Incremental planning of the location of public health facilities in a rural region

Olayinka Waziri Otun(1*)

(1) Department of Geography,Faculty of Social Sciences,Olabisi Onabanjo University Ago-Iwoye, Nigeria
(*) Corresponding Author


Some people in rural areas are often excluded from using health facilities in developing nations due to political interference in facility location decision-making. Limited attention has been paid in the literature to promoting inclusiveness in public facilities usage in developing nations. Therefore, this study was designed to examine the access to Primary Health Centres (PHCs) in the Yewa region,  Nigeria. Data on the 509 settlements and 91 PHCs in the Yewa region were obtained from government directories. The p-median Location-Allocation model was used for data analyses. The study showed that the number of PHCs increased and access to them improved in the Yewa region between 1991 and 2019. It was also shown that inclusiveness in facilities could be promoted by optimally adding new PHCs. The study assessed the effectiveness of past locational decisions, similar to other studies in Bangladesh and India, and revealed that the military administration performed better than the civilian administration in facility location decision-making between 1991 and 2019. The study showed how new facilities could be optimally located to improve access and inclusiveness in public usage.


Health care accessibility; Inclusive development; Incremental planning; Location-Allocation models; Nigeria.

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Abdelkarim, A. (2019). Integration of location-allocation and accessibility models in GIS to improve urban planning for health services in Al-Madinah Al-Munawwarah, Saudi Arabia. Journal of Geographic Information System, 11, 633-662. doi: 10.4236/jgis.2019.116039.

Abdulkader, M. (2018). Using GIS for Determining Variations in Health Access in Jeddah City, Saudi Arabia. ISPRS International Journal of Geo-Information, 7, 254

Aday, L.A. , Anderson, R. (1974). A framework for the study of access to medical care. Health Serv. Res. 9.

Alhassan, R.K., Nketiah-Amponsah, E., Akazili, J., Spieker, N., Arhinful, D.K., Rinke de Wit T.F.(2015). Efficiency of private and public primary health facilities accredited by the National Health Insurance Authority in Ghana. Cost Eff. Resource Allocation, 13(1) (no pagination).

Anderson, S. , Harbridge, L. (2010). Incrementalism in appropriations: Small aggregation, big changes. Public Administration Review. 70 (3): 464–474. doi:10.1111/j.1540-6210.2010.02160

Atkinson, M. (2011). Lindblom's lament: Incrementalism and the persistent pull of the status quo. Policy and Society, 30(1), 9-18. Retrieved from:

Ayeni, B. & Rushton, G. (1986). Distributional equity and efficiency in the locational analysis of public facilities: a case study. The Nigerian Geographical Journal, 28-29(1-2): 115-135.

Bagheri, N. Benwell, G. & Holt, A. (2005). Measuring spatial accessibility to primary health care. In Proceedings of the SIRC 2005—The 17th Annual Colloquium of the Spatial Information Research Centre University of Otago, Dunedin, New Zealand, 24–25 November 2005

Briney, A. (January,2020) An overview of Christaller's central place theory. Retrieved from:

Brooks, T. A. (1998). Information seeking in context. Journal of the American Society for Information Science, 49(6).<573

Cairney, P. (2012). Understanding public policy. Basingstoke: Palgrave Macmillan.

Carling, K., Hakansson, J. (2013). A compelling argument for the gravity p-median model:short communication. Eur. J. Oper. Res. 226, 658-660.

Daniels, P.W. (2017). Central place theory. New Jersey, USA: John Wiley & Sons Ltd. wbiego 0747

Daskin, M.S. (2013). Network and discrete location: Models , Algorithms and Applications. New York, USA: Wiley and Sons, Inc., ISBN: 0-471-01897-X.

Federal Government of Nigeria (2007) Legal notice and publication of details of the breakdown of the national and state provisional totals of 2006 census. Federal Government of Nigeria Official Gazette: No. 24, Vol. 94.

Fisher, H. B. , Rushton, G. (1979). Spatial efficiency of service locations and the regional development process papers, Regional Science Association, 42 .

Gupta, J., Cornelissen, V. , Ros-Tonen, M.A.F. (2015).Inclusive development in P. Pattberg and F. Zelli (Eds.) Encylopedia of global environmental governance and politics. Cheltenham, U.K: Edward Elgar.

Gupta, J. , Vegelin, C. (2016). Sustainable development goals and inclusive development, International Environmental Agreements: Politics, Law and Economics, Springer, 16(3), 433-448.

Hafidz, F., Ensor, T. , Tubeuf, S. (2018).Efficiency measurement in health facilities: asystematic review in low- and middle-income countries. Applied Health Economics and Health Policy. 16, 465–480.

