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Chapter 22
An Assessment Study on Hierarchical
Integrity of Road Connectivity and Nodal
Accessibility of Maternal Health Care
Service Centres in Itahar Block, Uttar
Dinajpur District, West Bengal
Madhurima Sarkar , Tamal Basu Roy , and Ranjan Roy
Abstract Access and reachability to healthcare centre is an important issue for
lucrative delivery of health services to its recipient. The basic essence of emergency
service facility is to assess the degree of reachability through its connectedness
and accessibility. Better connectivity and accessibility would provide nodal services
with greater extent. The first and foremost objective of this study is to recognize the
spatial location of different health care service centres as a nodal service point with
its linkage perspective in Itahar block, Uttar Dinajpur District. The study has given its
emphasis on to recognize the relative location of maternal health care service centres,
its network alignment, connectivity, and accessibility. The study put its effort to high-
light the fact that only maternal health care services equipped with better quality is
not enough to give its optimum until and unless the better accessibility is achieved
through the said services to its recipient. The entire study involves in acquiring
and analysis of the spatial data such as discrete location of the maternal healthcare
centres, its weathered road connectivity, degree of reachability and to recognize the
spatial extent of its services for each and individual healthcare service centre. In this
regard the road network connectivity to each health care centre has been taken into
consideration. The entire analysis has been carried out through the geospatial anal-
ysis techniques. A matrix algebra technique, different algorithm regarding network
analysis, has been carried out to assess and evaluate the connectivity and accessibility
of maternal healthcare service centres in Itahar block.
Keyword Maternal ·Health ·Network ·Connectivity ·Accessibility
M. Sarkar ·T. B. Roy (B
)
Raiganj University, Raiganj, India
R. Roy
North Bengal University, Siliguri, India
© The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2022
N. C. Jana et al. (eds.), Livelihood Enhancement Through Agriculture,Tourism and Health,
Advances in Geographical and Environmental Sciences,
https://doi.org/10.1007/978-981- 16-7310- 8_22
439
440 M. Sarkar et al.
22.1 Introduction
Maternal healthcare service centre is an important and emergency service facility
which helps to care about and improve the health of maternal community and their
child (Navaneetham and Dharmalingam 2002). The desirable treatment received
from the said centres is inevitable to the maternal community during antenatal and
postnatal period (Johri et al. 2011; Ali et al. 2016). Procreation period of maternal
community should be supervised with stipulated protocol. Any kind of negligence
of taking the proper healthcare services may be fatal to the maternal community
and its foetus (Shapiro et al. 2018). In this regard the access to maternal health-
care centre plays crucial role in maintaining the health and hygiene of maternal
community (Mahajan and Sharma 2014). The equity of the services has a direct
impact on the quality of life of individual. Usually, the burden of disease related
to the maternal health during the pre- and post-partum period should be properly
monitored and managed. Accessibility is concerned with the degree of reachability
to a specific point. Indeed, it is determined by the connectedness of the said point
of services (Mahajan and Sharma 2014; Cascetta et al. 2013). Accessibility to the
healthcare centre is the ability of population to obtain specified set of health care
services and accessibility measure the size of the population affected by the trans-
port (Halden et al. 2000). Spatial accessibility to the maternal health centre is very
important task for health planner because without proper access to the health care
centre; it is not possible to deliver the better healthcare services to its people (Alake
2014). The matter of health of the mother is an emergency aspect, as most of the
health aspects is matched with the institutional delivery system and its antenatal
and postnatal complexities (Fekadu et al. 2018). The dissemination of healthcare
services and its demand depend on the distance and time taken between the location
of the individual and the health care centres (Wellay et al. 2018). In this regard the
road connectivity and its accessibility to each centre play the key role for deter-
mining the overall spatial accessibility to the recipient (Neutens 2015). However, the
proximity of individual is the key concern of the maternal healthcare service issue.
