Work

Examining healthcare inequality for non-communicable diseases in Malawi: a hierarchical geospatial modelling approach

Year: 2025

Type: article

Abstract: OBJECTIVES: The prevalence of non-communicable diseases (NCDs) is rising in low- and middle-income countries, including Malawi, yet spatial inequalities in NCD healthcare coverage remain poorly understood. In this research, we aim to: (1) develop a novel hierarchical geospatial framework to assess population coverage and accessibility of NCD services in Malawi and (2) identify underserved areas and provide evidence for targeted resource allocation. METHODS: Using 2019 Malawi Harmonized Health Facility Assessment Survey, hierarchical catchment areas were defined by facility type-primary healthcare (PHCs), district-level and central hospitals, with distance thresholds of 5 km walking, 25 km driving and 100 km driving, respectively. Incorporating facility readiness, we computed population coverage at the third administrative level. When estimating spatial accessibility, we used enhanced two-step floating catchment area, applying Gaussian distance decay for chronic conditions and inverse power for acute conditions. RESULTS: Secondary and tertiary facilities (STFs) covered over 60% of population, providing broader NCD service than PHCs, where coverage was lower than 20%, particularly for acute conditions. Population coverage was higher in central and southeastern Malawi, notably around Mzuzu, Lilongwe and Blantyre. However, at least 24% of the population were not covered for any NCD conditions. Additionally, only 11.9% of the population lived in regions of high or very high accessibility to PHCs. DISCUSSION: We found substantial geographic inequalities in NCD service coverage and access, highlighting underserved regions and the demand to strengthen PHC readiness. CONCLUSION: This hierarchical geospatial approach offers insights for resource allocation and improving healthcare equity in other low-resource settings.

Source: BMJ Health & Care Informatics

DOI: 10.1136/bmjhci-2025-101641