Spatial analysis of accessibility and utilization of healthcare

facilities in the Greater Tubatse local municipality ward 26,

Leboeng.

by

PONTSHO PRISCILLA MOLOPE (201934485)

JENNY DIBAKOANE (201904893)
KHOLOFELO MASHAPA (201917853)

RESEARCH PROPOSAL submitted in partial fulfillment of the requirements for

the degree of

BACHELOR OF SCIENCE
in
ENVIRONMENTAL AND RESOURCE STUDIES

in the

FACULTY OF SCIENCE AND AGRICULTURE

(School of Agriculture and Environmental Studies)

at the

UNIVERSITY OF LIMPOPO

SUPERVISOR: Ms / T Mugwena
Dedication
This research is a dedication to the Lord God Almighty , who has given us the
strength, zeal, wisdom and has guided us from the beginning to the end of the
research. This research is also dedicated to our families , for supporting a d
believing in us all throughout our academic years.

i
Declaration

Pontsho Priscilla Molope, student no: 201934485; Jenny Dibakoane, student no:
201904893 and Kholofelo Mashapa, student no: 201917853, hereby declare that the
research proposal title "Spatial analysis of accessibility and utilization of healthcare
facilities in the Greater Tubatse local municipality ward 26, Leboeng" for the fourth
year at the University of Limpopo, hereby submitted by us, has not been submitted
previously for any research project or any university. It is our work design and
execution, and all reference material has been duly acknowledged.

Student’s signature: Date: 16 October 2022

Student’s signature: Date:16 0ctober 2022

Student’s signature Date:16 October 2022

ii
Acknowledgment
The completion of this research has been challenging, complex, and lengthy. During
this research and writing, they have been individuals that have helped to provide us
by shedding light on some of the things we did not understand. They had given us
such great support and encouragement when we lacked one. Ms. T Mugwena
supervised and provided us with information that helped our progress. Even when
we were sloppy, she encouraged us to push to our best limit. Thanks very much for
the needed support at the stages of the research.

The following friends and colleagues have provided us with support, one way or
another, Juliet Shai, and Faith Thekwane, for their time to give insight and support.

iii
Abstract
Physical access to healthcare facilities is poorly understood, and understanding this
situation is essential for future decision-making. There is a vastly unequal healthcare
distribution, and people travel a distance to access the facilities. The study evaluates
the accessibility and utilization of healthcare facilities by using spatial analysis. The
availability, distance, and affordability of healthcare facilities are examined to
measure the accessibility of the Leboeng community. The site suitability map is
created for the future potential allocation of a facility. The data is analyzed using
ArcMap 10.8.2. Findings showed that healthcare facilities are grossly distributed, and
far from the Leboeng, one clinic was found accessible for people in a 5km radius. To
access the nearest hospitals in the Tubatse Municipality, they must travel for a
distance of <10km. Therefore, a need for healthcare facilities in a pretty distributed
area is crucial.

Keywords: accessibility, spatial analysis, cost distance, site suitability, healthcare

facilities, Geographical information system (GIS).

iv
Table of Contents
Dedication.................................................................................................................... i

Declaration.................................................................................................................. ii

Acknowledgment........................................................................................................ iii

Abstract...................................................................................................................... iv

List of acronyms and abbreviations...........................................................................vii

List of Figures........................................................................................................... viii

1. INTRODUCTION..................................................................................................1

1.1. Background to the study................................................................................1

1.2. Statement of the problem...............................................................................2

1.3. Aim and objectives.........................................................................................2

1.4. Study area......................................................................................................3

1.5. Limitations of the study..................................................................................4

2. LITERATURE REVIEW........................................................................................5

2.1 Availability observing the distribution of healthcare facilities.............................6

2.2 Affordability measuring cost-weighted distance....................................................8

2.2 Accessibility of health in South African.............................................................9

2.4 Influence of accessibility on health in South Africa.............................................10

2.5 Site suitability for future healthcare facilities allocation.......................................10

2.6 Healthcare infrastructure affecting accessibility in South Africa..........................12

3. METHODOLOGY...............................................................................................13

3.1 Data collection.................................................................................................13

3.1.1. Data and Material used...................................................................................13

3.2 Distribution Map.................................................................................................. 14

3.3 Euclidean distance..............................................................................................15

3.4 Cost distance used to measure transportation cost............................................15

v
3.5 Site Suitability Map..............................................................................................16

3.5.1 Site suitability map in terms of slope.............................................................16

3.5.2 Site suitability map in terms of road map......................................................18

3.5.3 Site Suitability map in terms of a River map.................................................21

3.5.5 Site suitability map in terms of geology.........................................................23

3.5.6 Site suitability map in terms of land cover.....................................................25

4. RESULTS AND DISCUSSION...........................................................................27

4.1 Distribution of health care facilities......................................................................27

4.2 Euclidean distance..............................................................................................30

4.3. Accessibility of transport considering the Cost distance.....................................35

4.4 Site suitability analysis for the construction of a hospital.....................................37

5. Conclusion and Recommendation......................................................................43

5.1 Conclusion.......................................................................................................... 43

