Healthcare Facility Locations in Bamyan, Afghanistan by Yong Kiong Teo

Kiong completed his masters thesis at NPS in the winter of 2011.  His work concentrated on selecting good healthcare facility locations in Bamyan, Afghanistan.  Below you will find his executive summary, and the thesis itself.

Executive Summary

In this thesis, we aim to determine the optimal location and type of medical facilities to address to the healthcare needs of the people in Bamyan Province, Afghanistan. We do this using a variant of the facility location problem, one of the oldest and most researched operations research problems.

To model the location of healthcare facilities in Bamyan, we create a network model of transportation. The nodes of the network are the villages in Bamyan and the edges are defined by the available roads. We then formulate a linear, mixed integer location model to select the villages in which to place healthcare facilities. The model takes into account limitations such as the operating budget, infrastructure budget, capacity of the healthcare facilities, distance traveled by patients and other operational constraints. A key contribution of this thesis is the modeling of Afghan ethnic groups when it comes to selecting healthcare operators and locations. The model takes ethnicity into account by modeling each ethnic group’s acceptance to being served at a healthcare facility operated by a different ethnic group. The main objective of the optimization problem is to minimize the total distance patients travel to receive healthcare.

Our model leads to an increased understanding of healthcare facility locations and the selection of operators in Bamyan. The mathematical model can help decision makers to identify–given a fixed operating and infrastructure budget–the types, locations, and ethnic operators of healthcare facilities that minimize the total distance traveled by patients to receive healthcare.

Our results show that with a limited operating and infrastructure budget, the locations of healthcare facilities in Bamyan District may be improved. Possible improvements include:

  • Downgrade larger facilities into smaller ones
  • Relocate facilities to new locations with a minimal infrastructure budget of 200,000 USD
  • If further infrastructure budget is available, build new, small healthcare facilities at specified new locations.

In analyzing the ethnicity of healthcare operators, our model shows that the population of the major ethnic group travel shorter distances to arrive to a healthcare facility as compared to the minor ethinc group. More healthcare facilities are operated by the major ethnic group, even though the acceptance of the major ethincity is high. Facilities operated by the major ethnic group may still serve members of the minor ethnic group population who are willing to go to the facility that is not operated by its own ethicity. Members of the minor ethnic group who are unwilling to be served by an operator of a different ethnicity would have to travel farther, to a location operated by the minor ethnic group. In our results, where the ethnicity groups have an acceptance level of 60 percent, the patient of the major ethnicity travels about 5.76 km to a healthcare facility, whereas the patient of minor ethnicity travels about 9.75 km.

We derive our results using recent data gathered by coalition forces and the Bamyan Department of Public Health. However, our data does have some limitations. Naturally, with improved data on the population, ethnicity and location of demand nodes the model would be more accurate. Furthermore, more realism can be incorporated into our model, which focused only on the demand of the population and capacity of the facilities. Specifically, our model does not account for the types of services provided by the healthcare facilities and that services in a certain type of facility may not be available in another. Incorporating service types would likely change the suggested facility types and locations produced by the model.

Complete Thesis

Teo, Y. K. (2011). Improving Healthcare Facility Locations in Bamyan, Afghanistan (Masters Thesis).  Naval Postgraduate School.

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