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III Simposio Internacional de Doctorandos en Desarrollo Urbano Sustentable de Latinoamérica y el Caribe - REDEUSLAC

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Population Reference Bureau Blog: Analyzing Big Data on a Shoestring Budget

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Population Reference Bureau Blog: Analyzing Big Data on a Shoestring Budget

# data[].attributes.body
Population Reference Bureau, Toshiko Kaneda, and Lori Ashford. “Analyzing Big Data on a Shoestring Budget.” Blog. PRB, March 27, 2023. https://www.prb.org/articles/analyzing-big-data-on-a-shoestring-budget/.

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Big data has opened a new world for demographers and public health scientists to explore, to gain insights into social and health phenomena using the myriad digital traces we leave behind in our daily lives. But is analyzing big data practical and affordable? Researchers and organizations who have not made the leap might wonder: Do we need a lot more funding? Supercomputers? Armies of data scientists?

Three studies, presented recently in a PRB Demography Talk, show the feasibility of conducting research on a proverbial shoestring-using big data that are publicly, freely available to anyone with a personal computer and Wi-Fi connection.

Study 1: Can Google data help measure health care access more accurately?

The first study, presented by Luis Gabriel Cuervo of the Universitat Autònoma de Barcelona and the AMORE project, used Google mobility data to assess the effect of traffic congestion on people's ability to access health services in Cali, Colombia, a city of 2.3 million. The study aimed to improve how health care accessibility is measured and communicated, to inform urban and health services planning.

Cuervo assembled a multidisciplinary research team, including mobility experts, to examine travel times from where people live to urgent and frequently used health services. The team used Google's Distance Matrix API, which provides travel times and distance between origins and destinations, accounting for changing traffic conditions. The data are generated from Google Maps on people's cell phones.

Combining this information with census and health services data, the study measured travel times repeatedly and revealed significant inequality by sociodemographic characteristics. On typical days, 60% of the city's population lived more than 15 minutes by car from emergency care, with those in the poorest neighborhoods facing the longest travel times and a greater impact from traffic congestion.

Studies 2 and 3: Can Google data help predict changes in birth rates and examine excess deaths from COVID-19 related shutdowns?

In another study, Joshua Wilde from the Max Planck Institute for Demographic Research (MPIDR) and Portland State University asked, can Google search data predict whether COVID-related shutdowns will lead to a baby boom or bust? In 2020, early in the pandemic, Wilde and team constructed a forecasting model based on volumes of Google searches with keywords related to conception, pregnancy, childbirth, and economic stability. Their thinking was that if searches increased sharply for keywords such as "pregnancy test" and "missed period," one might expect higher birth rates seven to nine months later. On the other hand, prior research had associated unemployment with lower birth rates-so if unemployment-related searches climbed, one might expect a baby bust.

After selecting the most salient among 40 possible keywords from Google Trends, their model predicted a 12% decline in monthly birth rates between November 2020 and February 2021. The team was able to compare their results to official U.S. birth statistics in 2022. While not a perfect match, they found the model's predictions remarkably close to actual declines in birth rates, with Google searches related to unemployment being the strongest predictor of pregnancies and subsequent birth rates.

In the third study, Diego Alburez-Gutierrez and colleagues from MPIDR used Google mobility data to examine how restrictions on people's movements during the pandemic affected death rates in England and Wales between February and August 2020. Google's COVID-19 Community Mobility Reports contain aggregated records of movements tracked on cell phones with Google Maps (through October 2022), which researchers can search by mode of travel and type of activity.

The research team looked specifically at the extent to which stay-at-home measures during the first wave of COVID-19 affected excess mortality-the difference between current death rates and those that would be expected if mortality followed the patterns of prior years. Examining mobility patterns, they were able to estimate excess deaths with and without government-mandated restrictions on movement.

They estimated that in London, about 22,000 deaths were averted due to mobility restrictions; in England and Wales as a whole, more than 94,000 deaths were averted over the seven-month period. In other words, without shutdown measures, the number of excess deaths could have more than doubled during this period, especially in the London area. These findings are highly relevant for policymakers considering responses to future disease outbreaks.

Studies show promises and pitfalls of big data

What lessons can we draw about using publicly available, low-cost big data? Google data is surprisingly easy to find and use. For example, researchers can access the search data by selecting topics of interest and downloading the desired data in a spreadsheet. The data are nationally and internationally comparable due to Google's global reach and-as of now-its generous sharing of data files through a standard interface. By relying on these tools, the research teams had access to millions of data points that would have been nearly impossible to collect using more conventional methods.

In the PRB Demography Talk, some pitfalls of Google data came to light, some of which apply to all big data:

Data drawn from online activity do not represent the whole population, only those using electronic devices and Google apps.

The data are aggregated and anonymized so that the identities of individuals are not disclosed. While essential to protect people's privacy, such aggregation prevents researchers from analyzing specific characteristics of the people studied.

Google data are not available where the number of searches or map users is too low to be aggregated, such as in remote locations or places with poor connectivity.

Google (or any other company, for that matter) can make any changes to the data they collect or discontinue access at any time without notifying data users, adding uncertainty to those planning research studies. Also, data may not be archived and therefore cannot be retrieved for later analyses.

Much of these concerns relate to all big data, not just Google data. And, as one would expect, data collected for one set of purposes (in this case, commercial interests) are not always a perfect fit with the questions researchers are asking.

Moving forward with big data

Cuervo's experience in Colombia showed that multidisciplinary research teams are essential to bring in different skill sets, interests, and resources to a study. Collaboration among scientists in various disciplines, governments, health service providers, and end-users of data from the outset also made it more likely research results would be used and acted upon.-

Alburez-Gutierrez observed that relying on "the kindness of strangers" (in this case, technology platforms like Google) to provide digital trace data is not enough to build solid research infrastructure. Instead, he argued, "We should have forward-looking rather than reactive policies that allow researchers to access data, and regulation may be a way of achieving this." In other words, research institutions and governments need to negotiate agreements in which Google and other companies create systems that provide secure access to their data for researchers.

Greater access to these types of big data will enable researchers to explore many other pressing issues in the future, such as predicting the potential impact of climate change on births, deaths, migration, and other trends. Wilde and colleagues are already investigating some of these questions, for example, looking at how warming temperatures could drive changes in Google searches, and how these reflect changes in behaviors, such as dating, that are linked to fertility change. These and other innovative studies will enable policymakers to develop better-informed, real-time responses to the rapidly changing conditions of today's world.

Webinar video

2:16 Presentation by Luis Gabriel Cuervo

19:18 Presentation by Joshua Wilde

40:00 Presentation by Diego Alburez-Gutierrez

55:37 Q&A session

# data[].attributes.attachment_link.title
Analyzing Big Data on a Shoestring Budget

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Big data has opened a new world for demographers and public health scientists to explore, to gain insights into social and health phenomena using the myriad digital traces we leave behind in our daily lives. But is analyzing big data practical and affordable?

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PRB -Webinar: Big data analysis on a Shoestring. Using publicly available data for population and global health research. March 13, 2023. Population Reference Bureau.

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PRB -Webinar: Big data analysis on a Shoestring. Using publicly available data for population and global health research. March 13, 2023. Population Reference Bureau.

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Website: Analyzing Big Data on a Shoestring Budget | PRB
Recording: https://youtu.be/UwG6XivJWZo

Big data is increasingly utilized in demography and global health research to gain new insights and fill information gaps. Yet, cost and technical expertise challenges have hindered its widespread adoption. Join us for a webinar with Dr. Luis Gabriel Cuervo from the Autonomous University of Barcelona, Dr. Joshua Wilde from Max Planck Institute for Demographic Research (MPIDR) and Portland State University, and Dr. Diego Alburez-Gutierrez from MPIDR, who will discuss their experience using Google's big data to tackle important research questions.

# data[].attributes.attachment_link.readable_text
Big data has opened a new world for demographers and public health scientists to explore, to gain insights into social and health phenomena using the myriad digital traces we leave behind in our daily lives. But is analyzing big data practical and affordable? Researchers and organizations who have not made the leap might wonder: Do we need a lot more funding? Supercomputers? Armies of data scientists?

Three studies, presented recently in a PRB Demography Talk, show the feasibility of conducting research on a proverbial shoestring-using big data that are publicly, freely available to anyone with a personal computer and Wi-Fi connection.

Study 1: Can Google data help measure health care access more accurately?

The first study, presented by Luis Gabriel Cuervo of the Universitat Autònoma de Barcelona and the AMORE project, used Google mobility data to assess the effect of traffic congestion on people's ability to access health services in Cali, Colombia, a city of 2.3 million. The study aimed to improve how health care accessibility is measured and communicated, to inform urban and health services planning.

Cuervo assembled a multidisciplinary research team, including mobility experts, to examine travel times from where people live to urgent and frequently used health services. The team used Google's Distance Matrix API, which provides travel times and distance between origins and destinations, accounting for changing traffic conditions. The data are generated from Google Maps on people's cell phones.

Combining this information with census and health services data, the study measured travel times repeatedly and revealed significant inequality by sociodemographic characteristics. On typical days, 60% of the city's population lived more than 15 minutes by car from emergency care, with those in the poorest neighborhoods facing the longest travel times and a greater impact from traffic congestion.

Studies 2 and 3: Can Google data help predict changes in birth rates and examine excess deaths from COVID-19 related shutdowns?

In another study, Joshua Wilde from the Max Planck Institute for Demographic Research (MPIDR) and Portland State University asked, can Google search data predict whether COVID-related shutdowns will lead to a baby boom or bust? In 2020, early in the pandemic, Wilde and team constructed a forecasting model based on volumes of Google searches with keywords related to conception, pregnancy, childbirth, and economic stability. Their thinking was that if searches increased sharply for keywords such as "pregnancy test" and "missed period," one might expect higher birth rates seven to nine months later. On the other hand, prior research had associated unemployment with lower birth rates-so if unemployment-related searches climbed, one might expect a baby bust.

After selecting the most salient among 40 possible keywords from Google Trends, their model predicted a 12% decline in monthly birth rates between November 2020 and February 2021. The team was able to compare their results to official U.S. birth statistics in 2022. While not a perfect match, they found the model's predictions remarkably close to actual declines in birth rates, with Google searches related to unemployment being the strongest predictor of pregnancies and subsequent birth rates.

In the third study, Diego Alburez-Gutierrez and colleagues from MPIDR used Google mobility data to examine how restrictions on people's movements during the pandemic affected death rates in England and Wales between February and August 2020. Google's COVID-19 Community Mobility Reports contain aggregated records of movements tracked on cell phones with Google Maps (through October 2022), which researchers can search by mode of travel and type of activity.

The research team looked specifically at the extent to which stay-at-home measures during the first wave of COVID-19 affected excess mortality-the difference between current death rates and those that would be expected if mortality followed the patterns of prior years. Examining mobility patterns, they were able to estimate excess deaths with and without government-mandated restrictions on movement.

They estimated that in London, about 22,000 deaths were averted due to mobility restrictions; in England and Wales as a whole, more than 94,000 deaths were averted over the seven-month period. In other words, without shutdown measures, the number of excess deaths could have more than doubled during this period, especially in the London area. These findings are highly relevant for policymakers considering responses to future disease outbreaks.

Studies show promises and pitfalls of big data

What lessons can we draw about using publicly available, low-cost big data? Google data is surprisingly easy to find and use. For example, researchers can access the search data by selecting topics of interest and downloading the desired data in a spreadsheet. The data are nationally and internationally comparable due to Google's global reach and-as of now-its generous sharing of data files through a standard interface. By relying on these tools, the research teams had access to millions of data points that would have been nearly impossible to collect using more conventional methods.

In the PRB Demography Talk, some pitfalls of Google data came to light, some of which apply to all big data:

Data drawn from online activity do not represent the whole population, only those using electronic devices and Google apps.

The data are aggregated and anonymized so that the identities of individuals are not disclosed. While essential to protect people's privacy, such aggregation prevents researchers from analyzing specific characteristics of the people studied.

Google data are not available where the number of searches or map users is too low to be aggregated, such as in remote locations or places with poor connectivity.

Google (or any other company, for that matter) can make any changes to the data they collect or discontinue access at any time without notifying data users, adding uncertainty to those planning research studies. Also, data may not be archived and therefore cannot be retrieved for later analyses.

Much of these concerns relate to all big data, not just Google data. And, as one would expect, data collected for one set of purposes (in this case, commercial interests) are not always a perfect fit with the questions researchers are asking.

Moving forward with big data

Cuervo's experience in Colombia showed that multidisciplinary research teams are essential to bring in different skill sets, interests, and resources to a study. Collaboration among scientists in various disciplines, governments, health service providers, and end-users of data from the outset also made it more likely research results would be used and acted upon.-

Alburez-Gutierrez observed that relying on "the kindness of strangers" (in this case, technology platforms like Google) to provide digital trace data is not enough to build solid research infrastructure. Instead, he argued, "We should have forward-looking rather than reactive policies that allow researchers to access data, and regulation may be a way of achieving this." In other words, research institutions and governments need to negotiate agreements in which Google and other companies create systems that provide secure access to their data for researchers.

Greater access to these types of big data will enable researchers to explore many other pressing issues in the future, such as predicting the potential impact of climate change on births, deaths, migration, and other trends. Wilde and colleagues are already investigating some of these questions, for example, looking at how warming temperatures could drive changes in Google searches, and how these reflect changes in behaviors, such as dating, that are linked to fertility change. These and other innovative studies will enable policymakers to develop better-informed, real-time responses to the rapidly changing conditions of today's world.

Webinar video

2:16 Presentation by Luis Gabriel Cuervo

19:18 Presentation by Joshua Wilde

40:00 Presentation by Diego Alburez-Gutierrez

55:37 Q&A session

# data[].attributes.attachment_link.title
Analyzing Big Data on a Shoestring Budget

# data[].attributes.attachment_link.description
Big data has opened a new world for demographers and public health scientists to explore, to gain insights into social and health phenomena using the myriad digital traces we leave behind in our daily lives. But is analyzing big data practical and affordable?

# data[].attributes.attachment_caption
7 de febrero de 2023 a las 7 PM México, 8 PM COT/EST. 

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Seminario de la Escuela de Gobierno y Transformación Pública - Tecnológico de Monterrey

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Seminario de la Escuela de Gobierno y Transformación Pública - Tecnológico de Monterrey

# data[].attributes.body
Grabación: https://youtu.be/j1t321lVX7U?t=41

# data[].attributes.wish_content.attachment_props.text
Seminario📢 : Midiendo la accesibilidad urbana a los servicios de salud con perspectiva de equidad. 

📅 Martes 7 de febrero 
🕑 17:00 hrs 
📍 Virtual
Registrate aquí 👉 : https://t.co/slkAZNFAwC 

 #PoliticaPublica #SomosEGobiernoyTP #FormamosElFuturo #ODS #TecdeMonterrey

# data[].attributes.wish_content.attachment_props.author.name
Iniciativa de Política Pública y Salud @Tec

# data[].attributes.wish_content.attachment_props.original_text
Seminario📢 : Midiendo la accesibilidad urbana a los servicios de salud con perspectiva de equidad. 

📅 Martes 7 de febrero 
🕑 17:00 hrs 
📍 Virtual
Registrate aquí 👉 : https://t.co/slkAZNFAwC 

 #PoliticaPublica #SomosEGobiernoyTP #FormamosElFuturo #ODS #TecdeMonterrey https://t.co/0pjxGnbin1

# data[].attributes.attachment_link.authors[].name
Iniciativa de Política Pública y Salud @Tec

# data[].attributes.attachment_link.title
Iniciativa de Política Pública y Salud @Tec

# data[].attributes.attachment_link.embed_code
Seminario📢 : Midiendo la accesibilidad urbana a los servicios de salud con perspectiva de equidad.

📅 Martes 7 de febrero
🕑 17:00 hrs
📍 Virtual
Registrate aquí 👉 : https://t.co/slkAZNFAwC

#PoliticaPublica #SomosEGobiernoyTP #FormamosElFuturo #ODS #TecdeMonterrey pic.twitter.com/0pjxGnbin1
— Iniciativa de Política Pública y Salud @Tec (@IPPS_Tec) January 26, 2023

# data[].attributes.attachment_link.metadata.attachment_props_source.data.text
Seminario📢 : Midiendo la accesibilidad urbana a los servicios de salud con perspectiva de equidad. 

📅 Martes 7 de febrero 
🕑 17:00 hrs 
📍 Virtual
Registrate aquí 👉 : https://t.co/slkAZNFAwC 

 #PoliticaPublica #SomosEGobiernoyTP #FormamosElFuturo #ODS #TecdeMonterrey https://t.co/0pjxGnbin1

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Iniciativa de Política Pública y Salud @Tec

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Seminario📢 : Midiendo la accesibilidad urbana a los servicios de salud con perspectiva de equidad. 

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Seminario📢 : Midiendo la accesibilidad urbana a los servicios de salud con perspectiva de equidad. 

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🕑 17:00 hrs 
📍 Virtual
Registrate aquí 👉 : https://t.co/slkAZNFAwC 

 #PoliticaPublica #SomosEGobiernoyTP #FormamosElFuturo #ODS #TecdeMonterrey

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Iniciativa de Política Pública y Salud @Tec

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Congreso Internacional Del Modelo Territorial de Salud - Accesibilidad a Los Servicios de Salud Con Una Perspectiva de Equidad. 24 de noviembre de 2022.

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Congreso Internacional Del Modelo Territorial de Salud - Accesibilidad a Los Servicios de Salud Con Una Perspectiva de Equidad. 24 de noviembre de 2022.

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Cuervo LG, Villamizar CJ, Jaramillo C, Osorio L, Martínez-Herrera E. Congreso Internacional Del Modelo Territorial de Salud​​ - Accesibilidad a Los Servicios de Salud Con Una Perspectiva de Equidad: Evaluaciones Dinámicas Con Datos Públicamente Disponibles. Bogotá DC: Secretaría Distrital de Salud de Bogotá, 24 de noviembre de 2022. https://doi.org/10.6084/m9.figshare.21565614.v2 Grabación https://youtu.be/ldBFnAJb9VY?t=9069.

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Congreso Internacional del Modelo Territorial de Salud​​

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¿Qué es el proyecto AMORE? Equidad y accesibilidad  en Salud. Doctora Diana Elizabeth Cuervo

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¿Qué es el proyecto AMORE? Equidad y accesibilidad  en Salud. Doctora Diana Elizabeth Cuervo

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Publicado el 11 de noviembre de 2022. Grabado en Bogotá, Centro de Convenciones Ágora.

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¿Qué es el proyecto AMORE? Equidad y accesibilidad  en Salud

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Seventh. Global Symposium on Health Systems Research, Bogotá November 2, 2022.

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Seventh. Global Symposium on Health Systems Research, Bogotá November 2, 2022.

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Cuervo, Luis Gabriel. Assuring Access to Health Care for All: A New Approach to Assess Equity in Accessibility to Health Services.” Hybrid Oral Session on Comprehensive Primary Care in Promoting Sustainability: presented at the Seventh. Global Symposium on Health Systems Research. Ágora Conference Center, Bogotá DC., November 2, 2022. https://youtu.be/A2Ji47cM6wA?t=810

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20221101 Assuring Access to Health Care for All - Proyecto AMORE

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Las poblaciones más vulnerables de Cali están a más de 15 minutos de una sala de urgencias

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Las poblaciones más vulnerables de Cali están a más de 15 minutos de una sala de urgencias

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Las poblaciones más vulnerables de Cali están a más de 15 minutos de una sala de urgencias

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Las poblaciones más vulnerables de Cali están a más de 15 minutos de una sala de urgencias

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#EnCaliSeProgresaVé |👉 Las poblaciones más vulnerables de Cali están a más de 15 minutos de una sala de urgencias.
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#EnCaliSeProgresaVé |👉 Las poblaciones más vulnerables de Cali están a más de 15 minutos de una sala de urgencias.
@ingenieriauv
#Blog
✅ Conoce más en nuestro blog: https://t.co/Bc5wRsM2RD

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Las poblaciones más vulnerables de Cali están a más de 15 minutos de una sala de urgencias

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Las poblaciones más vulnerables de Cali están a más de 15 minutos de una sala de urgencias

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International Society for Urban Health. Sevilla, Spain November 2022.

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International Society for Urban Health. Sevilla, Spain November 2022.

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Martínez-Herrera, Eliana, Luis Gabriel Cuervo, Carmen Juliana Villamizar, Daniel Cuervo, and Ciro Jaramillo Molina. “Equitable Accessibility to Health Services Using Timely Measurements.” In International Society for Urban Health. Sevilla, Spain: International Society for Urban Health., 2022. https://doi.org/10.6084/m9.figshare.21375750.v1

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Poster presented at the 18th International Conference on Urban Health: Growing Our Global Community. Driving Action. Ensuring Equity.

24-27 October 2022, Valencia, Spain.

Martínez-Herrera E, Cuervo LG, Villamizar CJ, Cuervo D, Jaramillo C, on behalf of the AMORE Project Collaboration. * Equitable accessibility to health services using timely measurement.* International Society for Urban Health. 18th International Conference on Urban Health: Growing Our Global Community. Driving Action. Ensuring Equity. Poster presentation. 24-27 October 2022. DOI:10.6084/m9.figshare.21375750

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Equitable accessibility to health services using timely measurements

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Poster presented at the 18th International Conference on Urban Health: Growing Our Global Community. Driving Action. Ensuring Equity. 24-27 October 2022, Valencia, Spain. Martínez-Herrera E, Cuervo LG, Villamizar CJ, Cuervo D, Jaramillo C, on behalf of the AMORE Project Collaboration. *Equitable accessibility to health services using timely measurement.* International Society for Urban Health.

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Wang, F., and Y. Wang. “How Geographic Accessibility and Rural Governance Mitigate the Impact of Multiple Risks on Rural Households’ Well-Being: Evidence from the Dabie Mountains in China.” Journal of Geographical Sciences 34, no. 6 (2024): 1195–1227. https://doi.org/10.1007/s11442-024-2245-8.

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Abstract

Despite previous studies on the interconnectedness of livelihood risks and human well-being, limited emphasis has been placed on the influence of geographic accessibility and rural governance on the well-being of rural households. Furthermore, the interplay between geographic accessibility, rural governance, and livelihood risk remains inadequately explored. Based on 522 household samples collected in the Dabie Mountains and ordinary least squares regression, this study examines the influence of multiple risks on the subjective well-being of rural households by investigating the moderating roles played by geographic accessibility and rural governance. The results show that (1) multiple risk factors have a significant negative effect on rural households' well-being (β=−0.219, p<0.01); (2) geographic accessibility has a weak positive effect on rural households' well-being (β=0.064, p<0.1) compared to rural governance, which plays a larger positive role (β=0.228, p<0.01); and (3) geographic accessibility has a significant moderating effect on the relationship between multiple risks and rural households' well-being, decreasing the adverse impact of multiple risks on households' well-being. Our findings suggest that geographic accessibility and rural governance have positive implications for enhancing the well-being of rural households. The findings provide policy insight into mitigating livelihood risks and their negative impacts on household well-being in mountainous regions worldwide.

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Authors and Affiliations

1. Department of Land Resources Management, School of Public Administration, China University of Geosciences, Wuhan, 430074, China

Feifan Wang & Ying Wang

2. Key Laboratory of the Ministry of Natural Resources for Legal Research, Wuhan, 430074, China

Feifan Wang & Ying Wang

Corresponding author

Correspondence to Ying Wang.

Additional information

Foundation: National Natural Science Foundation of China, No.42371315, No.41901213.

Author: Wang Feifan (1999-), Master Candidate, E-mail: feifanwang5703@cug.edu.cn

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Wang, F., Wang, Y. How geographic accessibility and rural governance mitigate the impact of multiple risks on rural households' well-being: Evidence from the Dabie Mountains in China. J. Geogr. Sci. 34, 1195-1227 (2024). https://doi.org/10.1007/s11442-024-2245-8
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How geographic accessibility and rural governance mitigate the impact of multiple risks on rural households' well-being: Evidence from the Dabie Mountains in China - Journal of Geographical Sciences

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Despite previous studies on the interconnectedness of livelihood risks and human well-being, limited emphasis has been placed on the influence of geographic accessibility and rural governance on the well-being of rural households. Furthermore, the interplay between geographic accessibility, rural governance, and livelihood risk remains inadequately explored.

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UKRI-GCRF Gridding Equitable Urban Futures in Areas of Transition GREAT - Presentation of Proyecto AMORE. July 26, 2022.

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UKRI-GCRF Gridding Equitable Urban Futures in Areas of Transition GREAT - Presentation of Proyecto AMORE. July 26, 2022.

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Consortia led in the UK by the University of Lancaster and the Bartlett/Development Planning Unit, UCL; in Colombia by the Universidad del Valle; and, in Cuba, by the Technological University of Havana.