In this regard each and every individual health care centre should be better linked
with its neighbourhood. Health care facilities served from the different corner in any
region can be divided into three broad categories that is sub centre, primary health
care centre, and hospitals. Sub centre and primary healthcare services provide basic
healthcare services, and hospital provides services for specialist health treatment
as it is better equipped than the former. Health is one of the inevitable ingredient
parameters in developmental aspects of a region. However, it has been evolved with
better services with the passage of time. Nonetheless, the access of maternal health
services in rural areas of developing countries remains in poor condition because of
low availability of human resources (Iyengar et al. 2009). In India, the accessibility
to healthcare facilities is extremely limited in many rural parts and backward regions
(Saikia et al. 2014). The geographical location and the distribution of health service
centre, road network, status of connectivity and accessibility are the key component
in the utilization of maternal healthcare services (Otu 2018). Accessibility to the
22 An Assessment Study on Hierarchical Integrity … 441
healthcare is concerned with ability of the people to obtain certain set of health-
care services (Levesque et al. 2013). Thaddeus and Maine (1994) postulated three
delay models to establish the implication of importance of utilization of maternal
healthcare services (Thaddeus and Maine 1994). Maternal mortality and morbidity
remain a major problem in many developing countries like India (Ronsmans and
Collin 2008). Although there has been improvement in maternal mortality rate since
this issue was adopted by Union Nation of Millennium Development Goals (MDG)
in the year 2000, this is an important issue that needs to be monitored (Chatterjee
and Paily 2011). The well-being of mother is an important foundation of prospective
nation. The optimum distribution of health centres might be effective to deliver the
better healthcare services to the mothers. The regular visit to the centre may enhance
the awareness of the mother about their do’s and don’ts. Nowadays the proximity
the service and its poly nuclear and hierarchical character are getting popularised
in rural area. The traveling distance and time between location of maternal health
care centre and location of individual is playing the key role for determining the
better delivery of emergency services (Ghosh and Mistri 2016). Maternal health has
been becoming a global concern, because the lives of millions of women in repro-
ductive age can be saved through maternal health care services (Kifle et al. 2017). It
encloses the health care dimensions of family planning, preconception, prenatal, and
postnatal care in order to ensure a positive and make good experience and to reduce
maternal mortality and morbidity. Access to maternal healthcare service centre and
their connectivity measures the capacity of health system to reach the population
without excluding part of it and timely use of personal health services to achieve the
best health outcomes (Ghosh 2015). Ensuring a high degree of access to maternal
healthcare centre improves mother’s overall health status, extends life expectancy,
reduces health inequalities, and lessens Maternal Mortality Rate (MMR) and gives
the better health prospect for forthcoming generation.
22.2 Objectives of the Study
The broad objective of the study is to assess the role of road network and spatial
accessibility of maternal health care service centre in utilization of maternal health-
care services. In order to fulfil the above broad objective, the study has followed
some important essences as follows.
•To show the existing locational and distributional aspects of maternal health care
centres in the study area.
•To show the spatial connectivity and accessibility of maternal health care centre
within the study area.
•To determine the served area for each maternal health care centre and its functional
gaps.
442 M. Sarkar et al.
22.3 Database and Methodology
22.3.1 Study Setting and Data Sources
The entire work has been carried out under the ambit of geospatial technology, applied
GIS methods to analyse spatial accessibility to maternal health care centre. In this
regard the geo relational data model has been prepared. The discrete location of each
maternal health care centre is positioned spatially, and its geometric relationship
with weathered road network is conceptualised into topological map. The study is
based on information accrued from Google Earth, Block map, reports from CMOH
(Chief Medical Officer of Health) office of Uttar Dinajpur district, population census
(2011), data from Itahar Rural Hospital, and primary healthcare centres. With the
help of GPS, location of health centre has been identified.
22.3.2 Study Tool
Several datasets in non-digital format were collected and transformed into digital
format and processed through ArcGIS and QGIS software. The ArcGIS program
(version 10.4) was used to prepare the map of accessibility and proximity to the
maternal health facility. QGIS program (version 3.4.4) was used to construct road
network, spatial distribution of maternal health centre, and various connectivity
measurements.