5.2 Recommendations..............................................................................................44

6. References............................................................................................................45

vi
 List of acronyms and abbreviations

3D: Three-dimensional

ArcGIS: Aeronautical Reconnaissance Coverage Geographical Information System

DEM: Digital Elevation Model

DFFE: Department of Forestry, Fisheries, and the Environment

DPSA: Department of Public Service and Administration

ESRI: Environmental Systems Research Institute

GIS: Geographical Information System

HIV/AIDS: Human immunodeficiency virus and acquired immune deficiency

syndrome

MCDM: Multicriteria Decision-Making

MHOs: Mutual Health Organisations

NHA: National Health Act

NNA: Nearest Neighbor Analysis

RCMRD: The Regional Centre for Mapping of Resources for Development

RQIS: Resource quality information services

RSA: Republic of South Africa

SANCA: The South African National Council on Alcoholism and Drug Dependence

UHC: Universal Health Coverage

UTM: Universal Transerve Mercator

WHO: World Health Organization

vii
List of Figures

viii
1. INTRODUCTION
1.1. Background to the study

Accessibility is a measurement of an individual to reach a particular destination. It

can be to the clinic or hospital accessible via a specific transport network, travel time,
and travel cost (Ahmad, 2012). Accessibility is mainly concerned with the
complication between the interaction of the population's geographical separation and
the availability of health care services. So, it has a major geographic component
(Shengelia et al., 2003). Accessibility is defined as similar to access. It has several
spatial and temporal properties that are a barrier to the ability of an individual to
access a particular location (Witter et al., 2019). Some factors that affect
accessibility, such as uneven distribution, distance, and transportation network, act
as an essential part of the accessibility to healthcare facilities and healthcare
planning interventions (Mao,2013).

Although (Guagliardo,2004) argued that accessibility depends on the availability of

the services, in terms of the utilization of healthcare resources, accessibility is often
influenced by the geographical position of the healthcare facility; by assessing the
supply and demand, they are not distributed in a uniform manner (Wang, 2012).
According to (Penchansky and Thomas, 1981), availability, accessibility, affordability,
and location can be grouped to measure spatial accessibility. This research measure
spatial accessibility using spatial analysis. It incorporates a Geographical Information
System (GIS) installed in the computer and can be used for storage manipulation
and visualization of geographically referenced data (Defries, 2013). Spatial analysis
in the healthcare scale measures spatial patterns and spatial association between
the healthcare facility and the user (Ahmed, 2012).

Globally, spatial accessibility of health care is regarded as poor in terms of utilization

and quality, which is witnessed in developing countries (WHO, 2016). Each country
faces different challenges that are difficult to tackle when it comes to the increase in
the medical cost that is insinuated by the service delivery of the health care system.
The aging population increase with a decrease in health care services. This includes
the cost of the provision, which is the main problem, especially for developed
countries with few free public services ( Kotavaara, Nivala et., 2021). Accessibility is

1
the biggest challenge in many areas worldwide. In South Africa, despite spending
more money on health care facilities renovations than many other countries, South
Africa has poor results on accessibility to health in both rural and urban settlements
(Gaede, 2011).

According to (SANCA,1996), the South African constitution provides a right to health

care services to the population. The provision includes emergency services, primary
health care for children, reproductive health for individuals, and even those retained
or prisoners. However, this provision does not guarantee that access will be granted
without challenges, especially from the quality perspective. Most South African
districts fail dismally with health care services (Chiwire, 2016). Comparing the quality
of primary healthcare facilities between urban areas and rural areas of South Africa,
the rural areas have inadequate primary healthcare facilities. In contrast, urban
areas have acceptable quality (Anon, 2020). Limpopo is one of the provinces, with
many rural areas having inadequate.

A community monitoring group reported that health facilities in Limpopo face many
challenges, including long waiting times and dilapidated infrastructure( Mukwevho,
2021). About 26% of the facilities are in poor condition regarding infrastructure.
Some of them are old and poorly maintained( Mukwevho, 2021). People in Thusong
service centers in Limpopo have uneven accessibility between urban and rural
settlements. People in rural areas travel further to nearby facilities than those living
in urban areas(Snyman, 2017).

1.2. Statement of the problem

The community of Leboeng, situated under the Sekhukhune district, is facing an

issue of accessibility and utilization of healthcare facilities. There are not enough
healthcare facilities within a walkable distance, and one facility is available within the
boundary of the area. Being a rural area with poor transportation, residents face
issues with traveling to the available healthcare facilities that are kilometers away.

1.3. Aim and objectives

2
Aim: Evaluating the accessibility and utilization of healthcare facilities in Leboeng
using spatial analysis.

Objectives:

I. Examine the availability and number of public health facilities around the area
by mapping their distribution
II. Determine the accessibility of health facilities using Euclidean distance
III. Measure the affordability of transportation amongst the residents of Leboeng
by using Cost-distance
IV. Produce site suitability map for future potential healthcare facilities’ location

1.4. Study area

Figure 1: Study area of Leboeng in the Greater Tubatse.

The area of interest is Leboeng, located between -24°30'6.55" latitude and

30°39'32.15" longitude. It is a small village in South Africa, Limpopo, Sekhukhune
District municipality, in the Tubatse Local municipality. Sekhukhune district
comprises four regions, Elias Motsoaledi, Ephraim Mogale, Makhuduthamaga, and

3
Tubatse, where Leboeng is found in the Study area ward 26. It has a population of
8755 on 135.1 square kilometers, with each square kilometer having 64.8 people
(Census, 2011). 80% of the population is between the age of 18 to 65 years, with
100% Black African in the population, and Sepedi is the local language that is mainly
spoken. The great Tubatse is well known as South Africa's first democratic platinum
city. Ward 26 comprises many clustered villages, which hinders development and
service delivery for many villages, including Leboeng. The provision and
maintenance of service are very costly. This study area was chosen because of the
lack of healthcare facilities in the Study area, ward 26. People in this country must
travel long distances of kilometers to access primary health care facilities. The only
clinic they can reach is within estimated kilometers of the 5km suitable radius, the
Sterksspruit clinic being the closest.