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UKRI-GCRF Gridding Equitable Urban Futures in Areas of Transition (GREAT) in Cali, Colombia and Havana, Cuba

Led by Lancaster University, an international interdisciplinary team of researchers in the UK, Colombia and Cuba will seek to transform our understanding of the relationship between off-grid infrastructures and the dynamics of growth and change of informal settlements in areas of transition. Working closely with communities from two informal settlements, this 3-year UKRI-GCRF project will contribute to 'gridding' equitable urban futures in Cali, Colombia and Havana, Cuba. Through a series of three thematic publicLabs on policy and urban planning, transport and mobility, and waste management the project will combine: fieldwork and related research activities, participatory community workshops, seed-funded projects, and work with local policy and planning authorities as well as charitable organisations in the two cities.

The partner institutions are: in the UK, the Bartlett/Development Planning Unit, UCL; in Colombia, the Universidad del Valle; and, in Cuba, the Technological University of Havana. Several local partners including Directorates of Transport and Environmental Management, the Cali Mayor's Office and NGOs will take part in and help shape the main outcomes of the project. Joining the expertise of environmental scientists, transport and geomatics engineers, architects, designers and urban planners, entrepreneurs, historians and sociologists, the project will address key UN sustainable development goals by embedding the voice of settlement residents into ongoing initiatives centred on the social futures of Cali and Havana.

For more on the project click here

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Led by Lancaster University, an international interdisciplinary team of researchers in the UK, Colombia and Cuba will seek to transform our understanding of the relationship between off-grid infrastructures and the dynamics of growth and change of informal settlements in areas of transition.

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Macharia, Peter M., Kerry L. M. Wong, Lenka Beňová, Jia Wang, Prestige Tatenda Makanga, Nicolas Ray, and Aduragbemi Banke-Thomas. “Measuring Geographic Access to Emergency Obstetric Care: A Comparison of Travel Time Estimates Modelled Using Google Maps Directions API and AccessMod in Three Nigerian Conurbations.” Geospatial Health 19, no. 1 (May 27, 2024). https://doi.org/10.4081/gh.2024.1266.

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Population and Health Impact Surveillance Group, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya; Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.

Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.

Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.

School of Computing and Mathematical Sciences, University of Greenwich, London, United Kingdom.

Surveying and Geomatics Department, Midlands State University Faculty of the Built Environment, Gweru, Midlands, Zimbabwe; Climate, Environment and Health Department, Centre for Sexual Health and HIV/AIDS Research, Harare, Zimbabwe; Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, Zimbabwe.

GeoHealth Group, Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland; Institute for Environmental Sciences, University of Geneva, Geneva, Switzerland.

Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom; School of Human Sciences, University of Greenwich, London, United Kingdom; Maternal and Reproductive Health Research Collective, Surulere, Lagos, Nigeria.

Google Maps Directions Application Programming Interface (the API) and AccessMod tools are increasingly being used to estimate travel time to healthcare. However, no formal comparison of estimates from the tools has been conducted. We modelled and compared median travel time (MTT) to comprehensive emergency obstetric care (CEmOC) using both tools in three Nigerian conurbations (Kano, Port-Harcourt, and Lagos). We compiled spatial layers of CEmOC healthcare facilities, road network, elevation, and land cover and used a least-cost path algorithm within AccessMod to estimate MTT to the nearest CEmOC facility. Comparable MTT estimates were extracted using the API for peak and non-peak travel scenarios. We investigated the relationship between MTT estimates generated by both tools at raster celllevel (0.6 km resolution). We also aggregated the raster cell estimates to generate administratively relevant ward-level MTT. We compared ward-level estimates and identified wards within the same conurbation falling into different 15-minute incremental categories (<15/15-30/30-45/45-60/+60). Of the 189, 101 and 375 wards, 72.0%, 72.3% and 90.1% were categorised in the same 15- minute category in Kano, Port-Harcourt, and Lagos, respectively. Concordance decreased in wards with longer MTT. AccessMod MTT were longer than the API's in areas with ≥45min. At the raster cell-level, MTT had a strong positive correlation (≥0.8) in all conurbations. Adjusted R2 from a linear model (0.624-0.723) was high, increasing marginally in a piecewise linear model (0.677-0.807). In conclusion, at <45-minutes, ward-level estimates from the API and AccessMod are marginally different, however, at longer travel times substantial differences exist, which are amenable to conversion factors.

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Citation / Copyright

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Measuring geographic access to emergency obstetric care: a comparison of travel time estimates modelled using Google Maps Directions API and AccessMod in three Nigerian conurbations

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Population and Health Impact Surveillance Group, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya; Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium. Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.

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Citizens on the move: accessiblity and mobility in the Global South

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Citizens on the move: accessiblity and mobility in the Global South

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Presentación "Simple metrics and timely measurements to advance equitable accessibility to health services" por @lgcuervoamore Panel 2. @Proyecto_AMORE

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Presentación "Simple metrics and timely measurements to advance equitable accessibility to health services" por @lgcuervoamore Panel 2. @Proyecto_AMORE https://t.co/u5VPQbDnWA

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Presentación "Simple metrics and timely measurements to advance equitable accessibility to health services" por @lgcuervoamore Panel 2. @Proyecto_AMORE pic.twitter.com/u5VPQbDnWA
— CJaramillo (@cjaram1) September 2, 2022

# data[].attributes.attachment_link.metadata.attachment_props_source.data.text
Presentación "Simple metrics and timely measurements to advance equitable accessibility to health services" por @lgcuervoamore Panel 2. @Proyecto_AMORE https://t.co/u5VPQbDnWA

# data[].attributes.attachment_link.metadata.attachment_props.original_text
Presentación "Simple metrics and timely measurements to advance equitable accessibility to health services" por @lgcuervoamore Panel 2. @Proyecto_AMORE https://t.co/u5VPQbDnWA

# data[].attributes.attachment_link.metadata.attachment_props.text
Presentación "Simple metrics and timely measurements to advance equitable accessibility to health services" por @lgcuervoamore Panel 2. @Proyecto_AMORE

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Citizens on the move: accessibility and mobility in the Global South.

# data[].attributes.subject
Citizens on the move: accessibility and mobility in the Global South.

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Simple metrics and timely measurements to advance equitable accessibility to health services.
Speaker: Luis Gabriel Cuervo; Chair: Natalia Villamizar Duarte; Commentator: Kate Lowe, University of Illinois at Chicago. Panel 2, September 9, 2022.
Recordings will be added to: https://intalinc-lac.com/eventos/ Temporary access https://drive.google.com/file/d/12LMS8eEgKQA82tnvA0GH6kUoWJI7ejzR/view

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Banke-Thomas, Aduragbemi, Kerry L. M. Wong, Tope Olubodun, Peter M. Macharia, Narayanan Sundararajan, Yash Shah, Gautam Prasad, et al. “Geographical Accessibility to Functional Emergency Obstetric Care Facilities in Urban Nigeria Using Closer-to-Reality Travel Time Estimates: A Population-Based Spatial Analysis.” The Lancet Global Health 12, no. 5 (May 1, 2024): e848–58. https://doi.org/10.1016/S2214-109X(24)00045-7.

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www.thelancet.com needs to review the security of your connection before proceeding.

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Conduciendo hacia la Equidad, parte del Proyecto AMORE. Presenta la Dra. Ángela Suá

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Presentamos nuestra visión para la expansión y el desarrollo del Proyecto AMORE en 2023. Esta visión se desarrolló dentro del Desafío de Innovación LEAD 2023 de la OMS, una iniciativa de la Organización Mundial de la Salud para apoyar las innovaciones desarrolladas por el personal durante su capacidad profesional o personal.

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Improving Accessibility to Radiotherapy Services in Cali, Colombia: Cross-Sectional Equity Analyses Using Open Data and Big Data Travel Times from 2020.

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Improving Accessibility to Radiotherapy Services in Cali, Colombia: Cross-Sectional Equity Analyses Using Open Data and Big Data Travel Times from 2020.

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Cuervo LG, Villamizar CJ, Cuervo Daniel, Zapata P, Ospina MB, Valencia SM, Polo A, Suárez Á, Bula MO, Miranda JJ, Millan GF, Cuervo DE, Owens NJ, Piquero F, Hatcher-Roberts J, Paredes, GD, Navarro MF, Minotta IL, Palta CR, Martinez-Herrera Eliana, Jaramillo C. Improving Accessibility to Radiotherapy Services in Cali, Colombia: Cross-Sectional Equity Analyses Using Open Data and Big Data Travel Times from 2020. (February 10, 2024). Available at SSRN: https://ssrn.com/abstract=4722439 or http://dx.doi.org/10.2139/ssrn.4722439

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Comentario de orden por parte del Dr. Juan Manuel Anaya respecto al Proyecto AMORE durante la ceremonia de ingreso de  Luis Gabriel Cuervo, 3 de noviembre de 2022

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Comentario de orden por parte del Dr. Juan Manuel Anaya respecto al Proyecto AMORE durante la ceremonia de ingreso de  Luis Gabriel Cuervo, 3 de noviembre de 2022

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“una elegante y útil prueba de concepto para mejorar la equidad en salud reduciendo los tiempos de viaje a los servicios mediante la colaboración intersectorial” Juan Manuel Anaya, Académico y coordinador del Foco de Ciencias de la Vida y la Salud de la Misión Internacional de Sabios de Colombia.

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SESIÓN ACADÉMICA: CEREMONIA DE INGRESO ACADÉMICOS CORRESPONDIENTES

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Trabajos para ingreso como nuevos miembros"Hilando el fortalecimiento de la investigación para la salud en las Américas"Dr. Luis Gabriel Cuervo Amore"Prevale...

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XXIV Simposio de Investigaciones Consecuencias de la pandemia: una mirada global - Facultad de Salud / Universidad del Valle / Cali, Colombia

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XXIV Simposio Nacional e Internacional de Investigaciones en Salud;Consecuencias de la pandemia: una mirada global., Cali, Colombia, October 21, 2022.

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XXIV Simposio Nacional e Internacional de Investigaciones en Salud;Consecuencias de la pandemia: una mirada global., Cali, Colombia, October 21, 2022.

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Jaramillo Molina, Ciro, Lyda Osorio, Luis Gabriel Cuervo, and Carmen Juliana Villamizar. “Mejorando la equidad en la accesibilidad (tiempos de viaje) a los servicios de salud.” Presented at the XXIV Simposio Nacional e Internacional de Investigaciones en Salud;Consecuencias de la pandemia: una mirada global., Cali, Colombia, October 21, 2022. https://salud.univalle.edu.co/noticias/xxiv-simposio-de-investigaciones-consecuencias-de-la-pandemia-una-mirada-global

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Facultad de Salud / Universidad del Valle / Cali, Colombia

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Nos permitimos invitarles a postular sus trabajos de investigación para ser presentados en el " XXIV SIMPOSIO DE INVESTIGACIONES DE LA FACULTAD DE SALUD que tiene como temática para este año Consecuencias de la Pandemia "Una Mirada Global ", a realizarse los días 19, 20 y 21 de octubre de 2022.

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Los resúmenes postulados serán publicados en la página web de la Facultad de Salud como memorias del evento, posterior a la realización de este. Las certificaciones de presentación de ponencias podrán ser descargadas a partir del 24 de octubre desde la siguiente plataforma https://invessoft.com/certificados.

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AMPLIACIÓN DE FECHAS XXIV Simposio de Investigaciones "Consecuencias de la pandemia: una mirada global" - Facultad de Salud / Universidad del Valle / Cali, Colombia

# data[].attributes.attachment_link.description
Nos permitimos invitarles a postular sus trabajos de investigación para ser presentados en el "XXIV SIMPOSIO DE INVESTIGACIONES DE LA FACULTAD DE SALUD que tiene como temática para este año Consecuencias de la Pandemia "Una Mirada Global ", a realizarse los días 19, 20 y 21 de octubre de 2022.

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Geospatial investigations in Colombia reveal variations in the distribution of mood and psychotic disorders - Communications Medicine

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Song, J., Ramírez, M.C., Okano, J.T. et al. Geospatial investigations in Colombia reveal variations in the distribution of mood and psychotic disorders. Commun Med 4, 26 (2024). https://doi.org/10.1038/s43856-024-00441-x

https://www.nature.com/articles/s43856-024-00441-x

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Abstract

Background

Geographical variations in mood and psychotic disorders have been found in upper-income countries. We looked for geographic variation in these disorders in Colombia, a middle-income country. We analyzed electronic health records from the Clínica San Juan de Dios Manizales (CSJDM), which provides comprehensive mental healthcare for the one million inhabitants of Caldas.

Methods

We constructed a friction surface map of Caldas and used it to calculate the travel-time to the CSJDM for 16,295 patients who had received an initial diagnosis of mood or psychotic disorder. Using a zero-inflated negative binomial regression model, we determined the relationship between travel-time and incidence, stratified by disease severity. We employed spatial scan statistics to look for patient clusters.

Results

We show that travel-times (for driving) to the CSJDM are less than 1 h for ~50% of the population and more than 4 h for ~10%. We find a distance-decay relationship for outpatients, but not for inpatients: for every hour increase in travel-time, the number of expected outpatient cases decreases by 20% (RR = 0.80, 95% confidence interval [0.71, 0.89], p  = 5.67E-05). We find nine clusters/hotspots of inpatients.

Conclusions

Our results reveal inequities in access to healthcare: many individuals requiring only outpatient treatment may live too far from the CSJDM to access healthcare. Targeting of resources to comprehensively identify severely ill individuals living in the observed hotspots could further address treatment inequities and enable investigations to determine factors generating these hotspots.

Plain language summary

The frequencies of mental disorders vary by geographic region. Investigating such variations may lead to more equitable access to mental healthcare and to scientific discoveries that reveal specific localized factors that contribute to the causes of mental illness. This study examined the frequency of three disorders with a major impact on public health - schizophrenia, bipolar disorder, and major depressive disorder - by analyzing electronic health records from a hospital providing comprehensive mental health care for a large region in Colombia. We show that individuals receiving outpatient care mainly live relatively near the facility. Those receiving inpatient care live throughout the region, but cluster in a few scattered locations. Future research could lead to strategies for more equitable provision of mental healthcare in Colombia and identify environmental or genetic factors that affect the likelihood that someone will develop one of these disorders.

Introduction

Geographical variation in the distribution of mood and psychotic disorders has been observed, and extensively studied, in upper-income countries (UICs)1,2,3,4,5. These observed patterns may reflect inequities in the geographic accessibility of mental healthcare. Such inequities were first observed, and quantified, in a study published in 18521. This, and subsequent studies3,5,6,7 used statistical models to identify a relationship between mental healthcare utilization and distance. Specifically, these studies identified the phenomenon termed distance-decay, whereby the utilization of a healthcare facility declines in direct proportion to the distance (or travel-time8) to the facility1,2. Studies in UICs have also indicated that geographical variations in the observed frequency of particular mental health disorders and outcomes may reflect localized social, environmental, and genetic factors associated with treatment utilization or disease risk9,10,11,12,13,14,15.

The longstanding availability in UICs of population registries and other public databases has provided crucial resources that have enabled geospatial investigation of treatment for mental health disorders, as exemplified by the several studies referenced above. A lack of comparable data repositories has traditionally limited the opportunities for conducting such research in low- and middle-income countries (LMICs). Recently, however, electronic health record (EHR) databases have become available in some LMICs and enable population-level investigations of individuals who have sought treatment for these disorders. As we describe here for a middle-income country, Colombia, analyses of such databases may provide insights that could not be obtained using previously available forms of data.

The main sources of population-level data on mental health disorders in Colombia have been four National Mental Health Surveys, conducted, most recently, in 201516,17. The 2015 National Survey is an observational cross-sectional household-survey conducted in a nationally representative sample of 15,351 individuals aged seven and above, which obtained interview and self-report data. It has provided information on a wide range of topics (e.g., the prevalence of mental health and substance use disorders and on perceptions of access to care) that are important for our understanding of mental health disorders in Colombia and for efforts to improve the provision of mental healthcare.

Several critical types of information, however, are not available from the National Survey, but may be obtained by analyzing EHR databases; these include the distribution of the most severe and acute presentations of mental health disorders (the National Survey obtained little data on psychotic disorders), and the actual utilization of mental healthcare services. Additionally, as the National Survey sampled sparsely in any given location, its data cannot be used for geospatial investigation of mental health disorders. In contrast, as we demonstrate here, analyses utilizing the EHR database of the Clínica San Juan de Dios Manizales (CSJDM), provide a detailed picture of geospatial variation in treated mental illness across the entire department (state) of Caldas.

The CSJDM provides comprehensive mental healthcare for the one million inhabitants of Caldas. Located in the metropolitan municipality of Manizales, it provides mental health services to all individuals seeking care, regardless of health insurance status or other socioeconomic factors. We have identified and characterized geographic variation in the number of individuals who have sought treatment for the mood and psychotic disorders that most commonly result in psychiatric hospitalizations (bipolar disorder [BPD], schizophrenia [SCZ], and major depressive disorder [MDD]) and quantified differences, over the department, in geographic accessibility to mental healthcare, considering both individuals whose illness required inpatient care as well as those who were treated only as outpatients. We did so by combining diagnostic code data from the CSJDM EHR for the years 2005-2018, with publicly available geospatial data.

We show that travel-times (for driving) to the CSJDM are less than 1 h for ~50% of the population and more than 4 h for ~10%. We find a distance-decay relationship for outpatients, but not for inpatients: for every hour increase in travel-time, the number of expected outpatient cases decreases by 20%, an effect that is primarily driven by outpatients with MDD. Further, we identify nine hotspots where inpatient cases cluster. Notably, one hotspot comprises a nearly six-fold overrepresentation of inpatient BPD cases and crosses the administrative boundaries of two municipalities.

The results of the geospatial analyses that we performed can inform the design of programs aimed at reducing inequities in access to mental healthcare for mood and psychotic disorders. Additionally, they suggest the need for future studies aimed at identifying mechanisms for the geographical variations in disease incidence that we observed across the department of Caldas.

Methods

Inclusion criteria

We employed a retrospective cross-sectional design. Since 2005 the CSJDM has maintained EHRs on all outpatient visits and inpatient admissions. We utilized three forms of structured EHR data covering 2005-2018: demographic information, residential address, and diagnostic codes using the International Statistical Classification of Diseases and Related Health Problems: 10th Revision (ICD-10)18. The Institutional Review Boards (IRBs) at CSJDM and UCLA provided approval for the study, which involved uploading a version of the EHR database with patient names, dates (of birth and healthcare service), and with ID numbers removed, to a HIPAA-compliant Amazon Web Services server. Individual informed consent was not required for this study since only anonymized data were used. Gender was obtained through self-report and used as recorded in the EHR.

Using the EHRs for all adult patients 18-90 years, residing anywhere in Caldas, we focused on the 16,376 individuals who were assigned a diagnosis, at their first visit of BPD (diagnostic code: F31), SCZ (diagnostic code: F20), or MDD (diagnostic codes: F32 or F33). We used the initial diagnoses to eliminate possible bias introduced by right censoring of the diagnostic data, and did not use the longitudinal, repeated measures aspect of the EHR data in these analyses. In prior work, we have shown that diagnostic codes recorded in this EHR are highly accurate compared to diagnoses obtained by manual chart review by a psychiatrist19. We stratified analyses based on hospitalization status.

Geocoding workflow

We identified the subset of diagnosed individuals with available residential addresses ( N = 16,308). We assigned longitude and latitude coordinates to each patient's address using the Spanish language setting of OpenCage's geocoder through the R package opencage20. As input, OpenCage takes an address as free text. Prior to geocoding, we formatted addresses according to the following procedures. Most addresses ( N = 11,745) fit within a grid pattern that is typical throughout Colombia, comprised of parallel streets called "calles" and perpendicular streets called "carreras". We formatted addresses of this type according to the pattern "Calle [X], Carrera [Y], [Municipality], Caldas", where X is the street number for the "calle", and Y is the street number for the "carrera". The remaining addresses ( N  = 4563) were situated in small rural areas called "veredas" which have few roads. For these addresses, we took the name of the vereda or other address entry and appended the name of the municipality and department.

OpenCage provides a list of potential longitude and latitude coordinates with corresponding accuracy confidence scores. If multiple potential matches were returned, the most relevant was selected, based on the OpenStreetMap data21 relevance criteria for Colombian addresses. We excluded addresses with OpenCage confidence scores lower than 6. Using this threshold for confidence scores ensured that all addresses included in the study were within a 7.5 km bounding box measured diagonally and yielded geographic coordinates for 16,295 of the 16,308 patient addresses; all analyses reported here focus on these 16,295 patients.

Table 1 provides a summary of the dataset stratified by diagnosis (BPD, SCZ, or MDD), gender, and hospitalization status. All individuals had the location of their residence georeferenced to a 7.5 × 7.5 km bounding box; for 71% of them we could define the location of their residence to a 0.5 × 0.5 km bounding box.

Table 1 Summary of the dataset.

Calculating the incidence rate of mood and psychotic disorders

We first calculated the annual incidence per 100,000 individuals of newly diagnosed patients (both in- and outpatients) for each of the 27 municipalities within the department. For each year between 2005-2018, we divided the number of newly diagnosed patients in that specific year in each municipality by the estimated number of residents of that municipality in that year. The number of residents in a municipality was estimated using the WordPop database22, which includes gridded spatial demographic estimates. For most municipalities, the annual incidence of newly diagnosed cases was very low; we therefore conducted all our analyses based on the 14-year aggregate of the annual incidence. We subsequently referred to this aggregated value as the incidence rate and report this rate per 100,000 individuals.

We also calculated the incidence rate for each diagnosis, separately for in- and outpatients, at a more fine-grained geographic level unconstrained by municipality boundaries. To make these calculations, we imposed a grid (with a cell size of 5 km by 5 km) on the map of Caldas and counted the number of residents in each cell. Following the definition of the incidence rate at the level of the municipality, the incidence rate at the cellular level was defined as the number of newly diagnosed cases in the cell (between 2005 and 2018), divided by the total number of residents in that cell in the year 2018, and report this rate per 100,000. To visualize incidence rates, we generated maps using the R package ggplot2 v3.1.1 and shapefiles from the National Statistics Department of Colombia (DANE)23.

Calculating a friction-surface, and a geographic accessibility, map

To quantify the geographic accessibility of mental healthcare for the population of Caldas, and to identify a relationship between the distribution of cases and the travel-time to the CSJDM, we constructed a friction surface map and subsequently a geographic accessibility map. We first plotted maps of Caldas using shapefiles from the National Statistics Department of Colombia (DANE)23. We then used the software package AccessMod5 v5.6.024 to construct the friction surface map. This map quantifies the minimum amount of time that it takes to traverse one square kilometer, assuming driving time using a motorized vehicle on roads and walking time if no roads exist, while accounting for elevation changes and ground cover. To construct the map we combined geospatial data on topography25, land cover26, water bodies27 and road networks23 in the following stages: (1) We aggregated the topographic data to match the resolution (100 meters by 100 meters) of the WorldPop data. (2) We merged the land cover data, with data on roads and inland (permanent) water bodies, and with the aggregated topographic data. (3) We calculated travel-times using AccessMod, basing the estimated travel-time for each pixel on the quickest mode of transportation; Supplementary Table 1 lists the average speeds used to compute travel time, stratified by mode of transportation (see also Supplementary Material Section C in ref. 28). We then generated a geographic accessibility map by plotting the geographic location of the CSJDM on the friction surface map and computing the travel-time to the CSJDM from the centroid of each one square kilometer grid cell. We employed the option for anisotropic analysis, which uses the elevation data to modify travel speeds for walking.

The incidence rate of mood and psychotic disorder in relation to the travel-time to the CSJDM

To make these calculations, we modeled the expected number of cases by travel-time in hours, accounting for the number of individuals in each grid cell of the geographic accessibility map. We used a zero-inflated negative binomial regression from the R package pscl v1.5.5, a procedure that accounts for both the large number of grid units with zero cases and over-dispersion of cases. Normal 95% confidence intervals and two-sided p-values were calculated for each relative risk (RR) based on the distribution generated from 1200 bootstraps using the R package boot v1.3-20. We performed this computation for inpatients and outpatients separately, considering: (i) all three diagnoses together (i.e., two comparisons), and (ii) the three diagnoses separately (i.e., six comparisons). We applied Bonferroni thresholds to correct for eight independent tests, with a significance threshold of 0.00625 (0.05/8). To evaluate possible heterogeneity in the observed relative risk by gender, we conducted sensitivity analyses, including in the model gender, and a gender by travel-time interaction.

Identification of hotspots for residence of inpatients

To identify possible hotspots of residences of inpatients, we used the gridded map of Caldas showing the incidence rate of cases (for BPD, SCZ, and MDD combined, and separately). We then applied Kulldorff's Spatial Scan Statistic29, implemented in the software package SaTScan v9.630. SaTScan uses a circular window to scan a gridded surface. The window varies in size from one that encompasses a single grid cell to one that contains a predefined maximum population size. Use of a varying window size enables identification of hotspots unconstrained by municipality administrative boundaries. We used a cell size of 5 km by 5 km and set the maximum window size to encompass 25% of Caldas' population. SaTScan identifies hotspots by maximizing a likelihood ratio function, and assesses their statistical significance using a one-sided Monte Carlo hypothesis procedure29. To account for multiple testing for four different tests, we applied a Bonferroni correction with a significance threshold of 0.0125 (0.05/4). As a sensitivity analysis, we also performed separate hotspot analyses based on gender. We selected 25% as the maximum hotspot size as it is frequently considered the largest window with potential future utility for policymaking31. To evaluate the effect of this threshold, we conducted a sensitivity analysis exploring, for each diagnosis, how the identified hotspots changed in size/location when varying the maximum allowable size of the reported cluster32.

