Geo-spatial Analysis of Access to Healthcare in Rajpur

Rajpur, rural Nepal

Rajpur Rural Municipality is a municipality in southwestern Nepal with a population of about 28,000 spread out over an area of 577 square kilometers.

Slightly over half of the population lives in the narrow river plain, and the rest live in scattered settlements in the mountainous south.

There are no paved roads in most of the mountainous region - making it extremely difficult for transportation. The elderly, sick, and pregnant women are especially at risk in case of emergencies.

The map shows that a considerable number of settlements in the municipality are situated more than 35 km away from the main municipal hospital. Furthermore, it is noteworthy that these settlements predominantly reside on one side of the municipality. Considering this geographical concentration, it is evident that establishing a new birthing center in that particular area would be a strategic and practical step towards improving healthcare access and addressing the needs of the local population. Overall, these findings underscore the urgent need for additional resources, including human resources, infrastructure, and better transportation services, to overcome the geographical barriers.

Risky pregnancies

Women are disproportionately impacted by challenging terrain - even more so if they need to seek reproductive healthcare. Most maternal deaths occur in the post-partum period, right after birth - a sensitive time for the life of the pregnant woman and the newborn. Distance and lack of preparedness can be dangerous.

During the rainy season, access is further compromised by poor roads. In Rajpur, the areas with the highest distances to birthing centers are also the areas with the highest maternal deaths or unaddressed complications.

Program and Policy Design

Given these challenges, a couple of the interventions that may be useful are outlined below.

1. Outreach services are introduced that cater to those living in the remotest regions could be impactful. Specifically, targeting vulnerable groups like pregnant women and the elderly near their homes through mobile healthcare units may yield the most returns on investment.

Especially, since pregnant women can not walk up and down the road-less hills for hours to reach the health centers, it might be useful to conduct mobile rural ultrasound program with clinicians outreach to remote villages on certain days every month or two to provide obstetric ultrasound care.

2. Professional Community Health Workers can address healthcare awareness and access issues. They can not only provide basic testing and education but also act as facilitators for logistics, ensuring that individuals receive the care they need.