1.5. Limitations of the study

 The elevation data is blurred, preventing the extraction of the slope surface.
 Most of the files were corrupt.
 Layers of land use, roads, and geology did not cover the area of our study. A
new land cover map had to be created.
 RSA shapefiles are not updated. They are exceedingly difficult to utilize.

4
2. LITERATURE REVIEW

Introduction

Spatial accessibility to health care services gained traction in recent years, with a
rationale for understanding geographical barriers between the service providers and
the surrounding population(Kotavaara et al.,2011). This can contribute to the low
healthcare usage that is incurred at the facilities (Kotavaara et al., 2011). They were
a call issued by the 5th World Health Assembly in 2005, rendering the member of
states for Universal Health Coverage(UHC). It emphasized that every citizen needs
to be subjected to good-quality healthcare facilities (Novartis, 2016). it is preventative
when given circumstantial conditions, the ability to obtain a high chance of cure, and
a place for rehabilitation given that they do not experience financial hardship. Equity
is UHC's ultimate goal in healthcare access (Novartis, 2016).

According to Ahmad (2012), they are the different spatial distribution of a population,
the distance to the available local facility, and the transportation that can gain access
to the specific facility. This can lead to a variation associated with accessibility to
health care. In this manner, the local disadvantaged communities are affected by this
poor spatial accessibility(Ahmad, 2012). In a study conducted by (Ashiagbor et
al.,2022), accessibility was measured by using the location given that the movement
is restricted by a constraint, such as traveling a given distance to the nearest facility.
There is a type of spatial analysis, which is a type of geographic analysis that seeks
to explain the rationale of the observed pattern. This pattern is observed between
human behavior and spatial expression using terms of geometry and mathematics
called locational analysis(Ashiagbor et al.,2022). This makes it simpler to analyze the
utilization of healthcare facilities among individuals.

The utilization of healthcare services is an important indicator and a tool for planning
future systems to be implemented. According to WHO(2016), health is the
fundamental right of every human being. Therefore, there must be enough
healthcare facilities near everyone's habitat, concerning the number of the threshold

5
population, with healthcare that gives a high chance of success. (Penchasky and
Thomas, 1981) conducted a study that explains how utilization is determined
depending on the accommodation of every participant, whether the services can be
afforded, acceptability of the given services. Utilization can be determined by the
income of the given population, organizational barriers, and the characteristic of the
population( Penchasky and Thomas, 1981). Healthcare utilization was made
possible by Geospatial technology (Geographic information system), which
measures spatial accessibility worldwide. It is helpful in emergency services, site
analysis, and health care planning (Black et al., 2004; Mohammed, 2019). It is
famous because it contains various elements such as data capture, manipulation
tools for the attribute data, spatial data, mapping, and visualization tools to
communicate the analysis results (Black et al., 2004). Dermatitis, Tsoromokos,
Gozadiuos, and Lazadikou (2016) studied how GIS can be applied in research,
prepare the line of emergency, and the availability of the location of health care
facilities. In this research, GIS will be used to understand accessibility better. It will
be used to elaborate further on the spatial accessibility of Leboeng, situated in the
Sekhukhune district.

2.1 Availability observing the distribution of healthcare facilities

Availability refers to the existence of healthcare services that are readily available to
patients (Xing and Ng, 2022). A map indicating the distribution of healthcare facilities
is created to analyze the availability of healthcare facilities. Availability and
accessibility are inherently unique factors describing the number of services people
use and hindrances to travel between the two (Humphreys, 2014). (Mokgalaka,2014)
highlighted that the poor level of accessibility because of location is because of the
availability of healthcare facilities, especially for the population residing in the
Periphery.

The availability has been influenced by the policies to segregate different races
( Burger and Christian,2018). However, there was a change post-apartheid. Every
individual was given an opportunity for basic rights through the constitutional Bill of
Rights (Maseko and Harris, 2018). The availability of healthcare facilities has
improved since the post-apartheid period. Burger et al. (2012) have reported a
dramatically shorter traveling time to healthcare facilities. Hamphrey and Smith

6
(2019) have been convinced that the availability of services is crucial when
considering accessibility since the rules state that for a service to occur that it must
be accessible. The availability barriers that hinder accessibility include transportation
to the Healthcare Centre and the availability of facilities in the Healthcare
Centre( Hamphrey and Smith, 2019). The unequal distribution of healthcare facilities
influences the availability of healthcare facilities (Rani et al.,2022).

(Rahimi et al., 2018), They have emphasized that there is a need to address the
unequal distribution of healthcare facilities. Recognizing underserved population
allow politicians to determine where new healthcare facilities should be fairly and
equitably (Rahimi et al., 2018). However, not everyone has to reap the full benefits of
health care services because of her capability distribution. This is witnessed in
Nigeria, where there is a significant disparity, evident by their location pattern of
distribution (Ike and Esther, 2022). Some facilities are concentrated in one area at
the expense of others. The unequal distribution has prompted the health sector to
focus on creating healthcare facilities to meet the growing population's demand (Ike
and Esther. 2022).