We also employed SaTScan to quantify and visualize the uncertainty in defining the borders of hotspots, using Oliveira's F function33. This function assigns an intensity value, ranging from zero to one, to each grid cell surrounding a hotspot, reflecting the probability that the grid cell belongs to the hotspot. To visualize hotspots and the uncertainty in their borders, we used QGIS v3.1034. The Oliveira's F values were colored in categories split by Jenk's natural breaks35,36, a setting in QGIS that enables better visualization of potential borders.

Results

Inequities in the geographic accessibility of mental healthcare in Caldas

The Central Cordillera of the Andes Mountains divides Caldas into Eastern and Western sections, with the Western side containing the capital city, Manizales, and most towns (Fig. 1a, b). This division is evident in the geographic accessibility map (Fig. 1c), which shows the locations for which the CSJDM is the most inaccessible (travel-time (driving) of greater than 5 h, orange-red colored areas); virtually all these sites lie east of the Central Cordillera. While these relatively inaccessible locations, some of which are more than 10 h in travel-time from CSJDM, are geographically sizable, they include a relatively small proportion of the department's population. Most of the population can access the hospital with less than 1 h of travel, while 90% can access it within approximately 4 h (Fig. 1d, see also Supplementary Table 2).

The maps show main roads and towns in Caldas23 ( a), population size estimates for each 5 km x 5 km grid as specified in the WorldPop database22 ( b), travel-time to Clínica San Juan de Dios Manizales (CSJDM, in hours) from anywhere in the department ( c) and the percentage of the population of Caldas that can reach the CSJDM as a function of travel-time ( d).

Geographic variation in incidence rates

The pattern of geographic variation in incidence rates, differs substantially between inpatients and outpatients (Figs. 2 and 3). For outpatients, by far the highest incidence rate is in the municipality (Manizales) which includes the CSJDM (Fig. 3). Notably, we found that the observed pattern for outpatients reflects strong distance-decay (as measured here by travel-times8); for every 1-h increase in travel-time to the CSJDM, the number of expected outpatients decreases by 20% (RR = 0.80, 95% confidence interval (0.71, 0.89), p = 5.67E-05, zero-inflated negative binomial model, Supplementary Table 3).

a The incidence rate for each municipality for patients whose first visit to the hospital was as an inpatient (per 100,000). The blue dot on the maps indicates the location of the Clínica San Juan de Dios Manizales (CSJDM). b Hotspots for all inpatients with bipolar disorder (BPD), major depressive disorder (MDD), or schizophrenia (SCZ). The statistically significant locations are indicated by circles: circle size indicates cluster size and color codes correspond to different values of relative risk. The grid units are colored by Oliveira's F values.

a The incidence rate for each municipality of inpatients stratified by diagnosis of bipolar disorder (BPD), major depressive disorder (MDD), and schizophrenia (SCZ) (per 100,000). The blue dot on the maps indicates the location of the Clínica San Juan de Dios Manizales (CSJDM). b Hotspots stratified by diagnosis. The statistically significant locations are indicated by circles: circle size indicates cluster size and color codes correspond to different values of relative risk. The grid units are colored by Oliveira's F values.

For inpatients, by contrast, we found no significant distance-decay, either for the incidence rate overall (i.e., for BPD, SCZ, and MDD combined) or for that of any of the three diagnoses considered separately (Supplementary Table 3. The overall incidence rate (Fig. 2a) is highest in a municipality, Aranzazu, located ~55 km from the CSJDM. This pattern reflects the high concentration of inpatient mood disorders (BPD and MDD) cases from this municipality compared to the department, overall (Fig. 3a): the incidence rate of inpatients with BPD is nearly fourfold higher (862/100,000 vs. 219/100,000), and the incidence rate of inpatients with MDD is more than 1.5 times higher (364/100,000 vs. 235/100,000). For MDD this incidence rate is nearly as high as that in Manizales (387/100,000). For SCZ (Fig. 3a) the incidence rate is highest in three neighboring municipalities located ~111 km from the hospital, where it is about twofold higher than in the department, overall (93/100,000 vs. 45/100,000). We found no significant interactions between travel-time and gender.

Identification of hotspots for inpatients with mood and psychotic disorders

We identified nine distinct hotspots: eight hotspots were identified for the broad category of all inpatients with either BPD, SCZ, or MDD (Clusters 1-8, Table 2, and Figs. 2b, 3b), while one hotspot was unique to inpatients with BPD (Cluster 9). Seven of the nine hotspots were also found in our diagnosis-specific analyses (Clusters 1-6, 9, Table 2, and Figs 2b, 3b); i.e., they were hotspots for inpatients with either BPD, SCZ, or MDD.

Table 2 Hotspots for residences of inpatients.

In our diagnosis-specific analyses, we identified seven hotspots in total (Clusters 1-6 and Cluster 9, Table 2, Fig. 3b), all of which show a significant overrepresentation of inpatient BPD cases, and three of which (Clusters 1, 2, and 5) cross municipality boundaries. Cluster 2 is also a hotspot for MDD inpatients, while Clusters 1, 3, and 4 are hotspots for inpatients across all three diagnoses. The hotspot that includes the grid cells around the hospital (Cluster 1) displays the highest likelihood ratio for each of the three diagnoses, as well as for overall cases of MDD inpatients. This observation reflects the fact that many more patients reside in this metropolitan area than in any other region of the department; in particular, this hotspot is home to 1476 inpatients with MDD (60% of MDD inpatients in the department) and shows the greatest overrepresentation of this diagnosis (RR = 5.47, p = 1.00E-17). Other hotspots, however, show patterns of overrepresentation that appear to differentiate them by diagnosis. Cluster 9 (Fig. 3b) is specific to BPD and is not identified in the cross-diagnostic analyses.

Cluster 2 denotes the hotspot comprising the most extreme overrepresentation of inpatient BPD cases (RR = 5.83, p = 1.00E-17, Table 2 and Fig. 3b). It is the largest of the BPD hotspots in terms of geographical extent (covering four grid units: ~20 square kilometers) and crosses the administrative boundaries of two municipalities (Aranzazu, the municipality with the highest incidence rate of BPD [Fig. 3a/b] and Filadelfia); it is located about 1.5 h driving time from the hospital. This hotspot displays an extremely high average annual incidence of BPD hospitalizations (862/100,000) and also shows an overrepresentation of MDD but not of SCZ hospitalizations; it may therefore constitute a hotspot specific for inpatients with mood disorder diagnoses. Cluster 3, by contrast, appears to be a hotspot for inpatients overall, as evidenced by the overrepresentation of all three diagnoses, despite being located 5 h from the hospital. While the total number of cases of SCZ from this location is relatively small ( N = 85 inpatients, N=13 with SCZ), the nearly nine-fold overrepresentation of SCZ cases is particularly striking (RR = 8.98, p = 2.11E-05, Table 2 and Fig. 3b).

Finally, we conducted a sensitivity analysis to explore the impact on the identified hotspots of varying the maximum allowable size of the reported cluster. The hotspots for MDD and SCZ are insensitive to the maximum scanning window size parameter as we observed nearly identical hotspots, irrespective of the parameters used (Supplementary Fig. 1). For BPD, when we increased the maximum reported cluster size above 40% of the population, Cluster 2 disappears. This is a consequence of the process by which SaTScan pre-computes the most likely hotspot centered at each grid, and then iteratively selects non-overlapping hotspots with the highest likelihood ratio; at settings above 40% the hotspot centered at Cluster 2 includes the area of Cluster 1. Since Cluster 1 has a higher likelihood ratio, Cluster 2 cannot be selected. The overall consistency of the hotspot patterns in these sensitivity analyses indicates the robustness of our findings. Our findings are also consistent when analyzed separately by gender; no new hotspots emerged, and we identify the same clusters described in Table 2.

Discussion

Increasing the equitable availability and utilization of mental healthcare services is a major international development objective. Reducing inequities in the geographic accessibility of such services is critical to achieving this objective37,38,39,40,41,42 and, in turn, depends on detailed knowledge regarding variations in the geospatial distribution of mental health disorders and elucidation of the factors responsible for such variations. Within Latin America, geospatial methodology has been used to quantify geographic accessibility to different forms of healthcare39,43, but not to mental healthcare.

Our results show the inequitable geographic accessibility of specialty mental healthcare services in the department of Caldas, Colombia; while most of its population can access services at the CSJDM with a travel time of <1 h drive, a substantial proportion resides at >4 h drive distant from the facility. Our geospatial analyses of CSJDM EHR data reveal an important impact of this inequity, as utilization of outpatient care for mood and psychotic disorders demonstrates significant distance-decay in relation to the CSJDM. This observation aligns with findings from studies in UICs1,2,3,4,5, which have shown that most people will travel only short distances to obtain such care. The Government of Colombia recently enacted a strategy of increasing the geographical accessibility of mental healthcare by embedding it within primary care clinics distributed throughout the country44,45. Future geospatial investigations, including construction of geographic accessibility maps for primary care facilities and analyses of mental health treatment data from the EHRs of these facilities, could play a valuable role in evaluating the impact of this strategy.

Factors other than geographic accessibility, however, appear to be the main determinants of inpatient treatment for mood and psychotic disorders, which, as has also been found in UICs46, does not demonstrate significant distance-decay. Instead, utilization of such intensive treatment clusters significantly around nine hotspots, widely dispersed across the department of Caldas. This finding indicates that locally important sociodemographic, environmental, or genetic factors influence geospatial variation in risk, treatment-seeking behavior, or treatment accessibility for clinically severe presentations of these disorders.

Elucidating the above factors is a priority for future research aimed at reducing inequities in mental healthcare in this region, and an important early step will be to explain the approximately five-fold overrepresentation of BPD relative to SCZ in the CSJDM EHR database. Such an extreme excess of BPD among individuals hospitalized for mental disorders, has not, to our knowledge, been observed in studies of inpatients in other countries, where BPD and SCZ usually occur at roughly equal frequencies47,48,49. This excess is particularly striking in the observed BPD hotspots; for example, the hotspot at Cluster 2 displays an incidence for this disorder which may be the highest yet reported worldwide48,49,50. Systematic investigation of each of the hotspots, incorporating several additional types of data, may identify specific factors, contributing to these patterns.

Levels of socioeconomic inequality in Latin America, overall, are among the highest worldwide51, and have been associated with extreme disparities in utilization of mental health services52. Recent studies in Brazil and Peru have used geospatial analyses to document the relationship between inequalities in factors such as education levels, income, employment, and migration and geographic variation in the frequency of mental illness parameters (suicide and depressive symptomatology, respectively)53,54. By incorporating information on sociodemographic factors that is available at a detailed level throughout Colombia (e.g., each residence has an assigned socioeconomic status indicator, from 1 [lowest] to 6 [highest], which determines utility rates39), future studies, using sources such as Colombia's National Department of Statistics census microdata23, could provide a more comprehensive equity perspective by integrating disaggregated georeferenced population sociodemographic open data.

Among the environmental factors that may contribute to geographic variation in risks of mental disorders, exposure to violent conflict, and forced displacement associated with such exposure are particularly relevant in Colombia; its decades long history of internal armed conflict led to the forced displacement of nearly 6 million people between the 1960s and the 2000s, one of the highest rates of any country worldwide55,56. Previous studies in Colombia have linked exposure to violent conflict to poor health outcomes generally56, and increased rates of mental health disorders, specifically55,57. Georeferenced resources, such as those aggregated by the government58, can be used to test this hypothesis.

An additional possibility, which can be investigated, is that genetic variants have contributed to the generation of hotspots for mood and psychotic disorders and to the overall patterns of geographic variation in their frequencies that we observe in Caldas. The demographic history of its population suggests this possibility. The predominant population of Caldas ("The Paisa") is an example of a genetic isolate that has expanded rapidly subsequent to a series of migration-related bottlenecks59,60, from population founders of indigenous, African, and European ancestry61. Such rapid expansion from a bottleneck creates the opportunity for even deleterious variants to attain sizable frequencies - and thereby exert a substantial effect on disease risk - in a highly localized manner62. Because Caldas is part of a larger region in which the Paisa predominate ("The Paisa region"), extension of geospatial investigations to the EHR databases of healthcare facilities in neighboring departments provides an opportunity to determine the potential impact of such variants through well-powered genetic studies.

Finally, it is important to consider the possible impact of factors that may influence treatment-seeking behavior for mood and psychotic disorders but for which relevant data are currently unavailable and may be difficult to obtain on a sufficiently large scale to permit their use in detailed geospatial analyses. For example, several studies have suggested that stigma and the fear of discrimination may be important barriers to utilization of mental healthcare, in Colombia, but have focused on outpatient treatment63, excluded individuals living with psychotic disorders17 or were based on qualitative analyses of very small samples64.

We discuss here several limitations of this study. First, for simplicity sake our geospatial analyses have focused only on patients' clinical presentations and diagnoses at their first visit, while a major strength of the EHR database is that it enables longitudinal investigations of variations in patient trajectories; many patients experience changes in the severity of their illness (e.g., their initial visit is as an outpatient, but they subsequently have at least one inpatient admission) or in diagnosis (e.g., they initially are diagnosed with MDD but subsequently experience manic or hypomanic episodes which leads to a change in diagnosis to BPD). Future analyses that incorporate information on such changes may reveal geographic variations that differ from those reported here. Second, as the size of the inpatient population at CSJDM is smaller than that of the outpatient population, it is possible that the lack of significant distance-decay in the former group reflects a lack of power to detect modest effects; future studies that include additional catchment areas may find some degree of distance-decay for these patients. Third, our estimates of geographic accessibility of treatment are based on average travel speeds using different surfaces, and do not account for potential seasonal or daytime variations. As more granular information becomes available (e.g., through dynamic road use databases), it may be possible to incorporate such variations as has been accomplished in Colombia for geospatial investigations of tertiary emergency healthcare39. Other directions for future work include the development of more sophisticated geostatistical models that could have policy relevance. For example, SaTScan maximizes the likelihood ratio and selects the most likely hotspot sequentially rather than jointly, which may not always lead to the selection of the most precise global pattern of hospots.

It is increasingly recognized that population-level investigations in low- and middle-income countries must be a priority for mental health research - both to reduce health inequities and to increase opportunities for transformative scientific discoveries65. The work reported here extends geospatial investigation of mood and psychotic disorders to a middle-income country that has recently experienced extensive and traumatic social disruptions. Despite such disruptions, Colombia has established infrastructure, such as the CSJDM EHR database, that constitute extraordinary resources for population mental health studies. Future studies can make further use of these resources to contribute to our understanding of sociodemographic, environmental and genetic risk factors of mental illness.

Reporting summary

Further information on research design is available in the Nature Portfolio Reporting Summary linked to this article.

Acknowledgements

This work was supported by R01MH113078 (C.E.B., C.L.J. and N.B.F.), R01MH123157 (L.M.O.L., C.L.J. and N.B.F.), R00MH116115 (L.M.O.L.) and R56AI152759 (S.B. and J.T.O.). We thank Anjene Musick for valuable feedback on the manuscript.

Author information

Author notes

These authors jointly supervised this work: Loes M. Olde Loohuis; Sally Blower.

Authors and Affiliations

1. Center for Neurobehavioral Genetics, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA

Janet Song, Susan K. Service, Juan de la Hoz, Ana M. Díaz-Zuluaga, Terri Teshiba, Carrie E. Bearden, Nelson B. Freimer & Loes M. Olde Loohuis

2. Department of Mental Health and Human Behavior, University of Caldas, Manizales, Colombia

Mauricio Castaño Ramírez, Cristian Gallago & Alexandra Valderrama Sánchez

3. Center for Biomedical Modeling, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, CA, USA

Justin T. Okano & Sally Blower

4. Department of Psychiatry, University of Antioquía, Medellín, Colombia

Cristian Vargas Upegui, Alejandro Arias & Carlos Lopez Jaramillo

5. Department of Biomedical Data Science, Stanford University, Stanford, CA, USA

Chiara Sabatti

6. Department of Psychiatry, University of Pennsylvania School of Medicine and the Penn-CHOP Lifespan Brain Institute, Philadelphia, PA, USA

Ruben C. Gur

7. Department of Psychiatry, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA

Javier I. Escobar

8. Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA

Victor I. Reus

Contributions

Conceptualization: C.E.B., N.B.F., L.M.O.L., and S.B.; Methodology: J.S., J.T.O., S.K.S., C.E.B., N.F., L.M.O.L., and S.B.; Software: J.S., J.d.l.H., C.G., and A.A.; Formal analysis: J.S. and S.K.S.; Investigation: M.C.R., J.T.O., A.M.D.Z., C.V.U., A.A., and T.T.; Data curation: J.S., J.d.l.H., C.G., and A.A.; Writing Original Draft: J.S., N.B.F., L.M.O.L., and S.B.; Writing - review & editing: J.S., M.C.R., J.T.O., S.K.S., J.d.l.H., A.M.D.Z., C.V.U., C.G., A.A., A.V.S., T.T., C.S., R.C.G., C.E.B., J.I.E., V.I.R., C.L.J., N.B.F., L.M.O.L., and S.B.; Visualization: J.S., J.T.O., and S.B.; Supervision: C.L.J., N.B.F., L.M.O.L., and S.B.; Project Administration: C.E.B., C.L.J., N.B.F., L.M.O.L., and S.B.; Funding acquisition: C.E.B., C.L.J., L.M.O.L., and S.B.

Corresponding author

Correspondence to Loes M. Olde Loohuis.

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The authors declare no competing interests.

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Communications Medicine thanks Luis Gabriel Cuervo, Winfred Dotse-Gborgbortsi, Angela Suárez and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.

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Song, J., Ramírez, M.C., Okano, J.T. et al. Geospatial investigations in Colombia reveal variations in the distribution of mood and psychotic disorders. Commun Med 4, 26 (2024). https://doi.org/10.1038/s43856-024-00441-x
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DOI: https://doi.org/10.1038/s43856-024-00441-x

# data[].attributes.attachment_link.title
Geospatial investigations in Colombia reveal variations in the distribution of mood and psychotic disorders - Communications Medicine

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Song et al. conduct a geospatial analysis of variations in incidence of mood and psychotic disorders and access to care in Caldas, Colombia. They show that many patients requiring only outpatient care live too far away to access it and identify hotspots of more severely ill patients, highlighting the need for targeted interventions.

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Driving Towards Equity, part of the AMORE Project. Presenter: Dr. Ángela Suárez MPH

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We present our vision for the expansion and development of the AMORE Project for 2023. This vision was developed within the WHO 2023 LEAD Innovation Challenge, a World Health Organization initiative to support innovations developed by staff in their professional or personal capacity.

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Driving Towards Equity, part of the AMORE Project

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Accessibility to Haemodialysis preprint showing the situation and potential improvement if new services were added

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Accessibility to Haemodialysis preprint showing the situation and potential improvement if new services were added

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Cuervo LG, Villamizar CJ, Osorio L, Ospina MB, Cuervo DE, Cuervo D, Bula MO, Zapata P, Owens NJ, Hatcher-Roberts J, Martin EA, Piquero F, Pinilla LF, Martinez-Herrera E, Jaramillo C. Cross-Sectional Equity Analysis of Accessibility by Automobile to Haemodialysis Services in Cali, Colombia, in 2020 (December 9, 2022). Available at SSRN: https://ssrn.com/abstract=4299562

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See all articles by Luis Gabriel Cuervo

Universitat Autònoma de Barcelona; Pan American Health Organization/World Health Org.; Academia Nacional de Medicina de Colombia
affiliation not provided to SSRN
Universidad del Valle
affiliation not provided to SSRN affiliation not provided to SSRN
IQuartil SAS

Egis Consulting

IQuartil SAS
affiliation not provided to SSRN affiliation not provided to SSRN affiliation not provided to SSRN
Opportunities Amidst Uncertainty

Universidad de la Sabana

Universidad de Antioquia

Universidad del Valle

Date Written: December 9, 2022

Abstract

Objectives: To obtain dynamic spatial-temporal accessibility measurements of travel times by car to haemodialysis services and assess potential benefits of adding new services.

Design: Cross-sectional analyses of dynamic spatial-temporal accessibility, accounting for traffic congestion. A web-based platform integrating public census and health services datasets, with travel-time big data from Google Distance Matrix API and Traffic Analysis Zones, supported these analyses. Predictive and prescriptive analytics were used to identify optimal locations for new haemodialysis services and estimate potential accessibility improvements.

Setting and participants: Cali, Colombia (2020 population: 2.258 million) using geographic and disaggregated sociodemographic data from the adjusted 2018 Colombian census. Predicted travel times were obtained for 6-12 July 2020 and 23-29 November 2020. This study is part of a proof-of-concept study measuring accessibility to health services.

Primary and secondary outcomes: Percentage of residents within 20 minutes by car of a haemodialysis service at peak and free-flow traffic congestion. Locations where new services maximise accessibility and estimated improvements. Findings were disaggregated by sociodemographic characteristics, providing an equity perspective.

Results: Accessibility was lower in July, when COVID-19 pandemic-related traffic restrictions were not in effect. Traffic congestion sharply reduces accessibility to haemodialysis and hurts more people with lower educational attainment, residents of low-income housing and outlying neighbourhoods, and specific ethnic groups.

For 6-12 July, accessibility was 96.3% with free-flow traffic and 42.7% with peak traffic; 10.2% for the lowest-income stratum. Adding a service in the eastern district of Agua Blanca would increase accessibility to 81.4% at peak traffic hours; another service in southern Cali could raise accessibility to 90.5%. Accessibility for 23-29 November was better.

Conclusions: Providing haemodialysis services to people in eastern Cali would greatly improve overall accessibility and reduce inequities. This study justifies informing health services and land-use planning with dynamic accessibility measures.

Keywords: Health Services Accessibility, City Planning, Urban Health, Health inequality monitoring, Spatial analysis, Residence characteristics, Spatial distribution population, Accessibility Health Services, Health Services Geographic Accessibility, Health Services Research, Renal Dialysis, Kidney Failure

JEL Classification: I14, R41, R52, R53, I18

Suggested Citation

Cuervo Amore, Luis Gabriel and Villamizar Jaimes, Carmen Juliana and Osorio, Lyda and Ospina, Maria Beatriz and Cuervo, Diana E. and Cuervo, Daniel and Bula, Maria Olga and Zapata Murillo, Pablo and Owens, Nancy J. and Hatcher-Roberts, Janet and Martin, Edith Alejandra and Piquero Villegas, Felipe and Pinilla, Luis Fernando and Martinez Herrera, Eliana and JARAMILLO, CIRO, Cross-Sectional Equity Analysis of Accessibility by Automobile to Haemodialysis Services in Cali, Colombia, in 2020 (December 9, 2022). Available at SSRN: https://ssrn.com/abstract=

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cross-sectional equity analysis of accessibility by automobile to haemodialysis services in cali

# data[].attributes.attachment_link.title
Cross-Sectional Equity Analysis of Accessibility by Automobile to Haemodialysis Services in Cali, Colombia, in 2020

# data[].attributes.attachment_link.description
See all articles by Luis Gabriel Cuervo Universitat Autònoma de Barcelona; Pan American Health Organization/World Health Org.; Academia Nacional de Medicina de Colombia affiliation not provided to SSRN Universidad del Valle affiliation not provided to SSRN affiliation not provided to SSRN IQuartil SAS Egis Consulting IQuartil SAS affiliation not provided

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Blog ¡En Cali se progresa, vé! del observatorio ciudadano Cali Cómo Vamos

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Blog ¡En Cali se progresa, vé! del observatorio ciudadano Cali Cómo Vamos

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Blog del observatorio ciudadano de Cali, 19 de agosto 2022

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Este artículo apareció originalmente en el sitio web de la Facultad de Ingeniería (Universidad del Valle) aquí y fue reproducido con permiso. Su autor es Andrew James Wight (NCC-FI/Univalle).

Un mapa de calor mostrando el tiempo de viaje hacia una sala de urgencias, en un rango entre verde (10 minutos) hasta rojo (30 minutos). Crédito: Proyecto AMORE

Estudios previos realizados en el exterior, han mostrado que una atención de urgencia oportuna y adecuada puede evitar el 45% de las muertes, y el 36% de las discapacidades relacionadas con ella, en los países de media y baja renta (PRMB).

Read this article in English here .

En el contexto de este estudio, el médico Luis Gabriel Cuervo , estudiante de doctorado de la Universitat Autònoma de Barcelona en España, y el profesor Ciro Jaramillo , Director del Grupo de Investigación en Transporte, Tránsito y Vías ( GITTV ) de la Facultad de Ingeniería de la Universidad del Valle, son coautores del artículo en "preprint" titulado: "Cross-sectional equity analysis of accessibility by automobile to tertiary care emergency services in Cali, Colombia in 2020" .

