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Abstract  Typically, accessibility ratios have been calculated through a simple mathematical division of the number of people in an area by the number of facilities (or staff) in that area. This approach does not take into account the service area of the facility or its proximity to population centers, and is often performed using aggregate numbers for an administrative region. This paper describes an approach to calculating accessibility ratios such as population to facility ratios or population to staff ratios using Kernel density estimation (KDE) within a geographic information system. KDE disperses discrete phenomena across continuous space and is unrestrained by administrative boundaries. Therefore it provides a better representation of the spread of people and services across the landscape. Two types of accessibility ratios are calculated on a national level for Nicaragua: population-per-facility and population-per-staff; the merits of using KDE over traditional approaches are discussed. [ABSTRACT FROM AUTHOR]

Accurate knowledge of the characteristics of the health labour force that can affect health care production is of critical importance to health planners and policymakers. This study uses health facility survey data to examine characteristics of the primary health care labour force in Nicaragua, Tanzania and Bangladesh. The characteristics examined are those that are likely to affect service provision, including urban/rural distribution, demographic characteristics, and experience and in-service training, for three types of providers (physicians, nurses and auxiliary nurses). The profiles suggest a pattern of urban/rural imbalances in Nicaragua and Tanzania. The Bangladesh facility survey did not include hospitals, thereby making concrete conclusions on the supply and distribution of providers difficult to make. Multivariate logistic regressions are used to assess the relationship between the urban/rural placement of providers by health need, population demand and facility characteristics. Health need, as measured by child mortality rates, does not have a significant association with the placement of providers in either country, unlike population size and annual growth rates. The mean number of years providers have worked at a facility is significantly associated with a decreased likelihood of rural placement for the three types of providers in Nicaragua. The mean age and percentage of female providers at each facility has a negative association with the placement of rural providers in Tanzania. The use of health facility data to profile the health care labour force is also discussed. [ABSTRACT FROM AUTHOR]