According to (Ike and Esther, 2012), the distribution of health facilities was measured
using the Nearest Neighbor Analysis (NNA). The result indicated that the right index
measured was around 0,74. This indicates a clustered pattern, which means that the
healthcare facilities in Uyo State, Nigeria, were situated unequally. Another study by
(Isma'ill et al., 2014) emphasizes that Nigeria is the first development plan (1962-
1968) to recognize that a healthy population is an economic asset. It is well
acknowledged that health is vital, so the need to make health services and facilities
available is essential to the general population. Findings show that healthcare
facilities, in some words, are grossly inadequate, and their distribution is random
(Isma'ill et al., 2014). There is a need to provide health facilities that should be
distributed reasonably and logically.

Most rural community lack access to healthcare facilities. The study by (Kofi and
Ussiph, 2017) revealed that, on average, the distance to the healthcare center is 16
km. Many people in rural areas are within a 5km radius of a healthcare facility. Then
the other half cannot access healthcare within 5 km, which is one hour is a walking
distance (Kofi and Ussiph, 2017). There will always be an equal disparity of

7
healthcare facilities in different areas because of the current distribution and
available transport infrastructure. In most cases, the gravity model is used as an
indicator to measure both availability and accessibility( Mishra et al., 2019). This
measure fits in urban and Rural areas (Kofi and Ussiph, 2017).

2.2 Affordability measuring cost-weighted distance

In this topic, "Affordability by cost-weighted distance'', the focus is on the rural areas
of South Africa. The determination of what kind of impact affordability has on the
communities and the influence the distance of healthcare facilities has on them.
(Cleary et al., 2013) define affordability as "the capability between the costs of
accessing health care and the ability of a household to pay''. Axene (2003) define
affordability as the ‘’measure’’ of someone being able to pay for a service. He further
describes affordability as someone being able to pay for a service without making
any unreasonable sacrifices. Affordability refers to a person's or organization's
capacity to pay for or cover healthcare expenses (Axene, 2003).

In South Africa, private health care is costly and out of reach for most of the
population. Members' payments to schemes are growing at an alarming rate, and
members' out-of-pocket prices are increasing by double digits, making private
healthcare affordability a significant concern in the future (Plaks and Butler, 2012).
This is because of the growing population, which puts pressure on the economy and
health care as the demand for healthcare services becomes more significant than
the supply( Plaks and Butler, 2012). Affordability-focused policies have removed
user charges and expanded priority programs to increase the accessibility of
healthcare services for the poorest people (Burger and Christian., 2018). However,
accessibility is still an issue for many people, not only in rural areas but also in some
urban areas. Affordability alone cannot solve the issue of accessibility.

According to (Cleary et al., 2013), affordability is influenced by factors such as the

distance between the healthcare facilities and the communities, the physical
condition of the healthcare facility, and the type of service being provided in the
healthcare facilities. The Democratic Republic of Congo has implemented Mutual
Health Organisations (MHOs) through its national health policy (Criel et al., 2020).
These organizations aim to provide health care insurance to those in need,

8
especially the communities of rural areas (Criel et al., 2020). This is how the
Democratic Republic of Congo government ensures that everyone has physical
access to healthcare services without being affected by issues such as
affordability(Rani et al.,2022). A program called Batho Pele (People First) in South
Africa was implemented. This program was established during the formation of the
country's new constitution by the government throughout every
department(Amollo,2009). This program aimed to provide people who cannot afford
healthcare services with proper public healthcare service delivery throughout the
country (Khumalo, 2001).

2.2 Accessibility of health in South African

Accessibility remains unfair, and it is constitutionally enriched. This is mainly caused
by resource allocation. The barrier to access includes the distance and the cost to
travel to the facility(Harris et al.,2011). The most affected population in rural areas
results in long queues, taking care of the cost from their pockets, and
discouragement from visiting the facilities( Harris et al., 2011). For accessibility to
occur, they are a specific allowed average distance for an individual to travel to the
nearby healthcare facility from the place of habitat, which is 5km (WHO, 2016).
(Tsoka and le Seur, 2004) formulated a survey that indicated that 96% of the
population in the rural area of Kwa-Zulu natal were utilizing the clinic that was close
as possible. Only one-third of the population resided within 5km of the clinic(Tsoka
and le Seur, 2004). Therefore, it is for the utilization decreased with the increasing
distance. Looking at the location patterns, one can notice that the distance increases
in areas far from the healthcare facilities (Tsoka and le Seur, 2004). This sparked
policies that were essential to the transformation of South Africa's health system,
which also applied to the healthcare principles (Chiwire, 2016),

Chiwire (2016) found that the public health sector is under stress caused by an
increase in diseases, further aggravated by the growing population; increased
migration is another factor that contributed to the pressure posed on the health care
system. Another dissection of Chirwe found that the current situation indicates that
the 65 population is burdened with diseases. HIV/AIDS, tuberculosis, and non-
communicable diseases (Statistics of South Africa,2016). Statistics South Africa also
found that the HIV/AIDS prevalence of the South African population was estimated to

9
be 12,7% and 18,9% of the group, which is 65 and older, with a decrease in infant
mortality.