22.4 Methods
The road network map of Itahar block was created with the help of Google Earth
which describes the pattern of road network, road length, etc. and enables to under-
stand the spread of the road network over the study area. The location of health centre
has been identified with the help of GPS and overlaid with the road network in QGIS
platform to examine the relationship between the location of maternal health centres
and road network. The threshold pressure of each maternal health care centre has been
computed through ratio measurement at GP level. In order to accomplish the study
about the degree of connectivity, the major important connectivity indices devised
by Hanson and Kansky has been applied in the study which has its own applicable
meaning in the domain of transport geography. Cyclometric number (μ), Alpha Index
(α), Beta Index (β), Gamma Index (γ), and Eta Index (η) are the most fundamental
properties of a network system. Cyclometric number defines number of circuits in
the network, a high value of cyclometric number indicates highly connected network.
Alpha Index is one of the significant measures of connectivity of a network which
is adjusted from cyclometric number. It is the ratio between observed numbers of
22 An Assessment Study on Hierarchical Integrity … 443
circuit to the maximum number of circuits in the network system. The alpha index
value ranges between 0 and 1, and this measure may be written in percentage, thus it
ranges from 0 to 100. The value of 100% will be considered as completely connected
network. Beta Index is expressed by the relationship between numbers of link over
the number of nodes. β< 1 indicates simple or tree type network structure, β=1
indicates a connected network with one circuit and β> 1 denotes a complex network
with more than one circuit. Gamma Index measures connectivity that varies from a
set of nodes having no linkage to the one in which each node has an edge linked
with other nodes in the graph. It also ranges from 0 to 1, or it may be written in the
form of percentage. Eta Index is the ratio between total network distance and number
of arcs, and it is very useful in examining shape and utility of a transport network
system. In Eta index, block wise road distance is measured in kilometres and divided
it by the observed number of edges. All the values of these measures have been
transformed into standardized score. Composite Connectivity Score (CCS) has been
calculated subsequently by adding respective Z score values of cyclometric number,
alpha, beta, gamma, and eta index. Detour Index (DI) is measured with the help of
actual route distance and straight-line distance, and the resultant ratio is converted
into percentage. In this study detour value is calculated in respect of distances from all
sub health centre and primary health centre to rural hospital to know the efficiency of
the transport network or how well it overcomes the distance or the friction of distance.
Increasing the value of detour indicates reducing accessibility from the rural hospital.
Additionally, the low detour value signifies high accessibility and lesser degree of
surface friction and vice versa. Here assuming the index in 100, 130, and 160%, and
based on three isolines the entire resultant values are interpolated as <100 is high
accessible zone, 100–130 and 130–160 is moderate accessible zone, and >160 is low
accessible zone. Shimbel Index calculates minimum number of paths necessary to
connect one node with all the nodes in a specific network system. It is not necessary
to measure total number of paths between two health centres or between sub centre
and household, but rather what are the shortest paths between them is necessary.
Shimbel index is calculated with the different sub health care service centres and
primary health care centres to rural hospital (hierarchically apex body in the study
area in respect of maternal health care services) which is located at major junction
point of the study area. Shimbel index evaluates accessibility from rural hospital to
all the sub health centre and primary health care centre. The entire methods adopted
in the study has been briefly devised as (Rodrigue et al. 2019)
µ=(e−v+p),(22.1)
where
e is the total number of edges.
V is the total number of vertices.
P is the number of non-connected subgraphs.
α=(e−v+p)/2v −5,(22.2)
444 M. Sarkar et al.
where
v is the number of edges.
β=E/V (22.3)
where
E is the total number of edges.
V is the total number of vertices in the network.
γ=e/3(v−2),(22.4)
where
e is the number of edges.
v is the number of vertices in the network.
η=M/E,(22.5)
where
M is the total network length in kms.
E is the observed number of edges.
DI =D(S)/D(T),(22.6)
where
D(S) is the straight distance.
D(T) is the actual distance.
Ai=
N
j=1
dij,(22.7)
where
Aiis the Shimbel Index.
dij is the shortest path between i node to j node.
To identify the closeness of the maternal health centre multi buffer ring method
has been applied. For this application ArcGIS spatial analyst tool has been used to
calculate distances around the health centres.