Los investigadores utilizaron, en dos ocasiones durante 2020, una plataforma digital llamada proyecto AMORE para mostrar los efectos negativos de la congestión vehicular en el acceso equitativo a los servicios de urgencias de atención terciaria en Cali, con el propósito de evidenciar la información de forma sencilla, a través de un "mapa de calor" que ilustra las zonas con mayor desventaja en la ciudad, con relación a los tiempos de viaje (accesibilidad) a los servicios de salud, en distintos niveles de congestión de tráfico. Además de la sencillez para visualizar el problema, el proyecto es novedoso porque usa datos dinámicos, que permiten apreciar los cambios en la accesibilidad en distintas horas del día.

Imagen: Infográfica con base en la plataforma del proyecto AMORE. Crédito: Proyecto AMORE.

¿El impacto del acceso a los servicios de la salud?

"La ciudad es nuestro laboratorio a escala real y el tratamiento de los datos espaciales con herramientas geomáticas son esenciales", planteó el profesor Jaramillo".

"Para quienes acuden a los servicios frecuentemente, el tiempo es dinero: las familias de quienes frecuentan cuidados ambulatorios presenciales incurren en costos directos e indirectos con cada desplazamiento", dijo el médico Cuervo, añadiendo que los costos directos e indirectos aumentan con la duración de los viajes.

Leer más de la EICG: Investigadores de Univalle mapean las llanuras de inundación para minimizar el riesgo a la vida y los bienes

Impacto en Cali, Latinoamérica y el mundo

"Queremos proporcionar a las secretarías de salud, de movilidad y a otras dependencias en el gobierno municipal, herramientas que sean útiles para tomar decisiones de política pública, por ejemplo, trasladar puestos de salud más cerca a poblaciones vulnerables o repotenciar los servicios disponibles", afirmó el profesor Jaramillo, añadiendo que "Cali se constituye en la prueba del concepto, exponiendo el estudio un abordaje sencillo y eficiente"

Por ejemplo, un estudio previo reveló que en Dhaka , Bangladesh, una ciudad grande de Asia, sólo el 63% de la población de los barrios marginales de la ciudad está a menos de 60 minutos de la mayoría de los servicios de emergencia, en condiciones de tráfico congestionado.

Artículo elaborado por la Facultad de Ingeniería de la Universidad del Valle

Si le gustaría contactar a los investigadores o conocer más sobre los proyectos, escriba a la Oficina de Comunicaciones Facultad de Ingeniería: comunicaingenieria@correounivalle.edu.co.

Este artículo apareció originalmente en el sitio web de la Facultad de Ingeniería (Universidad del Valle) aquí y fue reproducido con permiso. Su autor es Andrew James Wight (NCC-FI/Univalle).

Un mapa de calor mostrando el tiempo de viaje hacia una sala de urgencias, en un rango entre verde (10 minutos) hasta rojo (30 minutos). Crédito: Proyecto AMORE

Estudios previos realizados en el exterior, han mostrado que una atención de urgencia oportuna y adecuada puede evitar el 45% de las muertes, y el 36% de las discapacidades relacionadas con ella, en los países de media y baja renta (PRMB).

Read this article in English here .

En el contexto de este estudio, el médico Luis Gabriel Cuervo , estudiante de doctorado de la Universitat Autònoma de Barcelona en España, y el profesor Ciro Jaramillo , Director del Grupo de Investigación en Transporte, Tránsito y Vías ( GITTV ) de la Facultad de Ingeniería de la Universidad del Valle, son coautores del artículo en "preprint" titulado: "Cross-sectional equity analysis of accessibility by automobile to tertiary care emergency services in Cali, Colombia in 2020" .

Los investigadores utilizaron, en dos ocasiones durante 2020, una plataforma digital llamada proyecto AMORE para mostrar los efectos negativos de la congestión vehicular en el acceso equitativo a los servicios de urgencias de atención terciaria en Cali, con el propósito de evidenciar la información de forma sencilla, a través de un "mapa de calor" que ilustra las zonas con mayor desventaja en la ciudad, con relación a los tiempos de viaje (accesibilidad) a los servicios de salud, en distintos niveles de congestión de tráfico. Además de la sencillez para visualizar el problema, el proyecto es novedoso porque usa datos dinámicos, que permiten apreciar los cambios en la accesibilidad en distintas horas del día.

Imagen: Infográfica con base en la plataforma del proyecto AMORE. Crédito: Proyecto AMORE.

¿El impacto del acceso a los servicios de la salud?

"La ciudad es nuestro laboratorio a escala real y el tratamiento de los datos espaciales con herramientas geomáticas son esenciales", planteó el profesor Jaramillo".

"Para quienes acuden a los servicios frecuentemente, el tiempo es dinero: las familias de quienes frecuentan cuidados ambulatorios presenciales incurren en costos directos e indirectos con cada desplazamiento", dijo el médico Cuervo, añadiendo que los costos directos e indirectos aumentan con la duración de los viajes.

Leer más de la EICG: Investigadores de Univalle mapean las llanuras de inundación para minimizar el riesgo a la vida y los bienes

Impacto en Cali, Latinoamérica y el mundo

"Queremos proporcionar a las secretarías de salud, de movilidad y a otras dependencias en el gobierno municipal, herramientas que sean útiles para tomar decisiones de política pública, por ejemplo, trasladar puestos de salud más cerca a poblaciones vulnerables o repotenciar los servicios disponibles", afirmó el profesor Jaramillo, añadiendo que "Cali se constituye en la prueba del concepto, exponiendo el estudio un abordaje sencillo y eficiente"

Por ejemplo, un estudio previo reveló que en Dhaka , Bangladesh, una ciudad grande de Asia, sólo el 63% de la población de los barrios marginales de la ciudad está a menos de 60 minutos de la mayoría de los servicios de emergencia, en condiciones de tráfico congestionado.

Artículo elaborado por la Facultad de Ingeniería de la Universidad del Valle

Si le gustaría contactar a los investigadores o conocer más sobre los proyectos, escriba a la Oficina de Comunicaciones Facultad de Ingeniería: comunicaingenieria@correounivalle.edu.co.

# data[].attributes.attachment_link.title
Las poblaciones más vulnerables de Cali están a más de 15 minutos de una sala de urgencias

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Las poblaciones más vulnerables de Cali están a más de 15 minutos de una sala de urgencias

# data[].attributes.headline
Dynamic Measurements of Geographical Accessibility Considering Traffic Congestion Using Open Data: A Cross-Sectional Assessment for Haemodialysis Services in Cali, Colombia. May 2024

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Dynamic Measurements of Geographical Accessibility Considering Traffic Congestion Using Open Data: A Cross-Sectional Assessment for Haemodialysis Services in Cali, Colombia. May 2024

# data[].attributes.attachment_link.title
Dynamic measurements of geographical accessibility considering traffic congestion using open data: a cross-sectional assessment for haemodialysis services in Cali, Colombia

# data[].attributes.attachment_link.description
Establishing haemodialysis services in targeted areas has significant potential benefits.
By increasing accessibility, it would enhance urban health and equity.

# data[].attributes.headline
Tutorial to access and use the AMORE Platform

# data[].attributes.subject
Tutorial to access and use the AMORE Platform

# data[].attributes.body
This is how to access and use the AMORE Platform to test assumptions and reach conclusions, regarding measurements of published results.

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Simposio de investigaciones en salud Univalle Octubre 2022.

# data[].attributes.subject
Simposio de investigaciones en salud Univalle Octubre 2022.

# data[].attributes.body
Jaramillo Molina, Ciro, Lyda Osorio, Luis Gabriel Cuervo, and Carmen Juliana Villamizar. “Mejorando la equidad en la accesibilidad (tiempos de viaje) a los servicios de salud.” XXIV Simposio Nacional e Internacional de Investigaciones en Salud; consecuencias de la pandemia: una mirada global. (26m 27s). Cali, Colombia, Oct 21, 2022. https://doi.org/10.6084/m9.figshare.21788273.v1. Grabación: https://youtu.be/ijlEh0zIObo?t=4994

# data[].attributes.attachment_link.authors[].name
Escuela de Salud Pública - Universidad del Valle

# data[].attributes.attachment_link.title
Mini Simposio de Investigaciones: Retos y respuestas a la pandemia: más allá del Covid-19”

# data[].attributes.body
Wang, J., Wong, K.L.M., Olubodun, T. et al. Developing policy-ready digital dashboards of geospatial access to emergency obstetric care: a survey of policymakers and researchers in sub-Saharan Africa. Health Technol. 14, 69–80 (2024). https://doi.org/10.1007/s12553-023-00793-9

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Developing policy-ready digital dashboards of geospatial access to emergency obstetric care: a survey of policymakers and researchers in sub-Saharan Africa

Jia Wang 1 na1,

Kerry L. M. Wong 2 na1,

Tope Olubodun 3,

Uchenna Gwacham-Anisiobi 4,

Olakunmi Ogunyemi 5,

Bosede B. Afolabi 6,7,

Peter M. Macharia 8,9,

Prestige Tatenda Makanga 10,

Ibukun-Oluwa Omolade Abejirinde 11,12,

Lenka Beňová 13 &

...

Aduragbemi Banke-Thomas orcid.org/0000-0002-4449-0131 2,9,14

Show authors Cite this article

Abstract

Background

Dashboards are increasingly being used in sub-Saharan Africa (SSA) to support health policymaking and governance. However, their use has been mostly limited to routine care, not emergency services like emergency obstetric care (EmOC). To ensure a fit-for-purpose dashboard, we conducted an online survey with policymakers and researchers to understand key considerations needed for developing a policy-ready dashboard of geospatial access to EmOC in SSA.

Methods

Questionnaires targeting both stakeholder groups were pre-tested and disseminated in English, French, and Portuguese across SSA. We collected data on participants' awareness of concern areas for geographic accessibility of EmOC and existing technological resources used for planning of EmOC services, the dynamic dashboard features preferences, and the dashboard's potential to tackle lack of geographic access to EmOC. Questions were asked as multiple-choice, Likert-scale, or open-ended. Descriptive statistics were used to summarise findings using frequencies or proportions. Free-text responses were recoded into themes where applicable.

Results

Among the 206 participants (88 policymakers and 118 researchers), 90% reported that rural areas and 23% that urban areas in their countries were affected by issues of geographic accessibility to EmOC. Five percent of policymakers and 38% of researchers were aware of the use of maps of EmOC facilities to guide planning of EmOC facility location. Regarding dashboard design, most visual components such as location of EmOC facilities had almost universal desirability; however, there were some exceptions. Nearly 70% of policymakers considered the socio-economic status of the population and households relevant to the dashboard. The desirability for a heatmap showing travel time to care was lower among policymakers (53%) than researchers (72%). Nearly 90% of participants considered three to four data updates per year or less frequent updates adequate for the dashboard. The potential usability of a dynamic dashboard was high amongst both policymakers (60%) and researchers (82%).

Conclusion

This study provides key considerations for developing a policy-ready dashboard for EmOC geographical accessibility in SSA. Efforts should now be targeted at establishing robust estimation of geographical accessibility metrics, integrated with existing health system data, and developing and maintaining the dashboard with up-to-date data to maximise impact in these settings.

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Article Open access

Dohyeong Kim, Malabika Sarker & Priyanka Vyas

Article Open access

Joshua Wells, Robert Grant, ... Reem Kayyali

1 Introduction

Globally, about 295,000 women lose their lives due to complications of pregnancy and childbirth annually, with 66% of these deaths occurring in sub-Saharan Africa (SSA) [ 1]. Similarly, there are about two million stillbirths annually, and 58% of these deaths occur in SSA [ 2]. These deaths are mostly associated with complications of pregnancy and childbirth, such as bleeding, high blood pressure, infection, and abortion, which can be worsened by events happening between the onset of the complication and the time when the woman receives care [ 3]. However, it has long been established that delays in travel to access emergency obstetric care (EmOC) can lead to deaths of mothers and their unborn child(ren). Indeed, access to EmOC reduces maternal deaths by 15-50% and stillbirths by 45-75% [ 4]. EmOC is a package of nine clinical and surgical evidence-based interventions including parenteral antibiotics, uterotonic drugs, parenteral anticonvulsants, manual removal of placenta, removal of retained products of conception, assisted vaginal delivery, neonatal resuscitation, blood transfusion and caesarean section [ 5]. Before women needing EmOC can access care, they need to travel from the community or be referred from other facilities to health facilities with EmOC capacity. Delays in reaching such health facilities have significant negative impacts on pregnancy outcomes of mothers and newborns [ 6, 7, 8, 9].

For policymakers and other pertinent stakeholders of health systems, addressing access barriers which pregnant women with obstetric emergencies face is an ethical obligation [ 10] and very much in line with achieving universal health coverage (UHC), which is a key component of the Sustainable Development Goal (SDG) 3 to reduce maternal mortality to 70 per 100,000 live births globally by 2030 [ 11, 12]. To support the EmOC service planning function of policymakers, including deciding location of new facilities, upgrading the existing facilities, or siting of ambulance services in SSA, researchers have mainly used modelled approaches to assess geographical accessibility [ 13]. However, modelled approaches, which are typically static and report one moment in time (depending on available data, this time might not be recent), do not reflect the dynamic reality of travel which may be affected by traffic, terrain difficulties, and weather conditions [ 14, 15]. For example, in Dhaka, Bangladesh, ignoring variability in traffic conditions results in as much as a three-fold overestimation of geographic accessibility to emergency healthcare [ 16]. In another study in Lagos, Nigeria, mean errors of > 45 min were estimated when modelled travel time was compared to actual travel time [ 14, 15].

Policymakers require closer-to-reality and up-to-date travel time estimates to be able to comprehensively assess geographic accessibility within their jurisdiction, which will translate to allowing them to effectively address the issue of EmOC access, as has been shown in Lagos, Nigeria [ 17]. To address this need, a new effort to develop an innovative policy-ready dynamic dashboard using closer-to-reality travel time estimates to EmOC in SSA is being championed as part of the 'On Tackling In-transit delays for Mothers in Emergency' (OnTIME) project [ 18]. Dashboards such as this have been used mostly in high-income countries and increasingly in low- and middle-income countries (LMICs) to support health policymaking. However, their use has been mostly limited to geographical accessibility to routine care, not emergency services like EmOC [ 19, 20, 21, 22]. During the 2019 Coronavirus Disease pandemic, policy dashboards were put forward and ultimately aided the pandemic response of governments and international stakeholders [ 23, 24]. Dashboards allow a "visual display of the most important information needed to achieve one or more objectives; consolidated and arranged on a single screen so the information can be monitored at a glance" [ 25]. If available, such visual display would make recognising areas of poor EmOC geographical accessibility easier for policymakers and facilitate evidence-based policy response [ 17, 26]. To guide the development of such fit-for-purpose dashboard, guarantee its uptake, and promote ownership, it is essential to gather user needs at the development stage from individuals who will use the dashboard [ 27, 28, 29] As such, our objective in this study was to survey policymakers and researchers on considerations needed for developing a policy-ready dashboard of geospatial access to EmOC in SSA.

2 Methods

2.1 Study design

We conducted an online survey of policymakers and researchers involved in health service planning, including for EmOC services in SSA.

2.2 Survey questionnaire

The survey questionnaire was initially developed in English and translated into French and Portuguese by health professionals who are native speakers to capture at least one official language for every country in SSA. Two versions of the survey were designed, one for policymakers and the other for researchers, and were made available online via Mentimeter (Mentimeter, Stockholm, Sweden). Separate versions were deemed necessary to ensure that the tool was pitched at the level of understanding of technical jargon matching each stakeholder group, with more simplified language used in the tool targeting policymakers. The online questionnaire was piloted with target participants, resulting in minor language changes being made to the tool before it was socialised to prospective participants.

The survey started with a demographic section that collected information about the participants' profession and the sub-Saharan African country in which they primarily worked as policymakers or conducted research on as researchers. The questionnaire consisted of three substantive sections collecting data on participants' awareness of areas of concern of EmOC geographic accessibility and existing tools, dynamic online dashboard features preferences among participants and perceptions of the potential of dashboard applicability to tackle geographic access to EmOC. Across the three substantive sections, questions were structured in different formats, including multiple-choice, Likert-scale, and open-ended text. In the first section, we asked the participants to describe the areas in their country of work that were affected by poor geographic access to EmOC services and existing technological resources used for planning of EmOC services. The second section pertained to the dashboard design features that they deemed relevant and desirable. For this section, we enquired about preference for a pre-set list of dashboard visual components including a base geomap showing EmOC service points, a display of various travel barriers, a heatmap showing travel time, the socio-economic status of the population and households, carparks at EmOC facilities, and public transport access points. These visual components were based on insight garnered from previous research [ 17]. We also asked participants for their opinion on the spatial granularity at which EmOC accessibility indicators and metrics are to be presented for maximum relevance and what modelling scenarios in the dashboard would help support policymaking and improve geographic access to EmOC services. Lastly, we collected information on the frequency of updates. The final section of the survey tool focused on the participant's perception of the future potential and usability of a dynamic dashboard in tackling geographic access to EmOC service. A copy of the questionnaire for the policymakers and researchers in all languages used for the survey is available in Additional file 1.

2.3 Recruitment of survey participants and data collection

The inclusion criteria for the survey were: policymakers currently working on EmOC service planning in SSA, and researchers interested in EmOC service planning in SSA, as established through their recent publication history and responses to screening questions while filling the online questionnaire. Using a quota sampling to ensure all countries in the region were represented [ 30], we targeted between two to four participants per country in SSA (48 countries in the sub-region, totalling 92-184 participants). Researchers were recruited through contact email addresses provided in published research on accessing critical maternal health services in SSA. Policymakers were recruited through targeted emails to national Ministries of Health from the listservs of the African Centres for Disease Control and Prevention and the West African Network of Emerging Leaders in Health Policy and Systems Research. We also distributed the survey through colleagues at the WHO's Partnership for Maternal, Newborn and Child Health. Data collection for the online survey commenced on 1 st August 2022 and continued until 30 th November 2022. The emails inviting participants to the study include a link to the informed consent sheet (containing the participant information sheet and the certificate of consent), which participants must complete before accessing the online survey. The survey took approximately 20 min to complete.

2.4 Data analysis

Responses were exported from the online data collection portal as Microsoft Excel sheets. Translation of survey responses completed in French and Portuguese to English were carried out before data analysis. Subsequently, data cleaning was performed and the extent of missingness reported. Corresponding to the three substantive sections of the questionnaire, we conducted a descriptive analysis to summarise the data by stakeholder group (overall, policymakers, researchers); multiple-choice and Likert-scale questions are reported as frequencies and percentages and are visually presented as maps or bar charts. We compared the proportion of policymakers who gave certain responses with those of researchers. Each response in the participants' free text responses were individually reviewed, coded as one of the original categories provided, where applicable, or recoded as a new category, following deliberations by co-authors who led the data analysis.

3 Results

3.1 Participants' demographics

A total of 206 participants (118 researchers and 88 policymakers) took part in the survey. The commonest age group was 31 to 40 years old (42%). Of the 206 participants, 188 reported the SSA countries where they worked including 32 respondents (15%) who worked in Nigeria, 25 (13%) in Cameroon, and another 14 (7%) each in Kenya or Uganda. Altogether, 34 countries were represented on the survey (Fig. 1). Twenty participants did not specify their country of work.

3.2 Participants' awareness of areas affected by poor EmOC geographic accessibility and related technological tools to improve access

Of the 153 participants who responded to this question, over 90% described areas affected by EmOC access issues as being characterised by rurality, including other similar characteristics, such as being hard-to-reach or sparsely populated. In comparison, 23% of participants described areas affected by EmOC access issues as typified by urbanicity, including peri-urban areas and urban peripheries. A higher percentage of policymakers (29%) had concern for urban areas compared to researchers (19%) (Fig. 2).

Disaggregated by country, respondents from the majority of represented countries in SSA only or mostly mentioned rural areas as areas affected by poor geographic access to EmOC. However, a relatively larger share of respondents working in the Democratic Republic of Congo (DR Congo) (five of seven respondents), Ghana (three of five respondents), and Nigeria (nine of 24 respondents) expressed concern about geographic access to EmOC in urban areas alone or both urban and rural areas. On the other hand, in Liberia, Ethiopia, Tanzania, for instance, no participants (at least five in each country) expressed concerns for geographic access to EmOC in urban areas (Fig. 3).

Forty-three percent of participants reported knowing at least one technological tool being used to deal with poor geographic access to EmOC in the countries where they worked - 38% of policymakers and 50% of researchers. Further, when asked about whether they were aware of the use of static digital maps of EmOC facilities to help guide service planning, 21% of the participants responded positively (5% among policymakers and 38% among researchers).

3.3 Dashboard design and functionality preferences

Regarding visual components desired by participants, the most highly regarded visual components were a map showing EmOC facilities' locations (80% answered "somewhat relevant" and "absolutely essential") and the display of various travel barriers (75%). When disaggregated by respondent type, there was consensus on desirability of several visual components of interest for policymakers and researchers, including a map of EmOC facilities (policymakers: 76%; researchers: 83%), travel barriers (e.g., difficult terrain and congested roads) (policymakers: 75%; researchers: 75%), public transport access points (policymakers: 64%; researchers: 57%), and carpark provided at EmOC facilities (policymakers: 29%; researchers: 25%). However, there were some notable differences. Almost 70% of policymakers considered the socio-economic status of the population and households relevant to the dashboard. The desirability for heatmap showing travel time was lower among policymakers (53%) when compared to researchers (72%), with a greater proportion of researchers (29%) feeling neutral about such heatmaps than policymakers (19%) (Fig. 4).

Most participants considered the facility catchment area of the buffer area as the most relevant spatial scale to display accessibility measures (91%). Both policymakers and researchers were largely in agreement with the levels of relevance of different spatial scales, except for the first administrative subdivision, which was more highly regarded among policymakers (53%) than researchers (22%) (Table 1).

Table 1 Dashboard design and functionality preferences among survey respondents

Nearly 90% of participants considered three to four data updates per year or less frequent updates per year adequate for the dashboard, while 3% of researchers and no policymakers considered real-time updates relevant for the dashboard (Table 1).

When asked if 24/7 ambulance availability and various facility upgrade modelled scenarios on the dashboard might help with decision-making to improve geographic access to EmOC services, over 85% of respondents answered positively. About 50% of respondents also suggested other modelled scenarios they considered useful, with the most common being alternative human resource for health (HRH) scenarios - e.g., more skilled health personnel and other allied health personnel (Table 1).

3.4 Perception of the potential usability of the dashboard to tackle geographic access to EmOC

The potential usability of a dynamic dashboard such as the one proposed was high amongst all respondents (72% among non-missing responses). Disaggregated by stakeholder group, the potential usability of the dashboard amongst researchers was 82%, while amongst researchers was 60% (Table 2).

Table 2 Perception on the potentials use of an online dashboard to tackle geographic access to EmOC services

Two-thirds of the policymakers (67%) believed that the dashboard would add value and benefits to ministries of health and equivalent government health authorities, with 27% indicating that the dashboard will also benefit the work of other government departments and offices (including scientific offices, regional planning, road construction departments, etc.). On the other hand, researchers tended more to think that the dashboard would be of use to researchers, research institutes, and academic institutes (Table 2).

4 Discussion

We set out in this study to conduct a survey with policymakers and researchers on considerations needed for developing a policy-ready dashboard of geospatial access to EmOC in SSA. Of all the 206 respondents who took part in the survey, 90% reported that rural areas and 23% that urban areas in their countries were affected by issues of geographic accessibility to EmOC. Five percent of policymakers and 38% of researchers and 5% of policymakers were aware of the use of maps of EmOC facilities to guide planning of EmOC facility location. Regarding dashboard design, most visual components such as location of EmOC facilities had almost universal desirability; however, the desirability of socio-economic status of the population and households relevant and a heatmap showing travel time to care differed between policymakers and researchers. Nearly 90% of participants considered three to four data updates per year or fewer adequate for the dashboard. The potential usability of a dynamic dashboard was high amongst both policymakers (60%) and researchers (82%).

Participants almost unanimously thought that rural areas are affected by lack of EmOC access. About a quarter expressed urban areas are also affected by EmOC geographical accessibility issues and were mainly respondents from/working in DR Congo, Ghana, and Nigeria. When compared, policymakers tended more to be concerned about EmOC geographical accessibility in urban areas than researchers. The consensus on rural areas as areas of concerns is not surprising. Indeed, evidence in the literature shows that women in these areas have limited access to EmOC [ 31]. Though, recent evidence shows that women in urban and peri-urban areas also experience difficult access [ 32] and, in the largest SSA metropolis (Lagos), have higher odds of poor pregnancy outcomes for themselves and their newborns than those in rural areas [ 7, 9]. In our survey, since the countries from where a larger share of participants deemed urban as a problem are also countries that house two of the most-populated megacities (population > 10 million) in SSA [ 33], this observation might be because these are stakeholders who are already experiencing some of the impacts of urbanisation. It might also explain why policymakers tended more to be concerned about EmOC geographical accessibility in urban areas, as many typically live and work in such settings. Indeed, the challenges with access to healthcare in fast-growing, urbanising countries in SSA, including Ghana and Nigeria, have been flagged by researchers, who advocated for a need to rethink health systems more broadly in the context of urbanisation [ 34].