2.4 Influence of accessibility on health in South Africa

South Africa has experienced negative health factors that have increased neonatal
and maternal mortality rates (Mukhove,2014). The factors that cause maternal
mortality can be prevented. More than 60 000 children below and under five years
old die early because they cannot access good quality healthcare
services( Mukhove,2014 ). This is caused by poor care in their homes and
community. Mental health is another factor that needs to be considered by accessing
medical attention. Having good mental health is particularly important. However,
South Africa's access to mental health care is seen as an obstacle (Majid, 2018;
Strasser and Neusy, 2010). Everyone must have the right to mental and physical
health and good quality health care. Life is already difficult for people born into
disadvantaged families and those with disabilities. Personally, these people do not
only experience poverty at home, but they sometimes feel socially excluded in
certain things amongst their peers (especially youth with disabilities). These factors
hinder them from seeking medical attention even when they need it.(Mukovhe, 2014;
Strasser et al., 2016).

According to (Mukovhe, 2014), problems of the past have not been solved, and this
is in the South African healthcare system. It is said that problems of the past can be
solved in the South African healthcare system, and this is supported by a vision
statement called "the National Health Act(NHA) of 2003" (Zonke, 2014). This vision
statement talks about having every South African citizen be able to have access to
good quality and affordable health care(Zonke, 2014). The mission of this vision
statement is about "building on the achievements of the past five years to improve
access to health care for all and reduce inequality. Introduce working in partnership
with other stakeholders to improve the quality of care on all levels of the health care
system(Saranto et al., 2009). All is done to promote the overall efficiency of the
healthcare delivery system.

10
2.5 Site suitability for future healthcare facilities allocation
Site suitability is the technique used to allocate new and ideal sides by analyzing the
existing infrastructure. It accounts for the pattern and condition based on several
appropriate criteria (Parvin et al., 2020). Euclidean distance, kernel density, and
proximity are other calculations that are analyzed to support the suitability analysis of
healthcare sites (Parvin et al., 2020). This is where facilities could be built to assist
people and provide better health care services. Site suitability is also called
selection. The basic idea of this concept is to rank alternate sides based on their
characteristics to identify the most suitable site for specific land use (Balluad, 2008).
Application applications for suitability include identifying animal habitats, mapping,
wildness, ecosystem services assessment, soil fertility, urban planning, and
susceptibility mapping (Chen, 2014).

The site selection process for basic facilities is vital when involving both quantitative
and qualitative evaluation (Kahraman et al., 2003). The decision support utilized in
GIS is vital in handling extensive spatial criteria, and the usual case is that GIS is not
a decision-making system(Mishra et al., 2019). the multi-criteria decision-making
(MCDM) technique is integrated with GIS to improve the chances of inhabitants
accessing healthcare services (Mishra et al.,2019). It gives a chance to maximize
coverage and ensure equity in the distribution of healthcare facilities (Mishra et al.,
2019). The hierarchical analytical process adopted is utilized in MCDM to assign
weightage to the criteria influencing the site selection process(Saaty,2008).

According to (Dell 'Ovo et al., 2018), there is a complex site selection decision
problem with several conflicting criteria, and different stakeholders hold this criterion.
Selecting the location of the allocation of healthcare is a multi-criteria decision
problem(Mishra et al.,2019). It includes the functional, locational, environmental, and
economic issues that go hand in with the associated problems (Dell' Ovo et
al.,2018). Integrating GIS and MCDM techniques by combining thematic layers of
information and weighing the correspondence of the criteria for determining the
suitability of an area to situate a Healthcare facility is being used (Dell 'Ovo et al.,
2018; Oppio et al., 2016; Rahimi et al., 2017; Faraque et al., 2012; and Gu et al.,
2012). Evaluating the suitability of a location to allocate the Healthcare facility
requires the criteria that will be used to determine the suitability of candidate

11
locations to locate the healthcare facilities. According to Oppio et al.,2016; Sharmin
and Neema (2013), criteria such as accessibility and proximity to facilities, population
density, and road network connectivity are often used to indicate suitable sites.

According to (Parvin et al.,2020), there are three dynamic tier analyses for accessing
accessibility, selecting a suitable site for healthcare facilities, and analyzing a
network with the shortest path. The spatial distance, density, and proximity are
stressed in existing healthcare to situate more deprived and inaccessible areas in
terms of healthcare facilities (Parvin et al., 2020). Finding suitable sites for new
healthcare services is essential. The second tier emphasizes some requirements in
finding a suitable site that must be put forward. The analysis is based on land use
and cover, distance to the road and rail, and proximity to the residential area in a
weighted overlay of accessibility (Parvin et al., 2021). The third-tier analysis
emphasizes that the suitable site that is preferred is identified utilizing the technique
for order of preference by similarity to the ideal solution (Wang et al.,2018). Site
suitability is part of efficient territorial planning strategies. It is vital to identify the
most suitable site for locating future land use based on explicit or implicit spatial
information (Collins et al., 2001).

2.6 Healthcare infrastructure affecting accessibility in South Africa

Healthcare facilities and equipment must be in good condition to provide adequate
healthcare services, despite the most rural areas in South Africa shortage of
healthcare professionals( Strasser et al.,2016). Their clinics appear too small to
provide certain required primary healthcare services (Strasser et al., 2016).
Provinces such as the North-west and Kwa-Zulu Natal health care facilities do not
have enough waiting and consultation rooms. The ones they have are in poor
condition or too small(Mukovhe, 2014). this is a negative impact because, in terms of
collecting a patient's personal information, isolation rooms are needed (Mukovhe,
2014). A survey of primary healthcare facilities in four Eastern Cape and KwaZulu-
Natal rural areas discovered problems with basic infrastructure such as water,
power, and phone connections. Inadequate infrastructure(Gaede,2011).
Infrastructure negatively influences accessibility since service quality depends on
fundamental operations like summoning an ambulance can. This can become a
major service delivery issue (Gaede, 2011).