22 An Assessment Study on Hierarchical Integrity … 445
22.5 Study Area
The study is carried out in Itahar community development block of Raiganj subdi-
vision under the Uttar Dinajpur district in the Indian state of West Bengal. Itahar
CD Block is bounded by Kaliyaganj and Raiganj CD Blocks on the north, Dakshin
Dinajpur district, Harirampur CD Block on the east, Malda district on the south and
Bihar on the west. This block consists of 12 Gram Panchayat (GP). Total population
of Itahar CB block is 303,678 of which 155,777 are male and 147,901 are female
(census 2011). The literacy rate of this block is 58.95%. The proportion of Muslim
community is higher in this region that is 51.98%, followed by Hindu (47.43%) and
Christian (0.43%). 42 sub health centres, 3 primary health centres, and one rural
hospital are present in Itahar block. Total ASHA karmi of this block is 254. 39 sub
centres have its own building and 3 sub centres are rented and all sub centres have
electricity connection.
22.6 Results and Discussion
22.6.1 Spatial Distribution of the Maternal Health Care
Centres and Prevailing Road Network
One of the major aims of this study is to find out the spatial distribution pattern
of healthcare centres within the study area. Availability of health care centre is
imperative factor to manage the utilisation of maternal health care services. In reality
the distribution of healthcare service centre is indeed skewed in nature. As in most
of the cases the pregnant women belonging to scanty resource region, many times
suffered from complications related to pregnancy and delivery due to less and timely
access to transport system to reach the health care centre. There are only one sub
centre present in Chhayghara GP, 5 sub centres in Durlavpur GP, 3 Sub centres in
Durgapur GP, 2 sub centres in Gulandar-I GP, 3 sub centres in Gulandar-II GP, 4 sub
centres in Itahar GP, 5 sub centres in Joyhat GP, 3 sub centres in Kapasia GP, 4 sub
centres in Marnai GP, 4 sub centres in Patirajpur GP, 4 sub centres in Surun-I GP,
and 2 sub centres in Surun-II GP (Fig. 22.1). The total 263 Asha worker engaged
in these sub centres. A block rural hospital and three primary health care centres
are present in the study area. Total road length of Itahar block is 732.42 kms. It is
observed that, in case of road length per sq. km in Marnai GP (115.62 kms) region is
in better position and lowest road network expansion has been observed Chhayghara
GP (26.12 kms) region (Fig. 22.2). There are total 39 Sub Centre (SC), 3 Primary
Health Centre (PHC), and one Rural Hospital (RH) present in Itahar block. But the
delivery facility is only available in PHC situated in Marnai Gram Panchyat (GP)
and RH situated in Itahar GP. Road network and its accessibility to the health care
centre significantly affect maternal health care services within the study area.
446 M. Sarkar et al.
Fig. 22.1 Spatial distribution of health centres
22.6.2 Distribution of Health Centre and Population
The population distribution and availability of health centre is one of the major
indices for measurement of health potentiality in a particular area. It is also essential
to study the structure of the health care centre because a sub centre provides the basic
or primary health care services to the maternal community at the grass-root level.
As per population norms a sub centre is set up for every 5000 people in plain areas
and for every 3000 population in hilly or desert or tribal areas, primary health care
centre established to serve 20,000–30,000 people, and community health centre or
block primary health centre set up to serve 80,000–120,000 population (Directorate
General of Health Services 2006). Ratio between GP wise population and healthcare
22 An Assessment Study on Hierarchical Integrity … 447
Fig. 22.2 Road network and spatial distribution of maternal healthcare centres
centre has been calculated which gives an overview about the population pressure
over the health facility (Table 22.1). Health centre and population ratio is higher in
Durgapur GP and Chayghara GP (Fig. 22.3). Total population of Durgapur GP is
32279, and number of health care centre is 3, that means each health centre of this
GP provide services to 10,759 people. Total population of Joyhat GP is 30118 and
5 health care centres present in this GP, that means each health centre provide their
services to 6023 people. So, the population pressure on health centre is highest in
Durgapur GP, followed by Chhayghara GP, Gulandar-I GP, and Surun-II GP. Least
population pressure on each health centre is recorded in Joyhat GP, followed by
Durlavpur GP, Patirajpur GP, Surun-I GP, and Itahar GP.