Participants reported some current use of digital technology to understand and address EmOC access issues. It is worth noting that the use of static maps showing facility locations was more frequently reported by researchers than policymakers. This is despite the fact that policymakers are the ones who need such evidence to support/guide EmOC service planning. As authors, we are aware of only two published studies reporting dashboards focused on geographical accessibility to health services in LMICs. There is one focused on primary health care in the Ifanadiana district of Tanzania called Lalana ( https://research.pivot-dashboard.org/) [ 22] and another one which is concentrated on emergency healthcare services in Cali, Colombia called the AMORE Project ( https://www.iquartil.net/proyectoamore/) [ 35]. There are probably other dashboards that are not publicly available. However, the 5% v. 38% awareness rate amongst policymakers and researchers that we observed in our survey suggests a significant disconnect between the creation of digital tools which is typically developed by researchers and their institutionalisation for supporting EmOC access policy actions. In a recently published qualitative study, policymakers specifically highlighted that digital tools that are dynamic and reflective of reality are more useful for decision-making [ 36]. We argue that these tools also need to be available beyond single districts of entire countries, as is the case with the two dashboards mentioned earlier, to realise their policy-influencing potential fully.

According to our survey respondents, the most highly desired visual component for a dynamic dashboard was a map showing facility locations. This desire is a legitimate need, as it is a fundamental requirement of a dashboard focused on EmOC access. The socio-economic status of populations and households was also reported as a desirable feature, especially among policymakers, indicating the interest in understanding access from the equity perspective, which is very much in line with the emphasis of the global community. Travel barriers showing difficult terrain and congested roads were also visual components of interest. We noted that compared to researchers, policymakers tended more to feel neutral about the relevance of a heatmap showing travel time. In static form, a heatmap based on closer-to-reality travel time estimates which showed congested roads was used to identify hotspots for EmOC geographical accessibility in Lagos, Nigeria [ 17]. The potential of these features may need to be brought to the attention of policymakers.

In addition, despite the premise of the survey being an online interactive dynamic dashboard showing EmOC access, the majority of survey participants considered three to four updates per year as adequate instead of more frequent updates (e.g., monthly) and no policymakers considered real-time updates as relevant. Bearing in mind the need to ensure optimum use of resources while assuring value for money of interventions such as this, which are aimed at improving outcomes for mothers and their newborns [ 37], this consideration will be critical for the sustainability of such dashboards. It also probably reflects that EmOC service planning from a supply side is not a real-time issue for policymakers. A dashboard updated three to four times a year or even less frequently, to aid in medium and long-term health policy planning is highly achievable. It minimises the need to collect primary data to update the inputs for the dashboard and efforts to re-run backend algorithms needed to keep the dashboard relevant for the times. In addition, most respondents wanted the dynamic dashboard to have the capacity to include modelled scenarios that offering comparison to the current situation in order to generate outputs to support better service planning and provision. In particular, the modelling scenarios of various locations and levels of ambulance availability and functionality of lower-tier health facilities, which could be upgraded for EmOC provision, were of interest to policymakers and researchers. For the latter, the functionality of EmOC facilities is known to vary even in settings such as urban areas where comprehensive EmOC is expected [ 38, 39, 40]. Ultimately, for such modelling features to work, there is a need to ensure that the dashboard is interlinked with other databases [ 41]. A feature allowing modelling various provision scenarios such as HRH, cost of service provision, or service outcomes could extend the utility of the dashboard for service planning and allow it to be more informative for policymakers in their efforts to identify areas of inequalities in healthcare utilisation, achieve cost-efficiency in provision of maternal and newborn health services and reduce maternal and neonatal morbidity and mortality [ 42, 43]. There are also other potential gains of a dashboard like this in SSA countries, including improving the routine health management information systems and enhancing accountability/stewardship of health systems and policymakers toward the population, as was the case with the routine immunisation dashboard implemented in Nigeria [ 21].

A key strength of the survey is that we covered almost all counties of SSA with 34 out of 48 countries in the sub-region included, representing 97% of the total population across the entire SSA region. However, there were some countries from which we could not secure any participant despite our best effort to disseminate the survey across all countries in SSA. We enlisted the major potential dashboard visual components in the survey but were unable to provide the participants with all the possibilities. Despite following up with an open-ended question in order to gauge other responses, respondents with little prior exposure to related tools were probably less able to provide further responses. Despite this, our findings provide critical insights that now need to be taken forward in the design and development of a user-friendly, context-specific, and customisable dashboard with the potential to inform and guide policymaking to address inequities in EmOC geographical accessibility in the sub-region.

In terms of the implication of our study findings for practice and policy, there is an appetite in government to improve EmOC geographical accessibility for women. However, efforts to do this are rarely data-driven [ 44, 45]. Dashboards like the one proposed in this study which will be built on up-to-date data on health facility functionality and closer-to-reality travel time [ 46] provide this much-needed evidence to support policymaking. The potential usability of similar dashboards may even extend beyond health service provision and the health sector in general and can benefit other crucial components of EmOC access, including road construction and urban and regional planning. However, currently, algorithms of navigation platforms which have the capacity to estimate closer-to-reality travel times, such as Google Maps ( https://maps.google.com) developed by Google, Waze ( https://waze.com) developed by Waze Mobile, Here WeGo ( https://wego.here.com/) developed by HERE Global B.V., and the open-source, World Bank supported platform, OpenTraffic ( http://opentraffic.io/) are more reflective of the situation in more urbanised settings compared to rural ones [ 15]. To put this in context, the team that worked on Lalana, which was done in a rural district, had to map over 100,000 buildings and 23,000 km of footpaths [ 22]. More work is needed to grow the functionality of the platforms and any resulting dashboards for rural areas, as these remain priority areas of inequities requiring attention. To ensure that when such dashboards become available, they are used, we have captured critical insights from policymakers and researchers that allow us to co-design a policy-ready dashboard study. At the minimum, a policy-ready dashboard should provide data on facility locations, the socio-economic status of populations and households, and travel barriers showing difficult terrain and congested roads. Its utility will be optimised if it is connected to other databases, and it can be updated quarterly. Some of the considerations highlighted by policymakers and researchers from their health system lens might be relevant for corollary dashboards at a facility-level and for demand-side dashboards for service users such as pregnant women.

In terms of future research, there is a need to test strategies aimed at augmenting uptake, utilisation, and fidelity of these dashboards amongst stakeholders when they are implemented [ 47] while also capturing impact stories on how it is making a difference in the functionality of service planners and policymakers and most ultimately in the lives of women and their newborns. This will stimulate more evidence-based planning and policymaking in SSA.

5 Conclusion

This study has provided vital considerations for developing a policy-ready dashboard for EmOC geographical accessibility in SSA. Insights gathered from the survey informed by two groups of stakeholders take us one step closer to the 'utopia' of geographical accessibility of maternal health services, where geographical information systems built on better data for better analytics will be available to support policymaking, as was imagined by researchers in this field previously [ 26]. Efforts now need to be placed on establishing partnerships that ensure the capture of closer-to-reality travel time, integration with existing health system data, and the development and maintenance of such policy-ready dashboards for EmOC geographical accessibility. If well implemented, the tool has all potential to contribute to critical policy decisions that will be lifesaving for mothers and their newborns.

Availability of data and materials

Data used in this study are available from the authors upon reasonable request.

Abbreviations

EmOC:

Emergency Obstetric Care

HRH:

Human Resource for Health

LMIC:

Low- and Middle-Income Country

OnTIME :

On Tackling In-transit delays for Mothers in Emergency

SDG:

Sustainable Development Goal

SSA:

Sub-Saharan Africa

UHC:

Universal Health Coverage

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Acknowledgements

We appreciate colleagues at the African Centres for Disease Control and Prevention, the West African Network of Emerging Leaders in Health Policy and Systems Research, the World Health Organization's PMNCH for Women's Children's and Adolescents' Health, Google, government representatives, and colleagues on Twitter and LinkedIn who helped in circulating the study questionnaire. We are particularly grateful to the policymakers and researchers who took time out of their busy schedules to participate in the survey that informed this study.

Funding

This study was funded by the Ideas Fund (Award 14650) from the University of Greenwich.

Author information

Author notes

Jia Wang and Kerry L. M. Wong are first authors.

Authors and Affiliations

1. School of Computing & Mathematical Sciences, University of Greenwich, London, UK

Jia Wang

2. Faculty of Epidemiology and Population Health, London, School of Hygiene and Tropical Medicine , London, UK

Kerry L. M. Wong & Aduragbemi Banke-Thomas

3. Department of Community Medicine and Primary Care, Federal Medical Centre Abeokuta, Abeokuta, Ogun, Nigeria

Tope Olubodun

4. Nuffield Department of Population Health, University of Oxford, Oxford, UK

Uchenna Gwacham-Anisiobi

5. Lagos State Ministry of Health, Ikeja, Lagos, Nigeria

Olakunmi Ogunyemi

6. Department of Obstetrics and Gynaecology, College of Medicine of the University of Lagos, Lagos, Nigeria

Bosede B. Afolabi

7. Maternal and Reproductive Health Research Collective, Lagos, Nigeria

Bosede B. Afolabi

8. Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya

Peter M. Macharia

9. Centre for Health Informatics, Computing, and Statistics, Lancaster Medical School, Lancaster University, Lancaster, UK

Peter M. Macharia & Aduragbemi Banke-Thomas

10. Surveying and Geomatics Department, Midlands State University, Faculty of Science and Technology, Gweru, Midlands, Zimbabwe

Prestige Tatenda Makanga

11. Dalla Lana School of Public Health, University of Toronto, Toronto, Canada

Ibukun-Oluwa Omolade Abejirinde

12. Women`s College Hospital Institute for Health System Solutions and Virtual Care, Toronto, Canada

Ibukun-Oluwa Omolade Abejirinde

13. Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium

Lenka Beňová

14. School of Human Sciences, University of Greenwich, Old Royal Naval College, Park Row, London SE10 9LS, UK

Aduragbemi Banke-Thomas

Contributions

AB-T conceptualised the study. AB-T and PMM conducted the literature review that informed the study. AB-T, JW, KLMW, and PMM developed the tool for the study. All authors were involved in the recruitment of participants for the survey. AB-T, JW, KLMW, TO, UG-A, and OO were involved in the data cleaning and recoding of the data. AB-T, JW, and KLMW conducted the analysis and prepared the first draft of the manuscript. All authors were involved in the preparation of subsequent drafts. In addition, all authors approved the final version.

Corresponding author

Correspondence to Aduragbemi Banke-Thomas.

Ethics declarations

Ethical approval and consent to paticipant

As this was research involving human participants, it was performed in accordance with the Declaration of Helsinki. Ethical approval was obtained from the University of Greenwich Research and Ethics Committee (UREC/21.4.7.8). Informed consent was obtained from all participants before recruitment.

Consent for publication

Not applicable.

Competing interest

None declared.

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Wang, J., Wong, K.L.M., Olubodun, T. et al. Developing policy-ready digital dashboards of geospatial access to emergency obstetric care: a survey of policymakers and researchers in sub-Saharan Africa. Health Technol. (2023). https://doi.org/10.1007/s12553-023-00793-9
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Keywords

# data[].attributes.attachment_link.title
Developing policy-ready digital dashboards of geospatial access to emergency obstetric care: a survey of policymakers and researchers in sub-Saharan Africa - Health and Technology

# data[].attributes.attachment_link.description
Background Dashboards are increasingly being used in sub-Saharan Africa (SSA) to support health policymaking and governance. However, their use has been mostly limited to routine care, not emergency services like emergency obstetric care (EmOC). To ensure a fit-for-purpose dashboard, we conducted an online survey with policymakers and researchers to understand key considerations needed for developing a policy-ready dashboard of geospatial access to EmOC in SSA.

# data[].attributes.headline
A one-minute pitch of our 2023 proposal Driving Towards Equity

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A one-minute pitch of our 2023 proposal Driving Towards Equity

# data[].attributes.body
This one-minute pitch was developed for WHO's 2023 LEAD Innovation Challenge and complements that brief published under "events" https://padlet.com/Proyecto_AMORE_Project/amore-project-portfolio-ocq9d91xtsew203j/wish/2683777860

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Dynamic Geographical Accessibility Assessments to Improve Health Equity: Protocol for a Test Case in Cali, Colombia

# data[].attributes.subject
Dynamic Geographical Accessibility Assessments to Improve Health Equity: Protocol for a Test Case in Cali, Colombia

# data[].attributes.body
Cuervo, LG, Jaramillo C, Cuervo D, Martínez-Herrera E, Hatcher-Roberts J, Pinilla LF, Bula MO, Osorio L, Zapata P, Piquero Villegas F, Ospina MB, and Villamizar CJ. “Dynamic Geographical Accessibility Assessments to Improve Health Equity: Protocol for a Test Case in Cali, Colombia.” F1000Research, November 28, 2022. https://doi.org/10.12688/f1000research.127294.1

# data[].attributes.attachment_link.readable_text
Traffic congestion can be an inconvenience, but it can also make the difference between life and death - a significant portion of the low-income population in Cali, Colombia cannot reach the nearest tertiary care emergency department in less than 15 minutes, reveals a new study by researchers from several international institutions including Universidad del Valle (Univalle).

Previous studies conducted abroad have shown that timely and adequate emergency care can prevent 45% of deaths and 36% of related disabilities in low- and middle-income countries (LMICs).

Lea este artículo en español aquí.

The researchers used, on two occasions during 2020, a digital platform called Project AMORE to show the negative effects of vehicular congestion on equitable access to tertiary care emergency services in Cali, with the purpose of displaying the information in a simple way, through a "heat map" that illustrates the most disadvantaged areas in the city, in relation to travel times (accessibility) to health services, at different levels of traffic congestion.

In addition to the simplicity of visualizing the problem, the project is novel because it uses dynamic data, which allows to appreciate the changes in accessibility at different times of the day.

The impact of access to health services?

Professor Jaramillo explained that the study was conducted with data downloads obtained in the urban area of Cali, a city in southwestern Colombia with more than 2 million inhabitants, where about half of them live in low-income households.

"The city is our full-scale laboratory and the treatment of spatial data with geomatics tools are essential," Professor Jaramillo said.

Professor Jaramillo explained that the project integrated demographic data from the Colombian National Census, traffic flow data from the Google Distance Matrix platform; and data corresponding to the 14 tertiary health care centers with emergency services.

"In a catastrophic health emergency, every minute counts-the time it takes to receive the right service can define the prognosis; those who receive timely, quality care have better options," Dr. Cuervo said.

The researchers explained that the data show which populations take longer to reach a facility within a time threshold under different levels of traffic congestion, i.e., people in vulnerable situations have to travel longer and therefore invest more direct and indirect personal resources to access tertiary care emergency services than the average population.

The researchers commented that there are also consequences, due to vehicular congestion, for those who attend ambulatory health services, for example hemodialysis, chemotherapy, rehabilitation, or radiotherapy patients.

"For those who attend services frequently, time is money: the families of those who frequent in-person ambulatory care incur direct and indirect costs with each trip," Dr. Cuervo said, adding that direct and indirect costs increase with the length of the trips.

"Imagine having to go for hemodialysis 3 or more times a week, this easily brings a family to ruin and limits family possibilities," explained Dr. Cuervo, adding that when services are closer to the people, the risks of transportation and the economic impact of the disease are reduced.

"I am excited about the possibility of improving the daily lives of families and patients facing high-cost illnesses by making it easier for them to access frequently used outpatient services without incurring lengthy trips," Dr. Cuervo said.

In addition, he dreams of a future where no less than 95% of Cali residents can reach the most accessible high-complexity emergency rooms in no more than fifteen minutes by car.

Read more from the School of Civil and Geomatic Engineering: Univalle Researchers Are Mapping Floodplains To Minimize Risk To Life And Property

Impact in Cali, Latin America and the World

Dr. Cuervo explained that in order to achieve change at the public policy level, it is important to provide the best possible data presented in practical and easy-to-use forms.

"Communicating by addressing the needs of decision-makers and in understandable language we can reach the heart and reason," Dr. Cuervo said, who is a post-graduate alumni of Univalle and maintains strong ties to the institution and his family in Cali, Colombia.

"We want to provide the health and mobility secretariats and other agencies in the municipal government with tools that are useful for making public policy decisions, for example, moving health posts closer to vulnerable populations or repowering available services," Professor Jaramillo said.

"Cali is the proof of concept, with the study exposing a simple and efficient approach," added Professor Jaramillo.

Dr Cuervo added that beyond the authorities, the information is useful and appropriate for users and providers of health services, and for members of the community, especially now that the local mayoralties of the Special District are defined.

"It can be replicated in many Latin American cities, since many of them, and certainly in Colombia, already have travel time measurements and georeferenced data on populations and health services," Dr. Cuervo said.

For example, a previous study revealed that in Dhaka, Bangladesh, a large city in Asia, only 63% of the city's slum population is less than 60 minutes from most emergency services in congested traffic conditions.

If you would like to contact the researchers or learn more about the projects, write to the Communications Office of the Faculty of Engineering: comunicaingenieria(at)correounivalle.edu.co.

Cover image: A heat map showing travel time to an emergency room, ranging from green (10 minutes) to red (30 minutes). Credit: AMORE Project

El estudiante Edison Albeiro Torres Duran de último semestre de Ingeniería Eléctrica realizó su práctica profesional en ECOPETROL , dejando en alto el nombre de la Universidad del Valle gracias a su excelente desempeño, que le valió un reconocimiento por parte de sus jefes en esta empresa. Edison Albeiro se inscribió en esta práctica gracias a la información que recibió en el correo institucional de la Universidad, esta información compendia la práctica en Ecopetrol . Esta posibilidad de práctica constaba de 3 vacantes para estudiantes de Ingeniería Eléctrica en tres lugares, Bogotá , Campo Petrolero Casabe e Instituto Colombiano del Petróleo en Piedecuesta Santander . Varios estudiantes de Ingeniería Eléctrica de la Facultad se inscribieron. Después de varias pruebas que se hicieron vía Internet, entre las que se evaluó el promedio de la carrera , participación en actividades extracurriculares e inglés, se escogieron dos estudiantes de la Univalle para ir a Bogotá a

Cualquiera que haya regado en exceso o defecto una planta ornamental sabe que la cantidad y el momento de añadir agua es fundamental para mantener las plantas sanas, y el reto es aún mayor cuando se trata de un cultivo sediento como el aguacate Hass. Investigadores de la Facultad de Ingeniería de la Universidad del Valle (Univalle) han desarrollado una aplicación que integra una gran cantidad de datos de cultivo, suelos y clima para dar a los agricultores de aguacate Hass, incluso los pequeños productores, una herramienta sencilla para el manejo preciso de riego. El profesor Edwin Erazo , vinculado a la Escuela de Ingeniería de los Recursos Naturales y del Ambiente ( EIDENAR ) de Univalle y autor principal de la publicación científica "Avances en la programación del riego de aguacate Hass bajo un enfoque de agricultura digital" explicó que hoy en día la mayoría de cultivadores de aguacate Hass están aplicando una cantidad constante de agua a sus cultivos, sin programar técnicamen

En el marco del proyecto "Fortalecimiento de las Competencias Comunicativas en Lenguas Extranjeras en la Universidad" que hace parte del Programa de Multilingüismo del Plan de Desarrollo 2016-2025, la Facultad de Ingeniería ofrecerá la formación en idioma alemán para 20 estudiantes de pregrado en el primer y segundo semestre de 2023. La primera parte de la formación se ofrecerá entre el 6 de marzo y el 21 de julio con una intensidad de 160 horas para alcanzar la mitad del nivel A2 según Marco Común Europeo de Referencia para las lenguas (MCER). Las clases se llevarán a cabo los días lunes y jueves de 6:00 a 9:00 pm. La segunda parte se hará en el semestre 2023-2 con la misma intensidad y horario hasta completar el nivel B1. CRITERIOS DE SELECCIÓN: Estar matriculado entre los semestres 3ro. a 6to. No presentar bajo rendimiento. Tener matrícula vigente en el semestre Marzo-Julio 2023. Tener un promedio acumulado de 4.0 al final del período académico 2022-2. Disponibilidad y c

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Cali's most vulnerable populations are more than 15 minutes away from an emergency room

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Traffic congestion can be an inconvenience, but it can also make the difference between life and death - a significant portion of the low-income population in Cali, Colombia cannot reach the nearest tertiary care emergency department in less than 15 minutes, reveals a new study by researchers from several international institutions including Universidad del Valle (Univalle).

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20230509 Bilingual infographic with maps / Infografía bilingüe con mapas https://doi.org/10.6084/m9.figshare.22777106

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Infographic for the AMORE Project / Infografía del Proyecto AMORE

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Infographic for the AMORE Project / Infografía del Proyecto AMORE

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Infographics and choropleths revealed the travel times by car to haemodialysis services in July 2020 and the predicted peak-traffic accessibility if services were added in one or two new locations in Cali, Colombia. / Infografías y coropletas revelaron los tiempos de viaje en automóvil a los servicios de hemodiálisis en julio de 2020 y la accesibilidad de tráfico pico pronosticada si se agregaran servicios en una o dos ubicaciones nuevas en Cali, Colombia. https://doi.org/10.6084/m9.figshare.22777106
Developed with ScientificInfographics

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Website (English / Español) Proyecto AMORE Project

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Website (English / Español) Proyecto AMORE Project

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Nuestra página, hospedada por IQuartil SAS, permite acceder los resultados publicados en la Plataforma AMORE

Our website is hosted by IQuartil SAS and offers access to our published results through the interactive AMORE Platform.

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Visualizaciones simples derivadas de análisis geoespacial dinámico y analítica que facilitan la comprensión de la accesibilidad a los servicios de salud, y la acción colaborativa para mejorar la equidad en salud. Prueba de concepto en Cali, Colombia.

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Digital App Technology to Assess Equity: Spatial Analysis and Equity for Health Services.” Presented at the Global Health Learning Network, University of Ottawa

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Cuervo, Luis Gabriel, and Sandra Orcí. “Digital App Technology to Assess Equity: Spatial Analysis and Equity for Health Services.” Presented at the Global Health Learning Network, University of Ottawa, Canada, January 20, 2022. https://med.uottawa.ca/international-global-health-office/global-health/education/global-health-learning-network

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International and Global Health Office | Faculty of Medicine

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The International and Global Health Office (IGHO) aims to promote international cooperation and exchange in health education and research, by supporting and coordinating international activities and projects initiated by Faculty members and academic units that are endorsed by Faculty Leadership.

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International Journal for Equity in Health 22, no. 1 (2023)

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International Journal for Equity in Health 22, no. 1 (2023)

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Funnell, S., J. Jull, L. Mbuagbaw, V. Welch, O. Dewidar, X. Wang, M. Lesperance, et al. “Improving Social Justice in Observational Studies: Protocol for the Development of a Global and Indigenous STROBE-Equity Reporting Guideline.” International Journal for Equity in Health 22, no. 1 (2023). https://doi.org/10.1186/s12939-023-01854-1.

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Improving social justice in observational studies: protocol for the development of a global and Indigenous STROBE-equity reporting guideline - International Journal for Equity in Health

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Background Addressing persistent and pervasive health inequities is a global moral imperative, which has been highlighted and magnified by the societal and health impacts of the COVID-19 pandemic. Observational studies can aid our understanding of the impact of health and structural oppression based on the intersection of gender, race, ethnicity, age and other factors, as they frequently collect this data. However, the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guideline, does not provide guidance related to reporting of health equity. The goal of this project is to develop a STROBE-Equity reporting guideline extension. Methods We assembled a diverse team across multiple domains, including gender, age, ethnicity, Indigenous background, disciplines, geographies, lived experience of health inequity and decision-making organizations. Using an inclusive, integrated knowledge translation approach, we will implement a five-phase plan which will include: (1) assessing the reporting of health equity in published observational studies, (2) seeking wide international feedback on items to improve reporting of health equity, (3) establishing consensus amongst knowledge users and researchers, (4) evaluating in partnership with Indigenous contributors the relevance to Indigenous peoples who have globally experienced the oppressive legacy of colonization, and (5) widely disseminating and seeking endorsement from relevant knowledge users. We will seek input from external collaborators using social media, mailing lists and other communication channels. Discussion Achieving global imperatives such as the Sustainable Development Goals (e.g., SDG 10 Reduced inequalities, SDG 3 Good health and wellbeing) requires advancing health equity in research. The implementation of the STROBE-Equity guidelines will enable a better awareness and understanding of health inequities through better reporting. We will broadly disseminate the reporting guideline with tools to enable adoption and use by journal editors, authors, and funding agencies, using diverse strategies tailored to specific audiences.

