Humanosphere is on hiatus. Many thanks to our web design, development and hosting partner Culture Foundry for keeping the site active while we plan our next move. Culture Foundry builds, evolves and supports next-level websites and applications for clients you know, and you couldn’t ask for a better partner to help you thrive in digital. If you’re considering an ambitious website design or development project, we encourage you to make them your very first call.

Visualizing health care access, equity and bottlenecks across the world

A woman holds her child during an examination at a community clinic in northwestern Liberia. 2012 AP

By Amy VanderZanden, special to Humanosphere

In global health, it’s often difficult to answer questions like “what’s really affecting people’s ability to access health services?”

When people in rural Uganda or Kenya don’t get the care they need or want, for example, we don’t always know why. Is it because local health facilities don’t stock the medications, or have enough trained medical staff? Did patients have to wait too long for service – or do they think their local health facility isn’t clean or has the services they need, and so they don’t seek care in the first place?

This week could mark an advance in our ability to answer these questions, as the Institute for Health Metrics and Evaluation (IHME) has released a number of nationally representative datasets that – based upon thousands of variables – detail facility stocks of medicines, human resources for health, costs of care, and patient experiences at the facilities where they sought care.

Human resources for health: average composition of facility staff in Kenya, by facility type, 2011

ABCE image1 IHME

Source: Health Service Provision in Kenya: Assessing Facility Capacity, Costs of Care, and Patient Perspectives (IHME, 2014). Link to report.

In combination, these data will provide a much better understanding of health system performance in sub-Saharan Africa.

The Access, Bottlenecks, Costs, and Equity (ABCE) project, led by IHME and country collaborators in Ghana, Kenya, Uganda, and Zambia, is an example of the kind of comprehensive and detailed assessment that is vital to health policymaking and resource allocation – and which rarely occurs because health system functions worldwide are complex and multidimensional.

ABCE seeks to assess four major components that contribute to optimal delivery of health services: access – factors that improve or hinder contact with health facilities; bottlenecks, supply-side limitations that can prevent patients from receiving proper care at a health facility; costs across levels of health systems, from what a patient pays for care to what facilities pay to provide services; and equity, how factors affect access to and use of health services.

Patient reports of wait times at facilities in Uganda, by facility type, 2012

ABCE Image2 IHMESource: Health Service Provision in Uganda: Assessing Facility Capacity, Costs of Care, and Patient Perspectives (IHME, 2014). Link to report.

The project’s findings give us insights into granular, long-difficult-to-answer questions about how people interact with health systems. The breadth and depth of data now available are vast, but here we delve a little deeper into the patient experience.

Looking at patient ratings of health facilities in Uganda, we can gain a better understanding of how something like a long wait time might influence people’s overall views and experiences.

Average patient ratings of facility indicators in Uganda, by facility type, 2012

ABCE Image3 IHMESource: Health Service Provision in Uganda: Assessing Facility Capacity, Costs of Care, and Patient Perspectives (IHME, 2014). Link to report.

Average wait times at referral hospitals in Uganda in 2012 lingered above two hours for nearly half of patients; at private hospitals, most people had to wait less than an hour to be seen. Factored alongside ratings of staff respectfulness, center cleanliness, and other measures, private hospitals were among the most highly rated platforms for health care in the country, while referral hospitals were rated fairly average – and quite low for spaciousness and wait time.

Another question about patients’ experiences with health facilities is whether they provide the medications or supplies people want – such as vaccines, contraceptives, or equipment to test for diabetes or hypertension. In Uganda, as in many developing countries, the disease burden due to conditions like diabetes and high blood pressure is rising. Are facilities able to test patients for these conditions – and provide them with medications to control disease?

Facility capacity to provide disease-specific services in Uganda, by facility type, 2012


Source: Health Service Provision in Uganda: Assessing Facility Capacity, Costs of Care, and Patient Perspectives (IHME, 2014). Link to report.

In 2012 in Uganda, the answer depended a great deal on facility type. Patients at the majority of referral hospitals, the highest level of care, could in large part expect diabetes-specific services. The story was very different for patients at health centers around the country, where even a diagnosis of diabetes might be hard to come by.

The ABCE project helps us to understand gains or gaps in improving inequalities in human resources for health for urban and rural areas in low-income countries worldwide.

The data now available can give decision-makers the information they need to determine exactly what is or isn’t working for their countries’ health systems. As studies continue to be completed in additional countries, including Colombia and Bangladesh, they increasingly have the potential to help inform and improve health systems and policymaking worldwide.

To find out more, go to the full report or

Amy VanderZandenAmy VanderZanden is a communications data specialist at the University of Washington’s Institute for Health Metrics and Evaluation (IHME). 


About Author


Humanosphere will sometimes post articles from authors from around the globe. Although these folks are not regular contributors, we hope you enjoy this change of pace.