448 M. Sarkar et al.
Table 22.1 Health centre and population ratio
Name of the GP Number of health centre Population (2019) Health centre and population
ratio
1. Joyhat 530,118 1:6023.6
2. Chhayghara 19631 1:9631
3. Marnai 434,110 1:8527.5
4. Kapasia 432,659 1:8164.75
5. Gulandar-I 219,000 1:9500
6. Itahar 640,975 1:6829.16
7. Patirajpur 426,916 1:6729
8. Durlavpur 530,578 1:6115.6
9. Durgapur 332,279 1:10,759.66
10. Surun-II 219,000 1:9500
11. Surun-I 427,155 1:6788.75
12. Gulandar-II 320,835 1:6945
Source Itahar Rural Hospital, 2019
22.6.3 Measurement of Connectivity and Accessibility
The connectivity and the degree of accessibility to the maternal healthcare centre
are not uniform for each and individual nodal centre for a particular region. The
connectivity of a network may be defined as the degree of completeness of links
between nodes. The role of sub centre or the primary health centre is to provide the
combination of services such as registration of pregnancy, antenatal care, postnatal
care, treatment of tiny or minor disease, prevention of malnutrition, counselling on
diet, rest, hygiene and contraception which are very crucial and basic requirement for
maternal community. Besides these services these health centre provides essential
drugs like iron tablets, folic acid supplements for 12 weeks, treatment of anaemia,
general examination such as blood pressure, height, weight, and tetanus toxoid injec-
tion which are rudimentary for every pregnant woman. These health centre also
provide services related to pre-birth preparedness and complication readiness, breast
feeding etc. As because of providing these essential services, connectivity and acces-
sibility to these health centres is an important issue for the maternal community. For
comprehensive analysis of road transportation network in administrative community
block like Itahar, there is a need for analysis of some connectivity indices. Cyclo-
metric number has been measured to discover the maximum number of independent
cycles in a graph. Cyclometric number highest in Marnai GP (10) indicates highly
connected network, and lowest value has been found in Gulandar-I GP (1) indicates
poorly connected network. Alpha index has been measured to identify the complexity
of the transport network system of this study region. It is a measure of connectivity
which evaluates the number of cycles in a graph in comparison to maximum number
of cycles in a network. In Itahar block the value of Alpha index varies from 4.4 to
22 An Assessment Study on Hierarchical Integrity … 449
Fig. 22.3 Population pressure on health centre
13.4%. Highest alpha index value found in Itahar GP usually indicates the greater
degree of connectivity than rest of the parts. Lowest alpha index found in Durlavpur
GP means the degree of connectivity is much lower in this region. Beta index also
reveals complexity and simplicity of a network. The value of Beta index in Itahar
block ranges from 0.894 to 1.166. Beta value is highest in Itahar GP, which indicates a
complicated network structure having more than one circuit. There are two GPs, viz.
Surun-I and Gulandar-II, having beta value less than 1, that indicates very simple and
lesser integrated networks. The Gamma index exhibits the relationship in between
the number of observed links and the number of possible links of a network. Highest
gamma index value found in Surun-II (42.5%), followed by Gulandar-I, Kapasia,
Itahar. Lowest gamma value is found in Gulandar-II (33.3%). Eta index is designed
to capture the structural relationship between the transport network as a whole and
450 M. Sarkar et al.
its routes as individual component of that network. Eta index has a great signifi-
cance in examining the utility of a particular network. Gulandar-I has the highest eta
value that indicates sparsely populated area and lack of connections with the en route
nodes. An opening of new node within Gulandar-I transport network may reduce the
value of eta index. The discussion indicates that none of the above measures can
properly evaluate the network connectivity. Therefore, composite connectivity score
(CCS) has been computed by adding all respective measures (Table 22.2). Based
on CCS, Itahar block has been divided into five categories. Surun-I and Gulandar-I
fall in very low connectivity zone, Joyhat, Chhayghara, Durlavpur, Patirajpur falls in
low connectivity region. Medium connectivity region includes Gulandar-II GP. High
connectivity zone comprises Surun-II, Durgapur and Marnai GP and very higher
degree of connectivity is observed in Itahar and Kapasia GP (Fig. 22.4).