12
3. METHODOLOGY

3.1 Data collection

3.1.1. Data and Material used

The type of method used is the qualitative method, and the type of data used is
secondary data. The data used was collected from different South African
Departments. Data for healthcare facilities (Hospitals and clinics) was obtained from
the department of health which is a shape file of all healthcare facilities in Limpopo.
The data about villages was obtained from the Department of Environmental Affairs
– South African Census. This included data from the local district municipality, which
was used in selecting the study area. The land cover data were obtained from the
Department of Forestry, Fisheries, and Environment (DFFE). The geology data was
gathered from the council of geoscience, one of the national councils of South Africa
and the official heir to the country's geological survey. The Department of Roads and
Public Works obtained data for the roads. The rivers from Resource Quality
Information Services (RQIS). The slope data is a 30-meter digital elevation model
(DEM) from a Shuttle Rader Topography Mission collected from RCMRD Geoportal.
The other layers used as administration and study area selection polygon include
South African local data, local district municipality, and villages collected from IGIS.
All these were added and used in ArcGIS to answer a research objective by creating
maps such as:

 The Distribution Map

 The Euclidean distance Map
 The Cost-weighted distance map
 The Site suitability map

13
Figure 3.1: Methodology flowchart

3.2 Distribution Map

Distribution maps are a form of thematic design used to illustrate and outline issues
about the study area by using the partitioned database environment of the study
area (Machines, 2022). In this research, a distribution map was generated using
ArcGIS. The type of data used was shapefiles such as Limpopo province, Limpopo
local municipalities, wards, Limpopo villages, roads, clinics, and hospitals. All shape
files are added to ArcGIS software; however not connected for a display to the
ArcMap of the software. During the creation of the map, the shape files of the
Limpopo local municipalities were narrowed down by selecting only the Greater
Tubatse local municipality. This was done through the attribute table. After
successfully connecting the Study area to the ArcMap and becoming a layer, adding
two more layers, villages and roads, and two features, clinics and hospitals, created
a digital map.

14
3.3 Euclidean distance
Euclidean distance is the most preferred way to reflect accurate distance( Zhang and
Wu, 2021). Euclidean distance is utilized to calculate the relationships between a
particular religion and a Healthcare facility where a researcher wants to measure
accessibility to healthcare. According to Coscia(2022), it is a tool used to obtain
distances of roads. It is a measure of the straight-line distance. It estimates between
two points X and Y in space or amount on the x and y axis (Parvin et al., 2021).

It is commonly used in GIS to measure the nearest location of a service center.

Without geocoding, Euclidean distance provides a good measure of travel costs.
However, it failed to consider transportation routes and barriers to
movement( Murad, 2018). This research is utilized to determine the distance from
the Healthcare facility to the community.

A new shapefile of hospitals and clinics that fall under the boundary of the study area
was created. To go about the process, Euclidean distance was selected in the arc
toolbox using ArcMap 10.8.2. The clinics were selected on the input, or the hospital
environment option was then selected, and the selection process insisted on
extending the choices of choosing the same as the boundary of the study area. The
following step was to select the Raster analysis to the option of a mask, the
boundary was selected, and a new raster layer of Euclidean distance with calculated
classes. The Euclidean distance measured the distance according to the units of
projection, and a cape UTM zone 35s was used. It utilized meters as units, and it
covers South Africa. This made it easy to analyze the map as it is known and can
calculate suitability.

Reclassification was performed utilizing two classes, in which class 1 symbolizes

suitable distance and class 0 for those which are not suitable. These indicate that all
villages under class 1 are suitable and those under class 0 are unsuitable. This is
essential in the site suitability analysis.

3.4 Cost distance used to measure transportation cost.

Cost distance tools are similar to Euclidean tools. Instead of calculating the distance
from one location to another, the cost distance determines the shortest weighted
distance or accumulated travel cost from each cell to the nearest source

15
location(Mahavar et al.,2019). These tools apply distance in course units, not in
geographical units.

A cost-weighted distance raster requires an input cost raster and a source raster or
feature(Wijesekera and Dissanayake,2017). It produces an output raster in which
each cell is assigned a value that is the least cumulative total cost of getting back to
the source(Wijesekera and Dissanayake, 2017). The cost will be given with different
weight values based on importance level.

The shapefile layer of elevation was added along with the shapefile of the greater
Tubatse. The elevation was extracted by mask using a spatial analyst tool with the
input raster or feature mask data as Great Tubatse. The shapefiles of the clinics, the
hospital, and the study area were added to help locate the source and destination.
The elevation layer was converted to a slope using a raster surface tool. The cost
distance was determined using the input feature as the hospital source) and the
Leboeng residence and the slope surface as a cost raster. This methodology is
applied to the cost distance between the hospital d the clinic.

3.5 Site Suitability Map

The purpose of a site suitability map is to illustrate possible options in terms of
spatial locations that have the potential for future construction of projects on them.
The site suitability map is led by the following criteria: town, roads, slope, land use,
geology, flora, fauna, etc. All of these criteria are important during the creation of the
map because they help identify which spatial locations of the study area will be
suitable for construction projects. The approach consists of 5 geospatial data, to
which the first is step 1, where the study location is determined , and the necessary
data are prepared. The selection of the study region aids in developing the standards
for carrying out the suitability analysis in later steps.

