Paper short abstract:

This study underscores a widening spatial disparity in health infrastructure adequacy as urban population densities grow. Policy implications include an urgent need for equitable distribution of health facility investments, prioritizing high-density, underserved poor and vulnerable populations.

Paper long abstract:

Access to health facilities has become pivotal in universal health coverage, particularly for rapidly urbanizing cities in low-and middle-income countries (LMICs). Despite research on health facility access, monitoring and tracking of spatial adequacy of the health facilities against changing city population density over time and space remains partially explored. This gap limits understanding of the extent of adequacy or inadequacy of urban health infrastructure and how vulnerable city dwellers cope. The current study, examines the spatiotemporal correlation of urban population density and health facility inequalities in the Greater Accra Metropolitan Area (GAMA) of Ghana, from 2010 to 2022 Using geostatistical analysis of population census data of 25 Metropolitan, Municipal and District Assemblies in GAMA and number of health facilities per unity area, the findings revealed significant spatial inequality of health facilities access. Densely populated areas such as Accra and Ashaiman had fewer health facilities relative to their populations, while sparsely populated peri-urban areas exhibited comparatively better accessibility. Vulnerable populations in underserved areas relied on informal healthcare providers and faced increased travel distances to facilities, exacerbating health inequities. The study underscores a widening disparity in health infrastructure adequacy as urban population densities grow. Policy implications include an urgent need for equitable distribution of health facilities, prioritizing high-density, underserved areas, and leveraging spatial equity for planning future healthcare facility investments. The findings call for a holistic urban planning strategy to mitigate the inequalities of health access for achieving the global Sustainable Development Goal Three (SDG3) in rapidly urbanizing LMIC cities.