Halden, D., Jones, P. , Wixey, S. (2005). Measuring accessbility as experienced by different socially disadvantaged groups. Working Paper 3, University of West Minster: Transport Studies Group.

Hayes, M. (2017). Incrementalism and public policy-making. Oxford Research Encyclopedia of Politics. Retrieved from: 0228637.001.0001/acrefore-97801902286 37-e-133.

Higgs, G. A. (2004). Literature review of the use of GIS-based

measures of access to health care services. Health Serv. Outcomes Res. Methodol. 5.

Hodgson, M. J. , Valadares, C. (1983). The spatial efficiency of health centres in Salcette, Goa National Association of Geographers of India, Annals, 3.

Joshi, G.S. (2010). Infrastructure development strategies for inclusive growth: India's eleventh plan. Leadership and Management in Engineering 10(2). 65-72. Doi: 10.1061/(ASCE) LM.1943-5630.0000057.

Kemboi, T.K. , Waithaka, E.H. (2013). GIS location-allocation model in improving accessibility to health care facilities: A case study of Mt. Elgon Sub-County. International Journal of Science and Research (IJSR) ISSN: 2319-7064

Lawson, V. (2010). Reshaping economic geography? Producing spaces of inclusive development. Economic Geography, 86(4).

Lindblom, C.E. (1959). The science of muddling through. Public Administration Review 19.

Mehretu, A. (1985). A spatial Framework for redressing disparities in rural service delivery systems, Tijdschrift voor Economische en Sociale Geogra, 76.

Ndiaye, F, Ndiaye, B, Mbaye, I. (2012). Application of the p-median problem in school allocation. American Journal of Operations Research, 2(2):253-259. doi: 10.4236/ajor.2012.22030

Nichols, E.N., Bradley, D.L., Zhang, X., Faruque, F., Duhé, R.J. (2014). The geographic distribution of mammography resources in Mississippi. Online J. Public Health Inform , 5, 226

Novignon, J. , Nonvignon, J. (2017).Improving primary health care facility performance in Ghana: efficiency analysis and fiscal space implications. BMC Health Services Research, 17(399).

O'Donnell, P., Tierney, E., O'Carroll, A., Nurse, D. & MacFarlane, A. (2016). Exploring levers and barriers to accessing primary care for marginalised groups and identifying their priorities for primary care provision: a participatory learning and action research study. International Journal for Equity in Health 15:197 DOI 10.1186/

Otun, W.O. (2016). A spatial decision support system for special health facility location planning in developing regions. Ethiopian Journal of Environmental Studies and Management 9(1).829-840.Doi:

Owoola, M.A. (2002). Between policy and practice decision support system-based assessment of facility location planning in Nigeria. Proceedings of a symposium on geospatial theory, processing and applications, Ottawa, 2002.

Rahman, S. , Smith, D.K. (1996). The efficiency of inefficiency: The deployment of health facilities in rural Bangladesh, in: M. Alauddin, S. Hasan (Eds.), Bangladesh: Economy, People, and the Environment. Brisbane: Department of Economics, University of Queensland.

Rahman, S., Smith, D. K. (2000). Use of location-allocation models in health service development planning in developing nations. European Journal of Operational Research 123: 437-452.

Ranieri, R. , Ramos, R. (2013). Inclusive growth: Building up a concept. No. 4 Working Papers from International Policy Centre for Inclusive Growth.

Richard, L., Furler, J., Densley, K., Haggerty, J., Russell, G., Levesque, J., & Gunn, J.( 2016). Equity of access to primary healthcare for vulnerable populations: the IMPACT international online survey of innovations. International Journal for Equity in Health 15:64 DOI 10.1186/s12939-016-0351-7.

Rushton, G. (1984) Use of location-allocation models for improving the geographical accessibility of rural services in developing countries. International Regional Science Review.

Sachs, I. (2004). Inclusive development strategy in an era of globalization, Working Paper No. 35, Policy Integration Development, World Commission on the Social Dimension of Globalisation, Geneva: International Labour Office.

Segura, E., Carmona-Benitez, R.B., Lozanoa, A. (2016). Implications of the assumptions on which the p-median problem are based when distribution network design. World Conference on Transport Research – WCTR 2016 Shanghai, 10-15 July 2016.

Spicker, P. (2009). The nature of a public service. International Journal of Public Administration. 32(11): 970-991. DOI: 10.1080/01900690903050927

WHO (1978). Declaration of Alma-Ata. International Conference on Primary Health Care, Alma-Ata, USSR, 6-12 September, 1978.

Wikipedia (2019). Public service. Wikipedia, the Free Encyclopedia. Retrieved from:


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