3.5.1 Site suitability map in terms of slope

In this research, the first step was creating a map showing the slope of the study
area. The process used the type of data that was used to achieve the completion of
the raster data. Two layers were added to the ArcMap, the study area, and the South
African DEM (Digital Elevation Model).

16
An extraction technique was done, by masking the South African DEM layer under
the study area layer, to create the Tubatse DEM as an output layer using the
extraction tools in the Arc toolbox. The following step was to add a surface slope
layer through a 3D analysis tool to the ArcMap and clip it to the output layer of
Tubatse DEM. This assisted in identifying the slope of each cell of the Tubatse DEM.
The tools and techniques used in this process helped to produce the final map of the
slope of every study area site.

Figure 2:Greater Tubatse slope map

An extraction technique was done, through masking in the South African DEM layer
under the study area layer, to have a Tubatse DEM as an output layer using the
extraction tools provided in the ArcMap. The next step was to add a surface slope
layer through a 3D analysis tool to the ArcMap and clip it to the output layer of
Tubatse DEM. This helped in identifying the slope of each cell of the Tubatse DEM.

17
All the slopes identified were classified into five classes looking into the steepness of
each slope. The classes ranged from:

 0% to 5%
 5% to 10%
 10% to 15%
 15% to 20%
 20% to 25%

From that range of classes, a reclassification tool was used to reclassify the layer
into two classes, one class ranging from 0% to 5% was given a value of 1 as a
suitable gentle distance for the construction of a hospital, and the other classes
ranging from 5% to 25% were given a value of zero as a steep slope which is
unsuitable. The techniques used in this process helped us produce the final map in
terms of the slope of every study area site.

3.5.2 Site suitability map in terms of road map

18
Figure 3: Greater Tubatse rasterized map

Two shapefiles were added to the ArcMap: study area shape files and the RSA
roads shape files. A tool called a clip, under the tool option Geoprocessing in the
ArcMap was used to clip the RSA roads to study the area layer. This intended to
form one resultant layer and name it Tubatse roads lines.

The next step was rasterization. The rasterization occurred by using conversion
tools-polylines to raster. This was made possible using the Tubatse road lines as an
input layer and selected classes in the value field, resulting in an output layer named
road lines raster. The classes that were selected are 6:

 Track footpath

 Other access

 Street

19
  Secondary roads

 arterial routes

 Main roads

The last step was reclassification. The classes were reclassified by a Track footpath
and other access to a value of zero. Because they were considered not to be
essential for the suitability analysis, their purpose did not have a role to play in the
functions and the organization of a hospital. The secondary roads: arterial routes,
and main roads were given the value of one as they were considered suitable
because they play a significant role in the organization of hospitals in terms of
transportation of medical equipment. The resultant output layer came out as road
line reclass, which had two classes: the first class was with a value of zero, which

20
was unsuitable, and the second class had a value of one, which was considered
suitable.

3.5.3 Site Suitability map in terms of a River map

Figure 4: Greater Tubatse rasterized rivers

21
Figure 5: Greater Tubatse reclassified river map

The following tools were used in creating this map: Geoprocessing-clipping,

rasterization, and reclassification. The first step was to add two shape files to the
ArcMap: study area shape file and the RSA rivers shape file. Next, the clipping tool
was used to clip the RSA rivers to study area, to form an output layer named
Tubatse rivers.

A buffering tool was then used to buffer the rivers so that when overlaying the
system does not see rivers as a suitable site for a construction of a hospital. An
analysis tool, multi ring buffer, was used to buffer the rivers in which the inner
buffering distance was 1,5km to account for unsuitable flood plein. The outer
buffering distance was 1km which is a suitable distance for the construction of a
hospital.

22
The next step was to do rasterization, whereby the rivers were rasterized using the
conversion tool option-polylines to raster, in the value field that classes were
selected, that required to be in the rivers, which formed an output layer that was
named reclass rivers. They were three selected classes:

 non-perennial
 Unknown
 Perennial

The reclassified process was done to the 'reclass rivers' as an input layer. Regarding
its classes, the first-class non-perennial was given zero value, and the second-class
Unknown value of zero was reclassified as unsuitable. The third value was given of
one to be reclassified as suitable because hospitals need to be near permanent and
dependable sources. The final output layer was still named reclass rivers with two
classes. The first class was a zero which indicated unsuitable, and the second class
indicated suitably.

3.5.5 Site suitability map in terms of geology.

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Figure 6: Geology map

Understanding geology becomes hugely beneficial when the Construction

Supervisor obtains information on rock type. In this research an RSA1M_Litho
chronostratigraphic polygons.shp geology layer was used to obtain the rock type and
formation of the study area. This geology layer was used in ArcGIS and the clipping
tool was used to clip the RSA geology layer to the study area. Clipping the layer to
the study area makes it easy to work with the classes which belong to the area
alone. A conversion tool was used after clipping, converting the layer from polygon to
raster choosing description in the value field and saving the output raster dataset as
geology. This made a new raster layer with all the description classes used in
reclassification for a suitable site.