Various kinds of measures have been used by geographers to measure accessibility.
One of the most popular measurements is the distance measured along the route from
a centre point. Hence, a region adjacent to a centre or route is well connected and
more accessible. With increasing the distance from the centre, accessibility become
decreasing. Direct distance between centre (Rural Hospital) and other location (Sub
Centre and Primary Health Care centre) can be determined along a straight line but
most of the roads are curve line or irregular bends owing to intervened by unavoid-
able objects or condition like, agricultural fields, settlement, river, lake or pond, govt.
buildings, etc. So, actual road distance and straight-line distance between two loca-
tions is not same and straight-line distance always underestimates the actual length
of a route. High Detour Index (DI) value indicates indirect and sinuous connection
between rural hospital and sub centre, low DI value denotes more often straight or
direct road connectivity of sub centre to the rural hospital. The analysis of DI value
Table 22.2 Composite connectivity score of Itahar C.D. Block
Composite connectivity score
Name of the
GP
Alpha index Cyclometric
number
Beta index Gamma
index
Eta index CCS
Joyhat −0.83355 0.51599 −0.30201 −0.93511 −0.33797 −1.89265
Chhayghara −0.19149 −0.5767 −0.19354 −0.06389 −1.76993 −2.79555
Marnai 0.11264 1.97291 1.03581 0.3543 −0.70982 2.76584
Kapasia 1.32918 0.15176 0.83092 0.94673 0.63437 3.89296
Gulandar-I −0.52942 −1.30516 −0.7359 1.08612 2.35966 0.8753
Itahar 1.76849 1.60868 1.26481 0.91188 0.09854 5.6524
Patirajpur −1.1039 −0.5767 −0.01276 −0.30783 0.71752 −1.28367
Durlavpur −1.27286 −0.5767 −0.07302 −0.44723 −0.49734 −2.86715
Durgapur 0.65333 0.51599 0.39341 0.11035 0.34336 2.01644
Surun-I −0.29287 −0.5767 −1.26621 −1.24875 −0.16475 −3.54928
Surun-II 1.09263 −0.21247 1.07197 1.39976 −0.59665 2.75524
Gulandar-II −0.73218 −0.94093 −2.01347 −1.80633 −0.07699 −5.5699
Computed by Authors
22 An Assessment Study on Hierarchical Integrity … 451
Fig. 22.4 Composite connectivity score
reveals that there is a lac hog straight line connection between Rural Hospital and
other health facilities (Fig. 22.5). Highest value of 262% is recorded in Lalganj sub
centre followed by Gulandar (222), Gopalpur (175), Indran (175), Damdoila sub
centre (172), and Surun primary health centre (162). On the other hand, low detour
value of Bangar (102), Sonapur (102), Baidara (103), Kukrakunda (106) sub centre
indicates direct road connection. All these sub centres are located along the periphery
of the block and lacking direct connectivity. Shortest path can be changed according
to traffic flow on each segment, but Shimbel index calculates minimum number of
paths necessary to connect a node to rest of the nodes in a network system. Shimbel
index also helps to examine accessibility which can be derived from shortest path
matrix shown in Fig. 22.6. From the Shimbel index it is observed that Mirjatpur
sub centre, Kamlapur sub centre, Paikpara sub centre, Sripur, and Ghera sub centre
having lower Shimbel value which indicates these are most accessible health centre
from rural hospital. Higher Shimbel value found in Koachpara sub centre (21) in
452 M. Sarkar et al.
Fig. 22.5 Accessibility map by Detour Index
Chhayghora GP and Joyhat sub centre (23) and Kasba sub centre (22) of Joyhat GP,
which are the outlying areas with sparse accessibility. This index is categorised into
five zones varying from very high accessible zone to very low accessible zone. Most
of the parts of Itahar GP and some parts of Durlavpur and Patirajpur GP fall in very
high accessible zone. Itahar GP is the main junction point of the study area that is
why accessibility is high in this area. Moderate accessibility is found in some parts
of Marnai, Kapasia, Gulandar-II, Durgapur, Durlavpur, and Patirajpur GP. Very low
accessibility zone is found in Joyhat, Chhayghara, Surun-I and Surun-II GP which
are far away from the rural hospital.
