Analyzing the Spatial Accessibility of Public Healthcare Services in Djibouti

Abstract

Ensuring access to healthcare for all, regardless of demographic, geographic, or socio-economic status, is essential for achieving universal health coverage. In Sub-Saharan Africa, where populations are often dispersed and healthcare services are limited, reducing distances or travel time to healthcare facilities is crucial for ensuring equitable access. This study examines the geographical access to public health services in Djibouti, highlighting the inequality in the distribution of medical infrastructure, especially for rural populations. The primary objective is to analyze spatial disparities in accessibility to public health facilities, identifying the least-served districts and proposing solutions to reduce these inequalities. Using the enhanced two-step floating catchment area (E2SFCA) method, the research evaluates spatial access. Data collected from the Ministry of Health of Djibouti show a high concentration of health services in the city of Djibouti, where more than 50% of the population resides. In contrast, inland districts such as Galafi and Moussa Ali display limited access, with travel times often exceeding 60 minutes, indicating an inequitable distribution of tertiary care facilities. Strengthening healthcare infrastructure in inland districts and deploying innovative solutions like mobile clinics and telemedicine are essential to reducing access inequalities and ensuring more equitable universal health coverage in Djibouti. Future research should assess the effectiveness of these interventions in sustainably improving healthcare access in the most vulnerable areas.