Geographic accessibility

Geographic accessibility is a little explored dimension of access to health care. Yet the WHO recommends that the spatial distribution of health services should be taken into account, as this factor has a direct impact on the speed with which patients can receive care in emergency situations, and therefore on the performance of health systems.
In this report, geographic accessibility is measured for maternity services across the Belgian territory.

Geographic accessibility of maternity services (A-16)

This indicator measures the percentage of women aged 15-49 years who live within a 30 minute drive or less to the nearest maternity service.
Distances are measured in travel time on the road network rather than in kilometres to be travelled, as this takes into account the density of the road network. This travel time is calculated by the Belgian National Geographic Institute (NGI – IGN). In total, the 104 Belgian maternity services have been geocoded according to their latitude and longitude. For each of these services, the NGI – IGN has determined 30-minute "isochrones", i.e. geographic areas from which a car can reach the service within 30 minutes on an average weekday with normal traffic conditions.

The choice of the upper 30-minute limit is arbitrary; it corresponds to the time used in other neighbouring countries, such as France, the Netherlands and England. The accessibility to maternity services has also been calculated for 15-minute and 45-minute limits (secondary indicators). The 15-minute limit can be used to estimate the actual accessibility with heavy traffic (it is assumed that distances that can be reached in 15 minutes in average weekday traffic take 30 minutes in heavy traffic). The 45-minute limit is often used in studies of emergency services.

Thanks to Statbel data on the population living on each km² of the territory (in 2016), it was then possible to calculate, for each maternity service, the number of women between 15 and 49 years old living in the isochrone of that maternity service.

For more details on the calculation of this indicator, see the KCE 323 report. 

Results

• More than 99% of women aged 15 to 49 can access one or more maternity services within 30 minutes under normal traffic conditions on an average weekday (100% in Brussels, 99.9% in Flanders and 99.5% in Wallonia). (Figure 1)
• When we take the 15-minute limit, this percentage is 92.3% (100% in Brussels, 94.4% in Flanders and 85.8% in Wallonia). However, this limit is only relevant for women living in large cities, where maternity services are also closer.
• Most of the women who cannot reach a maternity service within 30 minutes live near border areas and in the south of the country (it is quite likely that some of them give birth in the neighbouring country, but no information is available on this).
• The median number of maternity services accessible within 30 minutes in Belgium is 13 (14 for Flanders, 9 for Wallonia, 28 for Brussels). (see Table 1)

Link to the technical sheet and detailed results
Link to the KCE 323 report