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Get acquainted with the AMORE Project in 4 minutes

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AMORE Project - to improve health equity by reducing the travel time to essential health services

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Protocol to conduct dynamic time-space measurements of accessibility to health services in Cali, Colombia, using publicly available data. Version approved by institutional review boards.

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Protocol to conduct dynamic time-space measurements of accessibility to health services in Cali, Colombia, using publicly available data. Version approved by institutional review boards.

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AThe protocol submitted for ethical clearances

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Dynamic Geographical Accessibility Assessments to Improve Health Equity: Protocol for a Test Case in Cali, Colombia (Evaluaciones Dinámicas De Accesibilidad Geográfica Para Mejorar La Equidad: Prueba En Cali, Colombia: Protocolo De Investigación)

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This is the protocol for a health services quality improvement observational study that addresses the impact of mobility on health equity without researching hu

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Las poblaciones más vulnerables de Cali están a más que 15 minutos desde un sala de urgencias

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La congestión vehicular puede ser un inconveniente, pero también puede marcar la diferencia entre la vida y la muerte—una parte importante d...

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Abstracts of the 17th World Congress on Public Health, Rome, May 2-6,  2023

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Abstracts of the 17th World Congress on Public Health, Rome, May 2-6,  2023

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Cuervo LG, Villamizar CJ, Jaramillo C, Martinez E. “Equitable Accessibility to Health Services Using Timely Measurements.” Population Medicine 5, no. Supplement (April 26, 2023): Pg 268. 17th World Congress on Public Health. https://doi.org/10.18332/popmed/164377

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Introduction:
The links between traffic congestion, accessibility to health services, and equity show how traffic congestion impacts accessibility among different populations. It can also be used to improve health services and land use planning. The study proposes an approach to measuring, analysing, and communicating accessibility to health services in terms of travel time, as opposed to traditional travel time analyses.

Methodology:
We studied the entire city of Cali (2.258 million), assessing accessibility by car to urgent care (tertiary care emergencies) and frequent ambulatory care (haemodialysis and radiation therapy) in July and November 2020. The study is the cocreation of an interdisciplinary multisectoral group involving authorities, academia and other civil society, service providers and beneficiaries.

Results:
Services are far from where most of the population lives, especially some of the most vulnerable. These people pay more to access essential health services. New analyses will indicate potential solutions and their potential impact.

Discussion:
The study used a person-centred design to address the needs of different stakeholders. Studies like this can expand to other services, transportation means, and locations. They allow for integrating health equity with urban planning and enable participatory evidence- informed decision-making.

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Equitable accessibility to health services using timely measurements

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Introduction: The links between traffic congestion, accessibility to health services, and equity show how traffic congestion impacts accessibility among different populations. It can also be used to improve health services and land use planning. The study proposes an approach to measuring,...

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https://www.linkedin.com/company/the-amore-project-collaborative-group-proyecto-amore

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II Simposio Internacional de Doctorandos en Desarrollo Urbano Sustentable en Latinoamérica y el Caribe, Santiago, Chile, Mar 11, 2022.

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II Simposio Internacional de Doctorandos en Desarrollo Urbano Sustentable en Latinoamérica y el Caribe, Santiago, Chile, Mar 11, 2022.

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“Traducción integrada del conocimiento y análisis geoespacial para reducir los tiempos de traslado a los servicios de salud (accesibilidad) y mejorar la equidad en salud. Prueba de concepto en Cali, Colombia, usando métodos mixtos.” Virtual presented at the II Simposio Internacional de Doctorandos en Desarrollo Urbano Sustentable en Latinoamérica y el Caribe, Santiago, Chile, March 11, 2022. https://redeuslac.org/ii-simposio-internacional-de-doctorandos-dus/
Recording: https://youtu.be/so7qPot48r0?t=1287

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<< Volver a Simposio Internacional DUS

Los viernes 11, 18 y 25 de marzo de 2022 se llevará a cabo la segunda versión del Simposio Internacional de Doctorandos en Desarrollo Urbano Sustentable de Latinoamérica y el Caribe, organizado por CEDEUS en colaboración con REDEUS-LAC. En la instancia participaron más de 40 doctorandos de todo el mundo, quienes expusieron el avance de sus investigaciones a la fecha.

A continuación presentamos el repositorio de los resúmenes e información de contacto de los expositores.

REVISA EL REPOSITORIO 2021 AQUÍ >>
REVISA LOS PREMIOS A LA MEJOR TESIS TERMINADA 2022 AQUÍ >>

El encierro en la ciudad: miedo, segregación, desigualdad en el norte de Quito - Ecuador

BRISSA SUAREZ

Nicaragua

Doctorado en Arquitectura

Universidad de Valladolid , España

Hábitat y vida digna a partir de las alianzas socio-técnicas de la comunidad Wichí San Ignacio de Loyola (Salta, Argentina)

FRANCO HESSLING

Argentina

Doctorado en Ciencias con Orientación en Energías Renovables

Universidad Nacional de Salta, Argentina

La relación entre segregación escolar y segregación residencial: reconstruyendo el problema de la segregación urbana desde un enfoque multi-dominio

PABLO SERRATI

Argentina

Doctorado en Ciencias Sociales

Universidad de Buenos Aires, Argentina

El paisaje urbano y la valoración social de los servicios ecosistémicos culturales provistos a través de la infraestructura ecológica
CLARA KARIS
Argentina

Doctorado en Arquitectura y Urbanismo

Universidad Nacional de Mar del Plata, Argentina

Estudio de eficiencia energética territorial industrial en zonas urbanas, indicador en base a los Objetivos de desarrollo sostenible: Caso de la Cuenca Matanza Riachuelo

JONATHAN MORRIS

Argentina

Doctorado en Ingeniería

Universidad de Lomas de Zamora, Argentina

Análisis del efecto del cambio climático y cambio de uso de suelo sobre el régimen hídrico en cuencas altamente intervenidas. Caso de la cuenca del Río Maipo, Chile Central

LENIN HENRÍQUEZ

Honduras

Doctorado en Ciencias de la Ingeniería

Pontificia Universidad Católica de Chile, Chile

Aproximación al Potencial de movilidad y segregación socio-espacial en el Concepción Metropolitano

DANIELA VILLOUTA

Chile

Doctorado en Arquitectura y Estudios Urbanos

Pontificia Universidad Católica de Chile, Chile

El rol de los espacios colectivos en la cohesión social urbana. Aproximación multiescalar en el Gran Santiago

EMILIO BERRIOS

Chile

Doctorado en Ciencias de la Ingeniería

Pontificia Universidad Católica de Chile, Chile

(In)satisfacción residencial posreasentamiento de hábitats informales en conjuntos de viviendas sociales de tipología unifamiliar y multifamiliar en Concepción (Chile) y Manizales (Colombia)

JUAN CARLOS MARÍN

Colombia

Doctorado en Arquitectura y Urbanismo

Universidad del Bío-Bío, Chile

El borde río-ciudad en el área central de Buenos Aires. Paisaje y proyecto arquitectónico.

JUAN TRABUCCO

Argentina

Doctorado en Arquitectura

Universidad de Concepción Del Uruguay, Universidad de Flores y Universidad Abierta Interamericana, Argentina

La oportunidad de construir ciudades con materiales bio-basados
FELIPE VICTORERO
Chile

Doctorado en Arquitectura y Estudios Urbanos

Pontificia Universidad Católica de Chile, Chile

How visual arts methods contribute to co-design processes: An Action Research through Design in Chile

MACARENA GAETE

Chile

Doctorado en Gestion del Entorno Construido

Universidad Tecnologica de Delft, Holanda

Análisis de la figura de catálogo de protecciones. Propuesta de desarrollo normativo para el patrimonio inmueble del Ecuador
MANUEL BARCIA
Ecuador

Doctorado en Arquitectura, Edificación, Urbanística y Paisaje

Universidad Politécnica de Valencia, España

Control de buses en tiempo real considerando múltiples estrategias y capacidades de las estaciones
CLAUDIA BOCANEGRA
Colombia

Doctorado en Ciencias de la Ingeniería Industria y Organizaciones

Pontificia Universidad Católica de Chile, Chile

Movilidad residencial intrametropolitana de Ciudad de México 2000-2020
CRISTIAN LUNA
México

Doctorado en Estudios Urbanos y Ambientales

El Colegio de México, México

Gender Differences in Bicycle Use in Latin American Cities

MEGUMI YAMANAKA

Paraguay

PhD City and Regional Planning

University of California, Berkeley, Estados Unidos

Modos de transporte público existentes y recomendados en ciudades pequeñas y medianas de Chile
PAUL BASNAK
Argentina

Doctorado en Ciencias de la Ingeniería

Pontificia Universidad Católica de Chile, Chile

Urban resilience and well-being: contributions to strengthening Recife in addressing climate change

ANA MENESES

Brasil

Programa de Pós-Graduação em Desenvolvimento Urbano

Universidade Federal de Pernambuco, Brasil

Redes de política pública en la disposición final de los residuos sólidos urbanos de la Zona Metropolitana del Valle de México

CRISTAL AYALA

México

Doctorado en Urbanismo

Universidad Nacional Autónoma de México , México

Aves como bioindicador de sustentabilidad en el piedemonte mendocino urbanizado

VIVIANA GÓMEZ

Argentina

Doctorado en Ordenamiento Territorial y Desarrsollo Sostenible

Universidad Nacional de Cuyo, Argentina

Relevancia de la Clusterización en el Desarrollo Productivo Regional aplicando Instrumentos de la Bioeconomía. Caso de aplicación: Región Chaco Austral
TAMARA JACHESKY
Argentina

Doctorado en Ingeniería

Universidad Nacional de Lomas de Zamora, Argentins

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II Simposio Internacional de Doctorandos en Desarrollo Urbano Sustentable en Latinoamérica y el Caribe - REDEUSLAC

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REVISA LOS PREMIOS A LA MEJOR TESIS TERMINADA 2022 AQUÍ >> El encierro en la ciudad: miedo, segregación, desigualdad en el norte de Quito - Ecuador BRISSA SUAREZ Nicaragua Doctorado en Arquitectura Universidad de Valladolid , España Hábitat y vida digna a partir de las alianzas socio-técnicas de la comunidad

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Macharia, Peter M., Kerry L. M. Wong, Tope Olubodun, Lenka Beňová, Charlotte Stanton, Narayanan Sundararajan, Yash Shah, et al. “A Geospatial Database of Close-to-Reality Travel Times to Obstetric Emergency Care in 15 Nigerian Conurbations.” Scientific Data 10 (October 23, 2023): 736. https://doi.org/10.1038/s41597-023-02651-9.

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doi: 10.1038/s41597-023-02651-9.

Affiliations

¹ Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.

² Population & Health Impact Surveillance Group, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya.

³ Centre for Health Informatics, Computing, and Statistics, Lancaster Medical School, Lancaster University, Lancaster, UK.

⁴ Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.

⁵ Department of Community Medicine and Primary Care, Federal Medical Centre Abeokuta, Abeokuta, Ogun, Nigeria.

⁶ Google LLC, California, USA. chstanton@google.com.

⁷ Google LLC, California, USA.

⁸ Nuffield Department of Population Health, University of Oxford, Oxford, UK.

⁹ Lagos State Ministry of Health, Ikeja, Lagos, Nigeria.

¹⁰ School of Computing & Mathematical Sciences, University of Greenwich, London, UK.

¹¹ Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.

¹² Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto, Canada.

¹³ Surveying and Geomatics Department, Midlands State University Faculty of Science and Technology, Gweru, Midlands, Zimbabwe.

¹⁴ Climate and Health Division, Centre for Sexual Health and HIV/AIDS Research, Harare, Zimbabwe.

¹⁵ Maternal and Reproductive Health Research Collective, Lagos, Nigeria.

¹⁶ Department of Obstetrics and Gynaecology, College of Medicine of the University of Lagos, Lagos, Nigeria.

¹⁷ Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK. aduragbemi.banke-thomas@lshtm.ac.uk.

¹⁸ Maternal and Reproductive Health Research Collective, Lagos, Nigeria. aduragbemi.banke-thomas@lshtm.ac.uk.

¹⁹ School of Human Sciences, University of Greenwich, London, UK. aduragbemi.banke-thomas@lshtm.ac.uk.

Free PMC article

Free PMC article

doi: 10.1038/s41597-023-02651-9.

Affiliations

¹ Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.

² Population & Health Impact Surveillance Group, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya.

³ Centre for Health Informatics, Computing, and Statistics, Lancaster Medical School, Lancaster University, Lancaster, UK.

⁴ Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.

⁵ Department of Community Medicine and Primary Care, Federal Medical Centre Abeokuta, Abeokuta, Ogun, Nigeria.

⁶ Google LLC, California, USA. chstanton@google.com.

⁷ Google LLC, California, USA.

⁸ Nuffield Department of Population Health, University of Oxford, Oxford, UK.

⁹ Lagos State Ministry of Health, Ikeja, Lagos, Nigeria.

¹⁰ School of Computing & Mathematical Sciences, University of Greenwich, London, UK.

¹¹ Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.

¹² Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto, Canada.

¹³ Surveying and Geomatics Department, Midlands State University Faculty of Science and Technology, Gweru, Midlands, Zimbabwe.

¹⁴ Climate and Health Division, Centre for Sexual Health and HIV/AIDS Research, Harare, Zimbabwe.

¹⁵ Maternal and Reproductive Health Research Collective, Lagos, Nigeria.

¹⁶ Department of Obstetrics and Gynaecology, College of Medicine of the University of Lagos, Lagos, Nigeria.

¹⁷ Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK. aduragbemi.banke-thomas@lshtm.ac.uk.

¹⁸ Maternal and Reproductive Health Research Collective, Lagos, Nigeria. aduragbemi.banke-thomas@lshtm.ac.uk.

¹⁹ School of Human Sciences, University of Greenwich, London, UK. aduragbemi.banke-thomas@lshtm.ac.uk.

Abstract

Travel time estimation accounting for on-the-ground realities between the location where a need for emergency obstetric care (EmOC) arises and the health facility capable of providing EmOC is essential for improving pregnancy outcomes. Current understanding of travel time to care is inadequate in many urban areas of Africa, where short distances obscure long travel times and travel times can vary by time of day and road conditions. Here, we describe a database of travel times to comprehensive EmOC facilities in the 15 most populated extended urban areas of Nigeria. The travel times from cells of approximately 0.6 × 0.6 km to facilities were derived from Google Maps Platform's internal Directions Application Programming Interface, which incorporates traffic considerations to provide closer-to-reality travel time estimates. Computations were done to the first, second and third nearest public or private facilities. Travel time for eight traffic scenarios (including peak and non-peak periods) and number of facilities within specific time thresholds were estimated. The database offers a plethora of opportunities for research and planning towards improving EmOC accessibility.

PubMed Disclaimer

Conflict of interest statement

CS, MK, YS, GP, TS and SV are employees of Google LLC, which makes the Google Maps Platform. All other authors declare no competing interests.

References

Paxton A, Maine D, Freedman L, Fry D, Lobis S. The evidence for emergency obstetric care. International Journal of Gynecology and Obstetrics. 2005;88:181-193. doi: 10.1016/j.ijgo.2004.11.026. - DOI - PubMed

Holmer H, et al. The global met need for emergency obstetric care: A systematic review. BJOG. 2015;122:183-189. doi: 10.1111/1471-0528.13230. - DOI - PubMed

Wong KLM, et al. A tale of 22 cities: utilisation patterns and content of maternal care in large African cities. BMJ Glob Health. 2022;7:e007803. doi: 10.1136/bmjgh-2021-007803. - DOI - PMC - PubMed

Banke-Thomas A, et al. Assessing emergency obstetric care provision in low- and middle-income countries: a systematic review of the application of global guidelines. Global Health Action. 2016;9:31880. doi: 10.3402/gha.v9.31880. - DOI - PMC - PubMed

WHO, UNFPA & UNICEF. Averting Maternal Deaths and Disabilities. Monitoring emergency obstetric care: a handbook. (2009).

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national center for biotechnology information

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A geospatial database of close-to-reality travel times to obstetric emergency care in 15 Nigerian conurbations - PubMed

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Travel time estimation accounting for on-the-ground realities between the location where a need for emergency obstetric care (EmOC) arises and the health facility capable of providing EmOC is essential for improving pregnancy outcomes. Current understanding of travel time to care is inadequate in ma ...

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Familiaricese con el Proyecto AMORE en cuatro minutos

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Proyecto AMORE - para mejorar la equidad en salud reduciendo los tiempos de viaje a los servicios

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Preprint Accessibility to tertiary care emergency services

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Preprint Accessibility to tertiary care emergency services

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Cuervo, Luis Gabriel, Eliana Martinez Herrera, Lyda Osorio, Janet Hatcher Roberts, Daniel Cuervo, María Olga Bula, Luis Fernando Pinilla, Felipe Piquero, Ciro Jaramillo, and the AMORE Project Collaboration. “Cross-Sectional Equity Analysis of Accessibility by Automobile to Tertiary Care Emergency Services in Cali, Colombia in 2020.” medRxiv, February 4, 2022. https://doi.org/10.1101/2022.02.03.22269929.

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Cross-sectional equity analysis of accessibility by automobile to tertiary care emergency services in Cali, Colombia in 2020

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This study provides data on equity in accessibility to tertiary care emergency services in Cali, accounting for traffic congestion, in two separate weeks in 2020. This cross-sectional study builds on a proof-of-concept, the [AMORE Project][1][(1)][2] and provides a baseline assessment of accessibil…

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📣 @lgcuervoamore: "La #analítica permite evidenciar los #problemas de #cobertura de #salud que existe en la ciudad de #Cali, pero también inicia el cuestionamiento para poder plantear #soluciones al respecto"

🔴 4to foro #CiudadesCómoVamos #EnVivo

# data[].attributes.wish_content.attachment_props.original_text
📣 @lgcuervoamore: "La #analítica permite evidenciar los #problemas de #cobertura de #salud que existe en la ciudad de #Cali, pero también inicia el cuestionamiento para poder plantear #soluciones al respecto"

🔴 4to foro #CiudadesCómoVamos #EnVivo https://t.co/rpHEMIinht

# data[].attributes.wish_content.attachment_props.referenced_tweets[].text
@lgcuervoamore @maralegre @OcupaTuCalle @jjaimemiranda 📣 @lgcuervoamore: "La #duración de los viajes hacia equipamientos de #salud es un punto importante a considerar cuando estos son realizados por personas que siguen tratamientos como #hemodiálisis, #quimioterapia o #radioterapia"

💻  Ingresa a: https://t.co/a4aV8SBRBB https://t.co/JmP3O7XHdy

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📣 @lgcuervoamore: "La #analítica permite evidenciar los #problemas de #cobertura de #salud que existe en la ciudad de #Cali, pero también inicia el cuestionamiento para poder plantear #soluciones al respecto"

🔴 4to foro #CiudadesCómoVamos #EnVivo pic.twitter.com/rpHEMIinht
— Lima Cómo Vamos (@limacomovamos) November 5, 2021

# data[].attributes.attachment_link.metadata.attachment_props_source.data.text
📣 @lgcuervoamore: "La #analítica permite evidenciar los #problemas de #cobertura de #salud que existe en la ciudad de #Cali, pero también inicia el cuestionamiento para poder plantear #soluciones al respecto"

🔴 4to foro #CiudadesCómoVamos #EnVivo https://t.co/rpHEMIinht

# data[].attributes.attachment_link.metadata.attachment_props_source.includes.tweets[].text
@lgcuervoamore @maralegre @OcupaTuCalle @jjaimemiranda 📣 @lgcuervoamore: "La #duración de los viajes hacia equipamientos de #salud es un punto importante a considerar cuando estos son realizados por personas que siguen tratamientos como #hemodiálisis, #quimioterapia o #radioterapia"

💻  Ingresa a: https://t.co/a4aV8SBRBB https://t.co/JmP3O7XHdy

# data[].attributes.attachment_link.metadata.attachment_props.original_text
📣 @lgcuervoamore: "La #analítica permite evidenciar los #problemas de #cobertura de #salud que existe en la ciudad de #Cali, pero también inicia el cuestionamiento para poder plantear #soluciones al respecto"

🔴 4to foro #CiudadesCómoVamos #EnVivo https://t.co/rpHEMIinht

# data[].attributes.attachment_link.metadata.attachment_props.text
📣 @lgcuervoamore: "La #analítica permite evidenciar los #problemas de #cobertura de #salud que existe en la ciudad de #Cali, pero también inicia el cuestionamiento para poder plantear #soluciones al respecto"

🔴 4to foro #CiudadesCómoVamos #EnVivo

# data[].attributes.attachment_link.metadata.attachment_props.referenced_tweets[].text
@lgcuervoamore @maralegre @OcupaTuCalle @jjaimemiranda 📣 @lgcuervoamore: "La #duración de los viajes hacia equipamientos de #salud es un punto importante a considerar cuando estos son realizados por personas que siguen tratamientos como #hemodiálisis, #quimioterapia o #radioterapia"

💻  Ingresa a: https://t.co/a4aV8SBRBB https://t.co/JmP3O7XHdy

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Cuervo LG, Jaramillo C, Cuervo D et al. Dynamic geographical accessibility assessments to improve health equity: protocol for a test case in Cali, Colombia [version 1; peer review: 1 approved]. F1000Research 2022, 11:1394 (https://doi.org/10.12688/f1000research.127294.1

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Cuervo LG, Jaramillo C, Cuervo D et al. Dynamic geographical accessibility assessments to improve health equity: protocol for a test case in Cali, Colombia [version 1; peer review: awaiting peer review]. F1000Research 2022, 11:1394 ( https://doi.org/10.12688/f1000research.127294.1)

NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article.

Close Copy Citation Details

[version 1; peer review: awaiting peer review]

Carmen Juliana Villamizar Luis Gabriel Cuervo

https://orcid.org/0000-0003-2732-5019

¹¹ ¹, [...]

Ciro Jaramillo Daniel Cuervo Eliana Martínez-Herrera Janet Hatcher-Roberts Luis Fernando Pinilla María Olga Bula Lyda Osorio Pablo Zapata Felipe Piquero Villegas Maria Beatriz Ospina Carmen Juliana Villamizar Luis Gabriel Cuervo ²,

https://orcid.org/0000-0003-2732-5019

³, ⁴, ⁵, ⁶, ⁷, ⁸, ³, ⁹, ¹⁰, ¹¹ ¹, [...]

Author details Author details

¹ Department of Paediatrics, Obstetrics & Gynaecology and Preventative Medicine, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
² School of Civil and Geomatic Engineering, Universidad del Valle, Cali, Valle del Cauca, Colombia
³ IQuartil SAS, Bogotá D.C., 110111-300, Colombia
⁴ Facultad Nacional de Salud Pública, Universidad de Antioquia, Medellín, Antioquia, Colombia
⁵ WHO Collaborating Centre for Knowledge Translation and Health Technology Assessment for Health Equity, Bruyère Research Institute, University of Ottawa, Ottawa, Ontario, K1R6M1, Canada
⁶ Universidad de la Sabana, Bogotá D.C., Colombia
⁷ Egis Consulting, Bogotá D.C., Colombia
⁸ School of Public Health, Universidad del Valle, Cali, Valle del Cauca, Colombia
⁹ Author of patobiography, Independent Patient Representative, Bogotá, D.C., Colombia
¹⁰ Department of Public Health Sciences, Faculty of Health Sciences, Queen's University, Kingston, ON, K7L 3N6, Canada
¹¹ Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA

Luis Gabriel Cuervo
Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Project Administration, Resources, Supervision, Validation, Visualization, Writing - Original Draft Preparation

Ciro Jaramillo
Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Supervision, Validation, Writing - Review & Editing

Daniel Cuervo
Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Resources, Software, Supervision, Validation, Visualization, Writing - Review & Editing

Eliana Martínez-Herrera
Roles: Formal Analysis, Investigation, Methodology, Supervision, Validation, Writing - Review & Editing

Janet Hatcher-Roberts
Roles: Formal Analysis, Resources, Validation, Writing - Review & Editing

Luis Fernando Pinilla
Roles: Formal Analysis, Investigation, Resources, Software, Validation, Visualization, Writing - Review & Editing

María Olga Bula
Roles: Formal Analysis, Validation, Writing - Review & Editing

Lyda Osorio
Roles: Formal Analysis, Validation, Writing - Review & Editing

Pablo Zapata
Roles: Software, Visualization, Writing - Review & Editing

Felipe Piquero Villegas
Roles: Resources, Writing - Review & Editing

Maria Beatriz Ospina
Roles: Conceptualization, Resources, Writing - Review & Editing

Carmen Juliana Villamizar
Roles: Conceptualization, Project Administration, Validation, Visualization, Writing - Review & Editing

OPEN PEER REVIEW

REVIEWER STATUS AWAITING PEER REVIEW

Abstract

This protocol proposes an approach to assessing the place of residence as a spatial determinant of health in cities where traffic congestion might impact health services accessibility. The study provides dynamic travel times presenting data in ways that help shape decisions and spur action by diverse stakeholders and sectors.

