Table of Contents
Half the world lacks access to basic health care. This isn’t just a health crisis. It’s a threat to global productivity, job creation, and shared prosperity. For millions of people, whether to seek medical care is not just about cost or stigma but distance as an obstacle. A clinic may appear on a registry, but if reaching it requires a four-hour walk, access remains limited in practice. Geographic access is one of the most decisive and least discussed determinants of whether health systems deliver.
Globally, 3 billion people, around 43% of the world’s population, cannot reach a health facility within one hour on foot. This falls well short of the World Health Organization’s benchmark, which recommends that primary health care facilities be accessible within 5 km of where people live. In sub-Saharan Africa, access falls to 65% or lower in rural and dispersed areas, leaving large populations well outside the WHO’s recommended reach.
Traditional indicators such as facility counts, bed ratios, and spending levels miss this spatial reality. Are facilities reachable by the people who need them? And if not, where should new ones be built to make the greatest difference?
Seeing the full picture
World Bank Group is helping countries build health systems that truly work for people and for economies. Access to quality health care is part of the essential infrastructure and services that help people build their capabilities, participate productively in the economy, and access better job opportunities. To help increase access, we’ve deployed a Geospatial Planning and Budgeting (GPB) public infrastructure access (PIA) tool. An initial version supported a 2021 Public Expenditure Review for Timor-Leste, demonstrating the ability not only to map and measure access but to optimize new facility placement under tight budgets.
Scaling that approach is hard: geospatial analytics demand significant computing power for larger countries. For instance, Zambia, is about fifty times the size of Timor-Leste. To make GPB PIA replicable and sustainable, the team used MEGA (Microdata & Evidence for Government Action), the World Bank Group’s interoperable computational platform, and worked with Analytics for a Better World, a Dutch non-profit focused on the UN Sustainable Development Goals. The pilot was then refined into online PIA resources which were then deployed.
The tool starts by mapping what exists. Health facilities are georeferenced and overlaid with population which is often transformative in itself, since facility data are frequently fragmented or outdated. It then translates this into coverage of how many people live within a realistic distance of care, producing an evidence-based map of who is served and who remains beyond reach.
Driving vs. walking: two realities
A key insight is the gap between driving time and walking time. A facility that looks accessible by road may be hours away on foot. By modeling both, the tool produces two coverage maps for the same geography. A system that appears adequate under driving assumptions can reveal major access gaps when measured on foot – a more realistic baseline for policy decisions.
From mapping to decision-making
Beyond diagnosis, the tool supports optimal placement of facilities, evaluating thousands of locations to find where a new clinic / health post / health centre / hospital reaches the most underserved people. Crucially, it quantifies impact incrementally. The first facility in an underserved region may serve tens of thousands, while later ones reach far fewer people, yet those smaller-reach facilities can be equally justified where geography isolates communities. This trade-off between efficiency and equity is essential for prioritization, budgeting, and transparent communication.
