What are Medical Deserts?
“Medical deserts imply the inability of a given population (and / or a population group) to access health services, or the state of isolation when it comes to receiving health services, based on three categories of quantitative and qualitative barriers (‘dimensions’), which are interrelated and dependent on each other, in varying degrees and modalities.”
The severity of ‘desertification’ can be concluded on the values of the criteria/indicators in all three dimensions. The level of desertification can be said to be more serious if a) the values differ more from the benchmark values and b) all three dimensions of barriers are present.
Dimension 1: Physical access barriers
Physical access barriers can include:
- Limited number of primary health care personnel (such as general practitioners, pharmacies and pharmacists, community health centres and their staff), as indicated by density (number of medical staff per population or number of centres per population). Indicators for access should also account for the demographic composition of the population served by those health workers, based on the assumption that age determines to a great extent the need for health services. Indicators can then be compared to national standards or averages.
- Distance to primary healthcare facilities (general practitioners, pharmacies and pharmacists, community health centres) that are available.
- Average time to reach health facility, health service provider or emergency services.
Dimension 2: Social barriers
Social barriers arise from social constructions, including the acceptability of services to patients and affordability such as:
- High cost of health care (insurance costs, extra billing, informal payments, out-of-pocket expenditures, etc).
- Care not covered under the statutory package.
- Cultural sensitivity and context appropriateness of the care that is being offered.
Dimension 3: Policy barriers
These arise from policy level limitations, including inappropriate distribution of health services, health workers or facility’s inability to meet the needs of the population. These barriers can include but are not limited to:
- Lack of specialist personnel (or concentration of the specialist personnel in big cities).
- Lack of technology (or concentration of technology and providers of specialized medical care in the big cities).
- Lack of adequate training.
- Long waiting time for an appointment with specialist personnel.
Further development of the definition
The above definition will be validated and further developed through a series of research activities, including but not limited to: focus group discussions, stakeholder interviews, and consensus building sessions.