Equity assessments in geographical accessibility to health services typically rely on static metrics, such as distance or average travel times. This new approach uses dynamic spatial accessibility measures providing travel times from the place of residence to the health service with the shortest journey time. It will show the interplay between traffic congestion, accessibility, and health equity and should be used to inform urban and health services monitoring and planning.

Available digitised data enable efficient and accurate accessibility measurements for urban areas using publicly available sources and provide disaggregated sociodemographic information and an equity perspective.

Test cases are done for urgent and frequent care (i.e., repeated ambulatory care). Situational analyses will be done with cross-sectional urban assessments; estimated potential improvements will be made for one or two new services, and findings will inform recommendations and future studies.

This study will use visualisations and descriptive statistics to allow non-specialized stakeholders to understand the effects of accessibility on populations and health equity. This includes "time-to-destination" metrics or the proportion of the people that can reach a service by car within a given travel time threshold from the place of residence.

The study is part of the AMORE Collaborative Project, in which a diverse group of stakeholders seeks to address equity for accessibility to essential health services, including health service users and providers, authorities, and community members, including academia.

Keywords

Health services accessibility, City planning, Urban health, Health inequality monitoring, Spatial Analysis, Residence characteristics

Corresponding author: Luis Gabriel Cuervo Competing interests: LGC is contributing his time in his personal capacity and as part of his part-time doctoral studies. His contributions and reports do not necessarily reflect the policies or decisions of his employer, the Pan American Health Organization (PAHO/WHO). IQuartil SAS was commissioned to develop the backend and front end of the AMORE Platform and to host the platform. DCA was part of Team 33, where he led the team in developing the prototype of the AMORE Platform in coordination with the principal investigator. DCA is also a partner in IQuartil SAS and guided the company's technical support and coordination with the principal investigator. LFP worked with IQuartil SAS until March 2021.

Grant information: IQuartil SAS received consulting fees to support the development of the advanced prototype of the AMORE Platform. The prototype of the AMORE Platform was developed as part of a collaboration between the principal investigator and Team33 during the Data Science for All (DS4A) training. No grants have been secured to support this project that the principal investigator has financed. Subsequent developments of the AMORE platform have not been considered part of the objectives or reach of the AMORE project.

Cuervo LG, Jaramillo C, Cuervo D Copyright: © 2022 Cuervo LG How to cite: First published: 28 Nov 2022, Latest published: 28 Nov 2022, 11:1394 ( https://doi.org/10.12688/f1000research.127294.1) 11:1394 ( https://doi.org/10.12688/f1000research.127294.1) et al. Dynamic geographical accessibility assessments to improve health equity: protocol for a test case in Cali, Colombia [version 1; peer review: awaiting peer review]. F1000Research 2022, 11:1394 ( https://doi.org/10.12688/f1000research.127294.1) et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Introduction

Equitable accessibility is central to the United Nations Sustainable Development Goals and targets like universal health coverage and quality of care.1⁻5 A common definition of accessibility is the relative ease (travel time by car) by which a destination (health service) can be reached from a given location (residence).6⁻8 Equity assessments in geographical accessibility to health services typically rely on static metrics, such as distance or average travel times.9⁻11

Measuring equitable accessibility has several challenges. Accessibility studies assess distance or the shortest average travel time to the nearest facility; they seldom assess equity and are typically geared towards field experts. 12⁻14 These studies usually explore broad service categories without focusing on specific services people might need. They are lengthy, costly, and rarely address the dynamic temporospatial nature of accessibility, such as its links to traffic congestion. 6,15,16

Reliable data on equity of accessibility to urban health services has been elusive for most cities due to limitations in sampling techniques, extrapolations, and the use of complex methods to capture temporospatial variations associated with traffic congestion. Stakeholders, including urban and health service planners, have relied on indirect fixed assessments that fail to address the impact of traffic congestion on equity.6,9,15,17

These challenges were understandable because assessments were cumbersome and required detailed origin-destination studies with small samples from home surveys, traffic corridor speed cameras, or extrapolations from average traffic in selected corridors, with limited intersectoral and multistakeholder participation.6,16,18⁻26 Results would turn irrelevant given the rapid changes in conditions, including traffic congestion, populations, or infrastructure.27

Travel times affect geographic accessibility and the quality of care.1,28,29 Poor accessibility can lead the most socially disadvantaged populations to pay the highest share to reach health services, an aberration of social justice known as the "inverse care law." Lengthy travel times hurt people; they are detrimental to health, well-being, and family finances.28,30⁻35 Measuring travel times might reveal problems hiding in plain sight. Addressing accessibility might help people unable to choose a better place of residence overcome structural barriers to health.36

Travel time assessments have been widely available for commodities and commerce and powered consumer apps. These developments have yet to translate into a systematic integration of dynamic equity assessments into urban and health services planning or public sector debates about land use and how to put health services within reach of the broadest population possible.

Measurements have proven difficult, and this project explores a new approach to making measurements feasible, scalable, and adaptable to urban sprawl and lengthening journeys. This new line of research explores if market forces and land use plans achieve service accessibility and if this holds for populations in situations of vulnerability.9,12,29

The need for this study

This proposal spurs the scaling up and replicating of accessibility analyses to health services in urban centers while promoting accessibility indicators based on dynamic travel times. The research demystifies the use of big data and analytics that reveal the needs of citizens, including the most vulnerable.37⁻42 The project will lay the basis for subsequent studies that assess the value and use of dynamic accessibility and equity assessments in urban and health services planning.

This project explores a new approach to making such measurements feasible, scalable, and adaptable to urban sprawl and long journeys. This new line of research examines whether market forces and land use planning achieve services' accessibility and if this holds for populations in situations of vulnerability.29,43

Using reliable data that is systematically updated and publicly available could be a game-changer.6,37,44,45 This study tests a new approach for assessing dynamic accessibility to health services, providing an equity perspective and using digital data sources. 9,44,46

Using data readily available in the public domain allows these assessments to be completed in a shorter time and with a lower budget. When combined, the growing millions of measurements of travel times (big data) passively collected by mobile apps, the digitalized georeferenced sociodemographic data from the census, and the geolocation of health services, provide a dynamic assessment of accessibility that accounts for temporospatial variations related to traffic congestion.6,46,47 Big data provides millions of measurements that allow identifying unexpected correlations with a level of detail and accuracy that surveys and inferences cannot match.45

This study aims to overcome the limitations of regular accessibility assessments by prioritizing dynamic travel times and adopting recommended knowledge production and use practices. The following section details some key features and good practices that contribute to addressing present challenges:

* Multistakeholder engagement: a diverse intersectoral team of stakeholders contributes to the AMORE Project throughout the research process, and their inputs also informed the AMORE Platform conceptualization and development.48⁻51 Contributors to the AMORE Project Collaborative Group represent the government, community, health service providers, and end users (consumers) who may directly or indirectly shape decisions, policies, plans, and programs.48,52⁻54,55

* Measurement of dynamic travel times using "time to destination" is a universal and comparable metric used by urban dwellers and users of navigation and travel apps.44

* Digitization and datafication by using anonymized publicly available georeferenced data of housing, people, and services, including disaggregated sociodemographic characteristics.6,27,37

* Using analytics and modelling to obtain reasonable estimates and maintain efficiencies and affordability while still delivering valid and reliable forecasts.

* Disaggregating sociodemographic data to deliver an equity analysis of accessibility.56⁻58

* Scalability and replicability using sources increasingly available to low- medium, and high-income settings. The approach can be scaled, adapted, and replicated to other locations, transportation means, services, or sectors.

Subsequent research will explore if revealing territorial inequities in urban and health services planning could catalyze intersectoral responses.30,59⁻63 Intersectoral collaborations rarely occur naturally and are challenged by the lack of consensus on issues and metrics. Using metrics and methods that all parties understand and facilitate direct communication could contribute to intersectoral action; assessing this will require additional research and is the subject of a separate proposal.9,60,64⁻68

Objectives

General objective

To assess dynamic accessibility assessments for selected healthcare services in urban Cali, Colombia, and predict the maximum improvements possible if new services were added.

Specific objectives

* To assess the temporospatial characteristics of equity and accessibility to hemodialysis, radiation therapy (radiotherapy), and tertiary care emergency services when traveling by car in urban Cali, Colombia.

* To provide dynamic assessments based on selected (arbitrary) travel time thresholds.

* To assess if populations in a situation of vulnerability needing hemodialysis, radiotherapy, and tertiary care emergency services will likely incur longer journeys when traveling by car in urban Cali, Colombia.

* To identify common variations of dynamic accessibility at two moments of the COVID-19 pandemic from an equity perspective.

* Assess the magnitude of absolute and relative accessibility variations attributed to traffic congestion.

* To estimate potential improvement for accessibility gained by expanding services.

Box 1 provides a plain language summary of the project. The Extended data contains the goals of the AMORE project and previous versions of the protocol.69,70,71

What is already known on this topic - dynamic travel times are not available for most cities, including Cali, and are not integrated into urban and health service planning; dynamic geospatial analyses reveal the effects of traffic congestion on health equity and accessibility to health services, a determinant of health.

What this study adds - it will provide estimates of accessibility with an equity perspective using simple methods and metrics that concerned stakeholders might find familiar. This will test if dynamic accessibility assessments can be done with existing data. The study adds an approach to analyzing dynamic geographic accessibility by tapping into hundreds of thousands or millions of observations to analyze, predict, improve geographic accessibility to health services, and identify new correlations.

How this study might affect research, practice, or policy - This study will provide a new metric and data source to address inequities aggravated by poor accessibility offering new perspectives on land use and the expansion of health services. The study prioritizes travel times over distance, accounting for the temporospatial variations caused by traffic congestion. Subsequent examinations can explore stakeholders' valuing of the data and their communication of the methods and findings with peers and counterparts.

Protocol

Ethics

This health services quality improvement protocol will use anonymized coded secondary data sources from publicly available open records and will not include human subjects' research.

This cross-sectional study will use a research design of GIS modelling applied to case studies based on analyses of publicly available secondary data. This study will conduct paired cross-sectional assessments comparing equity in health services accessibility from the 6 th to the 12 th of July 2020 and from the 23 rd to the 29 th of November 2020.

Context and study population

The study will be a proof-of-concept for implementation in Cali (estimated 2,258 million in 2020), the third largest and most populous city in Colombia and the dominant urban center of Colombia's southwest and pacific regions (approx. 564 km ²). The study includes the entire urban population. Nearly half of Cali's population lives in low-income housing, 41% in medium income, and 9% in high-income housing. About 84% of the population identifies as white descent, and 14% identify as afro-descendent, with a small proportion identifying as Indigenous or Rrom.78⁻80

In preparatory dialogues with contributors, we learned about plans to transform Cali into a Special District with its twenty-two communes converted into six to eight minor districts to be led by minor district mayors.85 This new political and administrative layout might raise interest in this topic as new authorities might want to discuss accessibility and equity issues with their constituents and in power-brokering negotiations, noting the equity implications of the concentration of health services in a few sectors of the city.

Data sources

The study will use anonymized, aggregated data from the following data sources:

* Microdata of Colombia's National Census for Cali 2018 will be downloaded from the official public website of the National Department of Statistics- DANE.86 This will provide sociodemographic data of the populations at the block level for the entire city. The census population had a 28.1% adjustment estimated for 2020 to account for intercensal growth, under-registration, and migration.78,79,81,87

* The city's transportation analysis areas (TAZ) and census administrative sectorization for urban Cali will be obtained from the IDESC portal.88 This data allows linking TAZs with city blocks. TAZs are adequate to estimate travel times and less detailed than blocks, thus reducing the number of travel time measurements and adding anonymity to the population.

* Approved health services relevant to the chosen scenarios, will be obtained from the National Special Registry of health services providers - REPS from the Ministry of Health and Social Protection. The services geolocation will be verified with Google Maps. Approved services were checked in June and October 2020 and January 2021, finding they remained unchanged. This protocol will assess accessibility to the entire city's fourteen tertiary care hospitals with emergency services (REPS Code "Alta complejidad" + 501); eleven hemodialysis units totaling 370 chairs (REPS code 733); five radiotherapy services (REPS code 711).

* Google's Distance Matrix API provides big data measurements of travel times from the origin (TAZ for the residence) to the destination (TAZ of the health service). It allows the identification of travel time changes during the assessed weeks.

Data integration: The AMORE Platform

Secondary data will be integrated into the AMORE Platform, a web-based digital platform developed with inputs and feedback from stakeholders and piloted by the AMORE Project.89⁻91 The Platform is hosted by IQuartil SAS. See https://www.iquartil.net/proyectoAMORE.

Figure 1, Figure 2, and Figure 3 display examples of the AMORE Platform's interface or "front-end" panels (presentation layers) with its zoomable choropleth maps and graphics that integrate multiple layers of data. Filters activated by tapping on the graphs act on sociodemographic variables, travel times, and health services to offer a descriptive analysis. The front-end has been developed with Microsoft's Power BI™ (v. 2.102.683.0). The back end (data access layer) is written in Python (v. 3.9.10)™ open-source software from the Python Software Foundation - PSF and in the Konstanz Information Miner - KNIME (v 4.5.1), a free and open-source data analytics, reporting, and integration platform.

Study variables

Graphs will be used to present variations in accessibility as traffic congestion increases for different travel time intervals (e.g., 10-minute intervals vs. accessibility for each socioeconomic stratum), as shown in Figure 4. The contrast will be drawn between results obtained for July and November 2020. Reports will include the location(s) maximizing accessibility if one or two new services are added, contrasting predicted accessibility vs. measured accessibility for July and November 2020, and the recommended services locations. For an example, see Figure 3. All estimates in this test case use travel by car. Reports will include visualizations from the AMORE Platform, tables, and simple graphs with descriptive statistics.

Data analysis

Data and images for analyses will be obtained from the AMORE Platform and presented using descriptive statistics for absolute figures (people) and relative (percentage of population), as shown in Figure 2 and Figure 3.

The use of relatable and commonly used metrics (i.e., time to destination), descriptive statistics (percentage of a population that can reach the services within a travel time threshold), visualizations, and simple graphs (e.g., Figure 2, Figure 3, Figure 4) and maps (e.g., Figure 1) are chosen to allow non-specialized stakeholders to understand the effects of accessibility on populations and health equity.

The study will deliver (1) situational analyses of accessibility to a selection of urgent or frequent health care services scenarios in urban Cali, Colombia, and (2) predictions of potential improvements to the accessibility of adding services under changing assumptions.

Arbitrary travel-time points will be used (15 minutes for urgent care; 20 minutes for frequent care services); we found no standards for travel time thresholds.

The situational analyses of accessibility will consider the following study scenarios:

1. Urgent care, assessing travel times to the health emergency department with the shortest journey by car, among the 14 hospitals with tertiary care emergency departments.

2. Frequent care, assessing travel times to ambulatory services that require regular use. The analyses will investigate the shortest journey to five radiation therapy services and eleven hemodialysis units.

For these case studies, the project will deliver a:

* Situational analysis uses descriptive and diagnostic analytics to assess accessibility under traffic conditions. Choropleth maps mark the boundaries of travel times Figure 1. The blocks building the map represent Traffic Analysis Zones (TAZ), and their height in the 3D choropleth map represents population density. By pointing to a TAZ, identification, population, and travel time to the nearest facility are displayed, and the sociodemographic characteristics of the people are presented in a dashboard ( Figure 2). The dashboard also includes a choropleth map with the density of the population being analyzed.

Optimization analysis using predictive and prescriptive analytics for modelling. Using heuristic techniques, the research will predict accessibility with different service schedules or when adding up to two new services in locations that maximize accessibility. Case studies will focus on hemodialysis and radiotherapy, which are used to treat high-cost conditions and must be accessed repeatedly for prolonged periods. For example, hemodialysis usually requires 3-5 weekly sessions, and radiotherapy may require daily sessions for weeks. Predicted accessibility with new services will be compared with measured accessibility ( Figure 3).

Preparation for the project

Beginning on 12 th June 12 2020, interviews were conducted with key informants, local authorities, and experts to inform the project, assess feasibility, and develop a protocol. They provided verbal consent to participate. These interviews offered contextual insights and ideas for the AMORE Platform to address the needs of data users and stakeholders. Discussions helped identify contributors and provided valuable contextual information. They also revealed how stakeholders approached health equity and accessibility and the relationship to urban and health services planning and land use. Stakeholders offered insights into the elements and processes of urban and health services planning, public policy, and advocacy.

Interviewees included:

* Members of the SIGELO Project on vulnerability, accessibility, and logistics in the context of the COVID-19 pandemic, Universidad del Valle

* Health equity and public health experts at the Bruyère Institute, University of Ottawa

* Contributors to Cali's Administrative Department of Municipal Planning (DAPM)

* Advisors and staff working with Cali's local government, including the secretariats of Health, Mobility, Urban planning, and Emergency response and preparedness.

* Data Science for All Team33 and IQuartil SAS analysts.

* Former local government and education authorities

* Urban observatories, urbanists, and networks on urbanism, mobility, and public health.

* Innovators and advisors working with health services and systems

* Service providers, including managers and science advisors

* Health services and accessibility data users

* Doctoral and professional networks

* Designers, graphic and science communications professionals, and artists

* Researchers and research sponsors.

Overall, 28 meetings were held with key informants and stakeholders between July 2020 and March 2022, when the advanced prototype of the AMORE Platform was completed. Like every doctoral thesis, this project is subject of yearly follow-up reviews by the Commission of the Doctoral Program on Research Methodology for Biomedical Research and Public Health of the Universitat Autònoma de Barcelona, since October 2020.

During the preparatory phase, the project was also debated in international fora such as the Global Health Learning Network of the University of Ottawa, The 4 th Urban Forum "Lima Cómo Vamos," the CEDEUS-REDEUSLAC II International Symposium of Doctoral Candidates on Urban Development and Sustainability for Latin America, and the Caribbean (Chile), and with urban observatories (Cali, Bucaramanga).89,98,99

These interviews shaped the AMORE project and platform. The objectives and platform were discussed from a theoretical perspective. Once the prototypes of the AMORE Platform became available, tests and demonstrations were made as part of the validation.

Data downloads and sources were stored in a dedicated repository using CSV formats to adhere to data sharing and reuse good practices. They will be made public with the publication of relevant research reports. Similarly, the AMORE Platform hosted by IQuartil SAS is made accessible with the completion of non-disclosure agreements. We expect to make platform sections publicly available as relevant results are published.100

Fidelity/adaptation

The fidelity of the AMORE Platform is based on data validation and verification exercises, comparing the findings from the AMORE Platform using the two data downloads and the two development teams.

The results of the platform will likely be optimistic for several reasons. For example, people do not always travel to the service with the shortest journey for known (e.g., lack of coverage from the insurance in the institution) and unexpected reasons (familiarity, poor navigation aids, reputation). The potential for improved accessibility would be accurate if all people were entitled to access those services.

The census includes respondent-reported data that is subject to interpretation. For example, variables like disability and health status are self-reported, and the question is unspecific.

Respondents may not find a suitable response option. For example, ethnicity has no category for Caucasian or mestizo populations representing a substantial part of the population. People with mixed backgrounds may find no suitable option to represent them.

The census is still well suited for this study: the data has been digitized, and sociodemographic data are linked with the residential block. The place of residence is a common starting point for people undergoing hemodialysis or radiotherapy, children, the elderly, and those not engaged in formal employment.

Mobile phone data is impractical because it cannot be accurately tied to reliable sociodemographic data; coverage varies among the population and excludes those unregistered as users or without a phone. It also has technical limitations.101

Harms, risks, and ethical considerations

This observational study addresses the impact of mobility on health equity without researching human subjects and by integrating anonymized coded secondary data obtained from openly available records.

The study does not involve human subjects' research. The AMORE Platform and dynamic geospatial analyses expose social justice issues and potential solutions of benefit to society by enabling informed decisions relevant to policies, plans, and procedures for improving health equity. This data can also predict or monitor changes in urban accessibility. The data used is anonymized and publicly available. Under Colombian law, this component fits the definition of research without risk, as described in Resolution 008430-1993 of the Ministry of Health.108 This was corroborated on 25 th July 2022, by the Research Ethics Committee of the School of Engineering of the Universidad del Valle, which declared the project "without risk" per Colombian law (Ref: CEIFI 010-2022). The project was cleared on September 16, 2022 by the Commission on Ethics in Animal and Human Experimentation (CEEAH), and the Vice-Rector for Research, Universitat Autònoma de Barcelona (Ref: CEEAH-6100) on September 20, 2022.

The study can challenge current thinking with data and disrupt traditional approaches to land use and health services planning that may perpetuate pervasive inequalities that could fuel social strife and corruption.102⁻105,109⁻115

The ethical approach of this study follows the broader principles and considerations of public health ethics and health systems ethics; it generates population data valuable to address inequity and social injustice, is helpful for accountability and is relevant to intersectoral action.116,117 The need for further guidance on these issues remains a challenge for cross-sectoral collaboration. It is part of the ongoing discussions on stakeholder engagement in global health.73,117

Accessibility is a determinant of health on the supply side of health equity.119 Useful, valid equity assessments in accessibility matter to health systems and social justice. Having action-oriented data to challenge established thinking might contribute to various SDGs, such as improving good health and well-being (SDG 3), reducing inequalities (SDG10), having sustainable cities and communities (SDG11), improving infrastructure (SDG 9), and facilitating partnerships to achieve the SDGs (SDG17).3,48,52,60,116

There is a risk of errors in programming or labelling data; to control this risk, the validity of the data was tested, repeatedly reviewed, and found sensible by experts and local contributors. The chance that inaccuracies result from clustering traffic and times is low and is unlikely to change the overall picture the project analyzes.

The project reveals accessibility levels for populations and sectors of the city. It uses heuristic analysis to identify areas in which new services would significantly impact accessibility. These areas, like traffic conditions, may evolve. However, the data provided to inform decisions gives an overall idea of the locations that would optimize accessibility. It is unlikely that conditions and populations would change fast enough to make those broad estimations suddenly irrelevant. Regular updating of the AMORE Platform would allow for assessing these variations and would be the subject of further studies after this test case. Additional factors influence the use of a service, including insurance coverage entitlements. Exploring this would require different data layers and funding that exceeds the purpose and scope of the test case and would be a matter of subsequent implementation. There is an inherent risk of revealing social injustices or inequities that can lead to discomfort, alienation, or corrective action.

Dissemination, promotion, and implementation of findings

As part of the project, communication tools such as animations, infographics, videos, summaries, and logos were developed.

The research team seeks to publish its reports in open-access impactful journals and present them to diverse audiences, including observatories, networks, and intersectoral groups.

The planned reports include:

* Accessibility of health services for the urban population of Cali, 2020: urgent care and frequent care

* Predicted accessibility of health services for the urban population of Cali with the addition of health services in areas that would maximize accessibility (urgent care and frequent care scenarios) or changes in service schedules (frequent care)

* Editorials and methodological articles.

Protocol study status

Data extraction for research reports was initiated in January 2022 and is underway.

Data availability

Source data

The Data Sources section provides a list of publicly available data sources that will be used in this project. Relevant interfaces for each case study will be published with research results at https://www.iquartil.net/proyectoAMORE/.

Acknowledgments

The following people contributed to the brainstorming preceding the writing of the protocol and approved this acknowledgment: Peter Tugwell and Vivian Welch (Campbell Collaboration and Cochrane Equity Group); Myriam Rosero and María Fernanda Tobar Blandón (Universidad del Valle); Alberto Concha-Eastman (Senior Advisor to the Secretary of Public Health of Cali); David Paredes Zapata (Hospital Clinic, Transplant and Organ Donation Section, Barcelona, Spain); Fredy Enrique Ágredo Lemus (Ph.D. student in Health, Universidad del Valle and advisor to the Secretary of Health of Cali); Crhistian García (Grupo de Aseguramiento y Desarrollo de Servicios e la Secretaría de Salud de Cali); Fernando R. Martínez A. (Departamento Administrativo de Planeación Municipal); and María Fernanda Merino. As a tutor for the Doctoral program at the Universitat Autònoma de Barcelona, Dr Xavier Bonfill I Cosp has provided guidance with the academic program and reports. We are grateful to contributors working for the Escuela de Escuela de Salud Pública and the Departamento de Administración y Organizaciones of the Universidad del Valle, the Secretaría de Movilidad, and the Centro Regulador de Urgencias y Emergencias del Valle.

We thank artist Adriana Cabal Aulestia for authorizing Cali-themed paintings to illustrate the presentations and graphic designers Ingrid Faber and Carlos A. Faber for preparing the infographics. Ingrid Faber was commissioned to develop the logo and animation.

We acknowledge the contributions of the Team33/DS4A members to developing the prototype of the AMORE Platform: Catherine E. Cabrera, Daniel Cuervo, Darío Mogollón, Juan P. Morales, Santiago A. Tovar, Stephanie A. Rojas, Juan G. Betancourt, Rafael E. Ropero.

Stephen Volante and Cristina Cuervo provided editing assistance for early versions of the protocol.

An earlier version of this article can be found on SSRN (doi: http://dx.doi.org/10.2139/ssrn.4175407).