22 An Assessment Study on Hierarchical Integrity … 453
Fig. 22.6 Accessibility map by Shimbel Index
22.6.4 Proximity to Health Facility
Physical accessibility to maternal health facility has been influenced by some factors,
such as long travel distance, health behaviour, and population determinants. The
study aims to evaluate geographic proximity to the maternal health centre. One way
of defining accessibility to maternal health centres is by knowing how far the mother
live from their nearest health centre. In case of proximity, distance between provider
and recipient is the main tool for measuring health centre’s accessibility and identify
454 M. Sarkar et al.
barriers to timely interventions and treatments. The use of health care services is very
much related to service accessibility and quality of service. Still in many parts of the
world, health care accessibility is limited to urban areas from its peripheral part and
hence the unfortunate consequences happen in the form of maternal morbidity and
mortality. It is quite difficult to draw out a definite boundary of influence zone of
health facilities. For this application, distance has been calculated around the health
centres to identify the proximity to health centres. The service area has been contoured
in below following map which (Fig. 22.7) shows that there are 3 rings covering the
health care centres, each ring having 1 km width which shows the degree of influence
of each and individual health care centre. Obviously, the proximity to health care
centres its benefit is better achieved by the mother who resides within the tolerable
distant limit that she could reach easily to the health care centre and receive the
services from these health facilities. It is clear from Fig. 22.7 that several parts of
this block remain left from the benefit of proximity of health care service centre.
The yellow portion indicates outward area, where the health care centres are too far
from this zone. Some parts of Joyhat, Marnai, Chhayghara, Kapasia, Durgapur, and
Surun-II falls in this category. Health planner can use this model for the emergence
of new health facility so that all women can be able to access the health facility.
22.7 Findings and Conclusion
One of the main goals of the health system is to achieve 100% coverage of maternal
health care services. It is possible to achieve 100% maternal health care coverage by
spatially planning the location of each health facility based on population demand
for the maternal health services and measure distance between the location of health
care centres and households. The benefit of spatial accessibility planning is that an
impartial geographic distribution of health care service centre which can minimize
oversupply and at the same time increases the integrity of access to health services
for medically unserved areas. Major findings of this study are that well connected
traffic axial route is comparably inadequate in this region and these are distributed
with lesser density, resulting in weaker capability to deals with whole network.
The accessibility along the National Highway embellishes much better province
in the whole network system. This study has identified the major problems of the
concerned health services related to connectivity and accessibility. Detour Index (DI)
and Shimbel Index (SI) have become the prime factor in the analysis of accessibility.
It was found that there are some areas where sub health centres and primary health
centres are poorly connected with rural hospital. Some areas are situated far away
from the maternal health facility in accordance with deplorable road condition. This
can be considered as the reason behind the lower utilization of antenatal and post-
natal care services. Sub centre provides only basic facilities, if the pregnant women
suffering from complications, she must need advanced facilities which are available
in the rural hospital (Singh et al. 2019). In these cases, patient is referred to higher
order health facility. That is why connectivity and accessibility between sub centre
22 An Assessment Study on Hierarchical Integrity … 455
Fig. 22.7 Proximity to the health facility
456 M. Sarkar et al.
and rural hospital is very essential. In the study area rural hospital is in the foremost
position in respect of delivering services and provides much more opportunity to
the maternal community. For this reason, higher order health facility attracts women
living in the periphery area. Besides the distance factor, accessibility is affected by
availability of transport, transport cost, travel time, road condition, etc. (Varela et al.
2019). But the allocation and distribution of health care service centre should be
guided by standard norms, population strength, and demand. Finally, the study has
given its stressed to focus onto foster the promotion of transport connectivity in the
form of construction new roads and expansion of road network coverage, especially
to those areas where maternal health centres are located. It will ensure the strength-
ening of the capability and effectiveness of health care services provided by maternal
health facility of this region.
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