References

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38. Acosta A: Smart Cities & Inequidad: Forbes República Dominicana.2021 Jul 13 [cited 2021 Jul 17]; 82(julio-agosto 2021): 12. Reference Source

44. Śleszyński P, Olszewski P, Dybicz T, et al.: The ideal isochrone: Assessing the efficiency of transport systems. Res. Transp. Bus. Manag. 2022 Jan 19 [cited 2022 Jan 27]: 100779. Publisher Full Text Reference Source

51. Brown T Design Thinking. 2008.

99. Global Health Learning Network- Seminar on Digital app technology to assess equity: Spatial analysis and equity for health services:Ottawa; 2022 [cited 2022 Jan 22]. vol. 4. (Global Health Learning Network Seminar Series). Reference Source

105. Wilches Astudillo CA, Jaramillo C, Murillo-Hoyos J: Accesibilidad y equidad espacial al transporte público para pacientes con enfermedad neurodegenerativa en Santiago de Cali, Colombia. Investig Geográficas. 2021 May 13 [cited 2021 Jun 4]. Publisher Full Text Reference Source

Author details Author details

¹ Department of Paediatrics, Obstetrics & Gynaecology and Preventative Medicine, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
² School of Civil and Geomatic Engineering, Universidad del Valle, Cali, Valle del Cauca, Colombia
³ IQuartil SAS, Bogotá D.C., 110111-300, Colombia
⁴ Facultad Nacional de Salud Pública, Universidad de Antioquia, Medellín, Antioquia, Colombia
⁵ WHO Collaborating Centre for Knowledge Translation and Health Technology Assessment for Health Equity, Bruyère Research Institute, University of Ottawa, Ottawa, Ontario, K1R6M1, Canada
⁶ Universidad de la Sabana, Bogotá D.C., Colombia
⁷ Egis Consulting, Bogotá D.C., Colombia
⁸ School of Public Health, Universidad del Valle, Cali, Valle del Cauca, Colombia
⁹ Author of patobiography, Independent Patient Representative, Bogotá, D.C., Colombia
¹⁰ Department of Public Health Sciences, Faculty of Health Sciences, Queen's University, Kingston, ON, K7L 3N6, Canada
¹¹ Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA

Luis Gabriel Cuervo
Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Project Administration, Resources, Supervision, Validation, Visualization, Writing - Original Draft Preparation

Ciro Jaramillo
Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Supervision, Validation, Writing - Review & Editing

Daniel Cuervo
Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Resources, Software, Supervision, Validation, Visualization, Writing - Review & Editing

Eliana Martínez-Herrera
Roles: Formal Analysis, Investigation, Methodology, Supervision, Validation, Writing - Review & Editing

Janet Hatcher-Roberts
Roles: Formal Analysis, Resources, Validation, Writing - Review & Editing

Luis Fernando Pinilla
Roles: Formal Analysis, Investigation, Resources, Software, Validation, Visualization, Writing - Review & Editing

María Olga Bula
Roles: Formal Analysis, Validation, Writing - Review & Editing

Lyda Osorio
Roles: Formal Analysis, Validation, Writing - Review & Editing

Pablo Zapata
Roles: Software, Visualization, Writing - Review & Editing

Felipe Piquero Villegas
Roles: Resources, Writing - Review & Editing

Maria Beatriz Ospina
Roles: Conceptualization, Resources, Writing - Review & Editing

Carmen Juliana Villamizar
Roles: Conceptualization, Project Administration, Validation, Visualization, Writing - Review & Editing

Competing interests

LGC is contributing his time in his personal capacity and as part of his part-time doctoral studies. His contributions and reports do not necessarily reflect the policies or decisions of his employer, the Pan American Health Organization (PAHO/WHO). IQuartil SAS was commissioned to develop the backend and front end of the AMORE Platform and to host the platform. DCA was part of Team 33, where he led the team in developing the prototype of the AMORE Platform in coordination with the principal investigator. DCA is also a partner in IQuartil SAS and guided the company's technical support and coordination with the principal investigator. LFP worked with IQuartil SAS until March 2021.

Grant information

IQuartil SAS received consulting fees to support the development of the advanced prototype of the AMORE Platform. The prototype of the AMORE Platform was developed as part of a collaboration between the principal investigator and Team33 during the Data Science for All (DS4A) training. No grants have been secured to support this project that the principal investigator has financed. Subsequent developments of the AMORE platform have not been considered part of the objectives or reach of the AMORE project.

Copyright

© 2022 Cuervo LG et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Cuervo LG, Jaramillo C, Cuervo D et al. Dynamic geographical accessibility assessments to improve health equity: protocol for a test case in Cali, Colombia [version 1; peer review: awaiting peer review] F1000Research 2022, 11:1394 ( https://doi.org/10.12688/f1000research.127294.1)

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# data[].attributes.attachment_link.title
F1000Research Article: Dynamic geographical accessibility assessments to improve health equity: protocol for a test case in Cali, Colombia.

# data[].attributes.attachment_link.description
Cuervo LG, Jaramillo C, Cuervo D et al. Dynamic geographical accessibility assessments to improve health equity: protocol for a test case in Cali, Colombia [version 1; peer review: awaiting peer review]. F1000Research 2022, 11:1394 ( https://doi.org/10.12688/f1000research.127294.1) NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article.

# data[].attributes.headline
AMORE Platform - Accessibility to tertiary care emergency services 23-29 Nov 2020. 

# data[].attributes.subject
AMORE Platform - Accessibility to tertiary care emergency services 23-29 Nov 2020. 

# data[].attributes.body
https://tinyurl.com/AMORE-20201123-Situation. Data used for the Sept 1, 2022 publication in BMJ Open https://bmjopen.bmj.com/content/12/9/e062178

# data[].attributes.headline
Lima Cómo Vamos - Proyecto AMORE, noviembre 4, 2021.

# data[].attributes.subject
Lima Cómo Vamos - Proyecto AMORE, noviembre 4, 2021.

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Presentación Proyecto AMORE: Uso de Análisis Espacial Dinámico En Diálogos Con Actores Clave, Para Mejorar La Accesibilidad a Los Servicios de Salud de Uso Urgente o Frecuente, y Reducir Desigualdades.” Facebook Live presented at the Líma Cómo Vamos, Lima, Peru, November 4, 2021
YouTube: https://www.youtube.com/watch?v=J9avNPNa5os

# data[].attributes.body
Murillo-Hoyos J, García-Moreno LM, Tinjacá N, Jaramillo C. Mortalidad por lesiones de tránsito y desigualdades sociales en Colombia, 2019 [Deaths from traffic injuries and social inequality in Colombia, 2019 / Mortalidade por acidentes de trânsito e desigualdades sociais na Colômbia, 2019]. Rev Panam Salud Publica. 2023 Aug 31;47:e121. Spanish. doi: 10.26633/RPSP.2023.121. PMID: 37654795; PMCID: PMC10464641.

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doi: 10.26633/RPSP.2023.121.

Affiliations

¹ Escuela de Ingeniería Civil y Geomática Universidad del Valle Cali Colombia Escuela de Ingeniería Civil y Geomática. Universidad del Valle, Cali, Colombia.

² Organización Panamericana de la Salud Bogotá Colombia Organización Panamericana de la Salud. Bogotá, Colombia.

Free PMC article

Free PMC article

doi: 10.26633/RPSP.2023.121.

Affiliations

¹ Escuela de Ingeniería Civil y Geomática Universidad del Valle Cali Colombia Escuela de Ingeniería Civil y Geomática. Universidad del Valle, Cali, Colombia.

² Organización Panamericana de la Salud Bogotá Colombia Organización Panamericana de la Salud. Bogotá, Colombia.

Objective: To evaluate the association between social inequalities and deaths from traffic injuries in Colombia in 2019.

Methods: This ecological study evaluated the association between social inequalities and deaths from traffic injuries among users of the road transport system in Colombia in 2019, based on secondary information sources, using the department level as the administrative and geographic unit of study. A descriptive statistical analysis of health indicators and equity stratifiers was performed. Absolute and relative measures were used to determine social inequality gaps.

Results: In 2019, 6 580 people died from road traffic injuries in Colombia. The majority of them (82%) were men. The most critical user condition was being a motorcyclist. The age group with the most victims was approximately 30 years old. Departments with populations between 500 000 and 2 000 000 were the most represented. The most critical equity stratifier was the number of registered motorcycles per 100 000 population. Significant inequality gaps between departments were observed.

Conclusions: Inequalities in deaths from road traffic injuries in Colombia were observed. Policies and actions should focus on helping to reduce identified inequities, resulting in better quality of life, well-being, and health for the population.

Objetivo.: Evaluar la asociación entre las desigualdades sociales y la mortalidad por lesiones de tránsito en Colombia durante 2019.

Métodos.: En este estudio ecológico se evaluó la asociación entre las desigualdades sociales y la mortalidad por lesiones de tránsito de las personas usuarias del sistema de transporte terrestre carretero en Colombia durante 2019, con base en fuentes secundarias de información, a nivel de departamento como unidad administrativa y geográfica de estudio. Se hizo un análisis estadístico descriptivo tanto del indicador de salud como de los estratificadores de equidad y se utilizaron medidas absolutas y relativas para determinar las brechas de desigualdad social.

Resultados.: En 2019 murieron en Colombia 6 580 personas por lesiones de tránsito, la mayoría de las cuales (82%) eran hombres. La condición de usuario más crítica fue la de motociclista. El grupo etario con más víctimas tenía aproximadamente 30 años. Los departamentos con población entre 500 000 y 2 000 000 de habitantes tuvieron la más alta participación. El estratificador de equidad con la condición más crítica de desigualdad fue el número de motocicletas registradas por cada 100 000 habitantes. Se evidenciaron brechas de desigualdad importantes entre los departamentos.

Conclusiones.: Se reconocieron desigualdades de la mortalidad por lesiones de tránsito en Colombia. Se deben orientar políticas y actuaciones que contribuyan a la disminución de las inequidades identificadas, lo que redunda en la calidad de vida, bienestar y salud de los ciudadanos.

Objetivo: Avaliar a relação entre desigualdades sociais e mortalidade por acidentes de trânsito na Colômbia no ano de 2019.

Métodos: Este estudo ecológico avaliou a relação entre desigualdades sociais e mortalidade por acidentes de trânsito entre usuários do sistema de transporte rodoviário na Colômbia em 2019, com base em fontes secundárias de informação e departamentos como unidades administrativas e geográficas do estudo. Foi feita uma análise estatística descritiva do indicador de saúde e dos estratificadores de equidade, e foram utilizadas medidas absolutas e relativas para determinar as lacunas de desigualdade social.

Resultados: Em 2019, 6 580 pessoas morreram na Colômbia em decorrência de acidentes de trânsito, em sua maioria homens (82%). A categoria de usuário mais afetada foi a de motociclistas, e a faixa etária com o maior número de vítimas girava em torno dos 30 anos. Departamentos com população entre 500 mil e 2 milhões de habitantes tiveram a maior participação. O estratificador de equidade com a condição mais crítica de desigualdade foi o número de motocicletas registradas por 100 mil habitantes. Foram evidenciadas lacunas significativas de desigualdade entre os departamentos.

Conclusões: Foram reconhecidas desigualdades na mortalidade por acidentes de trânsito na Colômbia. É preciso implementar políticas e ações que contribuam para a redução das desigualdades identificadas, o que resultará em qualidade de vida, bem-estar e saúde para os cidadãos.

Keywords: Colombia; Socioeconomic factors; accidents, traffic; equity stratifiers; inequality, social; mortality.

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References

1. Busso M, Messina J. La crisis de la desigualdad: América Latina y el Caribe en la encrucijada. Washington, D.C.: Banco Interamericano de Desarrollo; 2020.

2. Busso M, Messina J. La crisis de la desigualdad: América Latina y el Caribe en la encrucijada. Washington D.C.: Banco Interamericano de Desarrollo; 2020.

1. Organización Panamericana de la Salud . Informe de juventud y siniestralidad vial. Colombia: Fondo de Población de las Naciones Unidas; 2021.

2. Organización Panamericana de la Salud. Informe de juventud y siniestralidad vial. Colombia: Fondo de Población de las Naciones Unidas; 2021.

1. Bloomberg Philanthropies; Global Road Safety Facility . The high toll of traffic injuries unacceptable and preventable. Washington, D.C.: The World Bank Group; 2017.

2. Bloomberg Philanthropies; Global Road Safety Facility. The high toll of traffic injuries unacceptable and preventable. Washington, D.C.: The World Bank Group; 2017.

1. Organización Panamericana de la Salud. OPS . Resumen: panorama regional y perfiles de país. Washington, D.C.: OPS; 2017. Salud en las Américas+, edición del 2017.

2. Organización Panamericana de la Salud. OPS. Salud en las Américas+, edición del 2017. Resumen: panorama regional y perfiles de país. Washington, D.C.: OPS; 2017.

1. Organización Panamericana de la Salud . La seguridad vial en la Región de las Américas. Washington, D.C.: OPS; 2016.

2. Organización Panamericana de la Salud. La seguridad vial en la Región de las Américas. Washington, D.C.: OPS; 2016. - PMC - PubMed

Grants and funding

Este estudio recibió apoyo financiero de la representación de la Organización Panamericana de la Salud en Colombia.

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national center for biotechnology information

# data[].attributes.attachment_link.title
[Deaths from traffic injuries and social inequality in Colombia, 2019Mortalidade por acidentes de trânsito e desigualdades sociais na Colômbia, 2019] - PubMed

# data[].attributes.attachment_link.description
Inequalities in deaths from road traffic injuries in Colombia were observed. Policies and actions should focus on helping to reduce identified inequities, resulting in better quality of life, well-being, and health for the population.

# data[].attributes.headline
Impact of traffic build-up on accessibility to tertiary care emergency services in Cali, Colombia, 6 - 12 July 2020

# data[].attributes.subject
Impact of traffic build-up on accessibility to tertiary care emergency services in Cali, Colombia, 6 - 12 July 2020

# data[].attributes.body
Shows how traffic congestion restricts accessibility, especially for people in outlying areas of the city

# data[].attributes.attachment_link.title
Impact of traffic build-up on accessibility to tertiary care emergency services in Cali, Colombia, 6 - 12 July 2020.

# data[].attributes.attachment_link.description
This animation shows the effects of traffic congestion build-up on accessibility to tertiary care emergency services. Measurement of dynamic accessibility for Cali, Colombia, 6-12 July 2020.

# data[].attributes.body
“AMORE Project: Integrated Knowledge Translation and Geospatial Analysis to Improve Travel Times to Health Services (Accessibility) and Health Equity in Cali, Colombia: A Proof of Concept Using Mixed-Methods Research.” Preprint. Thesis Commons, November 19, 2021. https://doi.org/10.31237/osf.io/4atqc

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CUERVO, L., MD, MSc, SFM, Cuervo, D., Hatcher-Roberts, J., Herrera, E. M., Pinilla, L. F., Piquero, F., ... Molina, C. J. (2021, November 19). AMORE Project: Integrated knowledge translation and geospatial analysis to improve travel times to health services (accessibility) and health equity in Cali, Colombia: a proof of concept using mixed-methods research. https://doi.org/10.31237/osf.io/4atqc

CUERVO, Luis Gabriel, MD, MSc, SFM, et al. "AMORE Project: Integrated Knowledge Translation and Geospatial Analysis to Improve Travel Times to Health Services (accessibility) and Health Equity in Cali, Colombia: A Proof of Concept Using Mixed-methods Research." Thesis Commons, 19 Nov. 2021. Web.

CUERVO, Luis Gabriel, MD, MSc, SFM, Daniel Cuervo, Janet Hatcher-Roberts, Eliana M. Herrera, Luis F. Pinilla, Felipe Piquero, Maria Ospina, et al. 2021. "AMORE Project: Integrated Knowledge Translation and Geospatial Analysis to Improve Travel Times to Health Services (accessibility) and Health Equity in Cali, Colombia: A Proof of Concept Using Mixed-methods Research." Thesis Commons. November 19. doi:10.31237/osf.io/4atqc.
Get more citations

# data[].attributes.attachment_link.title
AMORE Project: Integrated knowledge translation and geospatial analysis to improve travel times to health services (accessibility) and health equity in Cali, Colombia: a proof of concept using mixed-methods research

# data[].attributes.attachment_link.description
Addressing accessibility to health services requires intersectoral multi-stakeholder action. There is not a lot of knowledge about the effects of traffic congestion on accessibility. The availability of new data allows putting forward simple metrics that all stakeholders can manage. This proof-of-concept reveals accessibility using a platform with intuitive heatmaps/choropleths, dials, and graphs.

# data[].attributes.wish_content.attachment_props.text
📣 @lgcuervoamore: "La #analítica permite evidenciar los #problemas de #cobertura de #salud que existe en la ciudad de #Cali, pero también inicia el cuestionamiento para poder plantear #soluciones al respecto"

🔴 4to foro #CiudadesCómoVamos #EnVivo

# data[].attributes.wish_content.attachment_props.original_text
📣 @lgcuervoamore: "La #analítica permite evidenciar los #problemas de #cobertura de #salud que existe en la ciudad de #Cali, pero también inicia el cuestionamiento para poder plantear #soluciones al respecto"

🔴 4to foro #CiudadesCómoVamos #EnVivo https://t.co/rpHEMIinht

# data[].attributes.wish_content.attachment_props.referenced_tweets[].text
@lgcuervoamore @maralegre @OcupaTuCalle @jjaimemiranda 📣 @lgcuervoamore: "La #duración de los viajes hacia equipamientos de #salud es un punto importante a considerar cuando estos son realizados por personas que siguen tratamientos como #hemodiálisis, #quimioterapia o #radioterapia"

💻  Ingresa a: https://t.co/a4aV8SBRBB https://t.co/JmP3O7XHdy

# data[].attributes.attachment_link.embed_code
📣 @lgcuervoamore: "La #analítica permite evidenciar los #problemas de #cobertura de #salud que existe en la ciudad de #Cali, pero también inicia el cuestionamiento para poder plantear #soluciones al respecto"

🔴 4to foro #CiudadesCómoVamos #EnVivo pic.twitter.com/rpHEMIinht
— Lima Cómo Vamos (@limacomovamos) November 5, 2021

# data[].attributes.attachment_link.metadata.attachment_props_source.data.text
📣 @lgcuervoamore: "La #analítica permite evidenciar los #problemas de #cobertura de #salud que existe en la ciudad de #Cali, pero también inicia el cuestionamiento para poder plantear #soluciones al respecto"

🔴 4to foro #CiudadesCómoVamos #EnVivo https://t.co/rpHEMIinht

# data[].attributes.attachment_link.metadata.attachment_props_source.includes.tweets[].text
@lgcuervoamore @maralegre @OcupaTuCalle @jjaimemiranda 📣 @lgcuervoamore: "La #duración de los viajes hacia equipamientos de #salud es un punto importante a considerar cuando estos son realizados por personas que siguen tratamientos como #hemodiálisis, #quimioterapia o #radioterapia"

💻  Ingresa a: https://t.co/a4aV8SBRBB https://t.co/JmP3O7XHdy

# data[].attributes.attachment_link.metadata.attachment_props.original_text
📣 @lgcuervoamore: "La #analítica permite evidenciar los #problemas de #cobertura de #salud que existe en la ciudad de #Cali, pero también inicia el cuestionamiento para poder plantear #soluciones al respecto"

🔴 4to foro #CiudadesCómoVamos #EnVivo https://t.co/rpHEMIinht

# data[].attributes.attachment_link.metadata.attachment_props.text
📣 @lgcuervoamore: "La #analítica permite evidenciar los #problemas de #cobertura de #salud que existe en la ciudad de #Cali, pero también inicia el cuestionamiento para poder plantear #soluciones al respecto"

🔴 4to foro #CiudadesCómoVamos #EnVivo

# data[].attributes.attachment_link.metadata.attachment_props.referenced_tweets[].text
@lgcuervoamore @maralegre @OcupaTuCalle @jjaimemiranda 📣 @lgcuervoamore: "La #duración de los viajes hacia equipamientos de #salud es un punto importante a considerar cuando estos son realizados por personas que siguen tratamientos como #hemodiálisis, #quimioterapia o #radioterapia"

💻  Ingresa a: https://t.co/a4aV8SBRBB https://t.co/JmP3O7XHdy

# data[].attributes.headline
Improving equity using dynamic geographic accessibility data for urban health services planning using existing data that accounts for traffic congestion

# data[].attributes.subject
Improving equity using dynamic geographic accessibility data for urban health services planning using existing data that accounts for traffic congestion

# data[].attributes.body
“Improving equity using dynamic geographic accessibility data for urban health services planning.” Gaceta Sanitaria 36, no. 6 (November 1, 2022): 497–99. https://doi.org/10.1016/j.gaceta.2022.05.001

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AMORE Platform - Accessibility to tertiary care emergency services, Cali, 6-12 July 2020

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AMORE Platform - Accessibility to tertiary care emergency services, Cali, 6-12 July 2020

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https://tinyurl.com/AMORE-20200706-Situation. Data from the platform was used for the Sept 1, 2022 publication in BMJ Open https://bmjopen.bmj.com/content/12/9/e062178

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Team 33, Cali Hospital Coverage. Ministerio de Tecnología y Comunicaciones de Colombia, Correlation One. Data Science for All. Grand Finale DS4A Colombia 2020.

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Team 33, Cali Hospital Coverage. Ministerio de Tecnología y Comunicaciones de Colombia, Correlation One. Data Science for All. Grand Finale DS4A Colombia 2020.

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Presentación de 10 minutos para los finalistas.
https://www.youtube.com/live/sdjJWz9BqiQ?feature=share&t=7363

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Open the link or scan the QR Code - Pinche el enlace o escanée el código

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List of contributors, authors, and project coordinators

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Miao, Y., Dai, T., & Song, J. (2023). Assessing the effects of the large‐scale road construction on the ethnic disparities of accessibility in Tibet from 2010 to 2020. Growth and Change, 54(3), 754-770. https://doi.org/10.1111/grow.12668

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Zotero collection of references for the AMORE Project

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Zotero is a free, easy-to-use tool to help you collect, organize, cite, and share research.

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@Proyecto_AMORE featured in https://t.co/GuJDRfPxHM 

#Digital #app technology to assess #equity: Spatial analysis and equity for health services @Sand_Orci & @lgcuervoamore invited by @uOttawa moderated by Janet Hatcher-Roberts, Global Health Learning Network @OttawaHub

# data[].attributes.wish_content.attachment_props.original_text
@Proyecto_AMORE featured in https://t.co/GuJDRfPxHM 

#Digital #app technology to assess #equity: Spatial analysis and equity for health services @Sand_Orci & @lgcuervoamore invited by @uOttawa moderated by Janet Hatcher-Roberts, Global Health Learning Network @OttawaHub https://t.co/0jD9ZJli7u

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@Proyecto_AMORE featured in https://t.co/GuJDRfPxHM #Digital #app technology to assess #equity: Spatial analysis and equity for health services @Sand_Orci & @lgcuervoamore invited by @uOttawa moderated by Janet Hatcher-Roberts, Global Health Learning Network @OttawaHub pic.twitter.com/0jD9ZJli7u
— Proyecto AMORE - AMORE Project (@Proyecto_AMORE) January 29, 2022

# data[].attributes.attachment_link.metadata.attachment_props_source.data.text
@Proyecto_AMORE featured in https://t.co/GuJDRfPxHM 

#Digital #app technology to assess #equity: Spatial analysis and equity for health services @Sand_Orci & @lgcuervoamore invited by @uOttawa moderated by Janet Hatcher-Roberts, Global Health Learning Network @OttawaHub https://t.co/0jD9ZJli7u

# data[].attributes.attachment_link.metadata.attachment_props.original_text
@Proyecto_AMORE featured in https://t.co/GuJDRfPxHM 

#Digital #app technology to assess #equity: Spatial analysis and equity for health services @Sand_Orci & @lgcuervoamore invited by @uOttawa moderated by Janet Hatcher-Roberts, Global Health Learning Network @OttawaHub https://t.co/0jD9ZJli7u

# data[].attributes.attachment_link.metadata.attachment_props.text
@Proyecto_AMORE featured in https://t.co/GuJDRfPxHM 

#Digital #app technology to assess #equity: Spatial analysis and equity for health services @Sand_Orci & @lgcuervoamore invited by @uOttawa moderated by Janet Hatcher-Roberts, Global Health Learning Network @OttawaHub

# data[].attributes.headline
Situational Analysis of Accessibility to Emergency Services in Cali, Colombia, 2020.

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Situational Analysis of Accessibility to Emergency Services in Cali, Colombia, 2020.

# data[].attributes.body
“Dynamic Accessibility by Car to Tertiary Care Emergency Services in Cali, Colombia, in 2020: Cross-Sectional Equity Analyses Using Travel-Time Big Data from a Google API.” BMJ Open 12, no. 9 (September 1, 2022): e062178. https://doi.org/10.1136/bmjopen-2022-062178.

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https://twitter.com/Proyecto_AMORE

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Tweets by Proyecto_AMORE