24
Figure 7: Geology reclass map

.The spatial analysis tool was used for reclassification for suitable classes which
were given a value of one (1) and unsuitable classes were given a value of zero (0).
The classes were given values after a study about geology in construction of
hospitals, it gave a clear understanding of geology in the construction of a hospital

3.5.6 Site suitability map in terms of land cover

Figure 8: Land cover map

Land cover in terms of suitability is the degree to which a certain region fits the
needs of the land user or is appropriate for a particular form of land use. It usually
appears as a classification (classes) or grade (Doula et al, 2017). In this research a
SANLC 2020.tif shapefile data was added and manipulated in ArcGIS as one of the
criteria for suitable site for the construction of a hospital. A spatial analysis tool was
used to extract the raster file to the study area using extract by mask tool the output
dataset was saved as land cover. The output layer was used in reclassification for a
selection of suitable classes.

25
Figure 9: Land cover reclass map.

The spatial analysis tool was then used to reclassify the output layer, in the reclassify
tool all bare land classes were given a value of one (1) as suitable and all the other
layers were given a value of zero (0) for unsuitable.

All the reclassified layers where overlayed using the raster calculator spatial analysis
tool, in the spatial analysis tool an (and) function was used to combine the classes
which produced one final map showing all suitable and unsuitable sites.

26
4. RESULTS AND DISCUSSION

4.1 Distribution of health care facilities.

Due to a limited number of secondary healthcare facilities, many disadvantaged rural
villages lack access to secondary healthcare facilities. After examining the current
distribution state of healthcare facilities in the area, the current study seeks to
determine the distribution of healthcare facilities, the accessibility due to distance,
and the best location for a medical institution.

To know if the distribution of primary or secondary healthcare facilities was clustered,

random, or dispersed, a spatial statistic tool named averaged nearest neighbor tool
in ArcGIS was used. The average nearest neighbor measures how far off each
spatial feature's centroids are from those of its closest neighbors (Mansour, 2016).
The average of all these distances is then calculated and contrasted with an
idealized random distribution. The spatial arrangement of the features under analysis
(the observed) is said to be clustered if the mean distances of an observed
distribution are lower than the average of a fictitious random (expected distribution).
In this situation, the average nearest-neighbor ratio is above one. On the other hand,
the spatial pattern is regarded as scattered if the average distance is higher than the
predicted distribution.

The average closest-neighbor ratio is determined by dividing the observed distances

by the predicted distances with the same number of features covering the same
study region(Esri,2015). After all the calculations, the tool generates a report which
explains the results.

Average Nearest Neighbour Summary

27
Figure 6: z-score for the average nearest neighbor.

Given the z-score of 3492.7467539, there is a less than 1% likelihood that this
dispersed pattern could result from random chance.

Figure 7: Average Nearest Neighbour Summary

The average nearest neighbour for hospitals shows the distribution of hospitals in the
study area using the Euclidean distance as a distance method of calculation. The
observed mean distance is the distance from one hospital to the next in a straight
line. The observed mean distance is 15,5km one hospital is from each available
hospital in the study area.

28
Figure 6: Distribution of map facilities in the Great Tubatse.

The distribution map of healthcare facilities shows the existing primary and
secondary healthcare facilities.

The type of analysis used in this map was spatial accessibility analysis. It helped
determine the problem in healthcare facilities' distribution and availability in the study
area. The map illustration of study area clearly shows that there are more primary
healthcare clinics than hospitals within the entire municipality. In terms of the
distribution pattern of Hospitals in this municipality, however, only the North-west of
the municipality has available hospitals except for the northeast, south, and east
sides of the municipality. More clinics are in the northwest part of the Tubatse
municipality, but a few are available in the northeast and southwest parts.

29
4.2 Euclidean distance
Euclidean distance is a Spatial analyst measuring tool that computes the distance to
the nearest source for each cell(Esri,2019). The Euclidean distance output raster
includes the measured distance from each cell to the nearest
source(Esri,2019).Distances are computed from cell center to cell center as the crow
flies (Euclidean distance) in the projection units of the raster, such as feet or meters.

Figure 8: Euclidean distance map.

Figure 8 was used to compute the distance from the center of each clinic that is
available in the study area.shp to each cell from those source centers. Euclidean

30
distance was measured from each clinic to the nearest villages around the study
area. This is to measure the accessibility of primary health care in the Great Tubatse
using calculated zones of Euclidean distance ranging from

Symbol Range (m) m to km km

0 - 5000 5000/1000 5
5000 - 10 000 10000/1000 10
10 000 - 15 000 15000/1000 15
15 000 - 20 000 20000/1000 20
20 000 - 25 000 25000/1000 25

Figure 9: Symbology of converted meters to kilometers

The table below shows the converted distance from meters to kilometers from each
zone; this is done to know the distance a person has to travel to get to a clinic from
the surrounding villages to measure the suitable distance. In this case, villages that
fall along the range of 0 – 5000 (m) in which they travel 5 km was considered a
suitable distance a person can travel using public transport or even walking. The
range from 5000 – 10 000 (m) was considered a moderate distance an individual can
travel using a private car or an ambulance. The individual will be traveling from 10
km to (0 km), the center where the primary health care facility is. Then any distance
from 10km to 25km was considered unsuitable distance an individual can travel to
visit a primary health care facility.

These ranges were set considering factors like walkable distance in which, according
to (Michele 2022), access distance to primary health care is 5km, and the walkable
time is 0 to 30 minutes. Health status is considered in health care utilization,
including sickness, treatment, check-ups/consultation, and medicine collection. A
person sick and in pain cannot be expected to walk 30 minutes to a primary health
care facility. A person that visits a clinic for the collection of medicine or prevention
purposes can walk 30 minutes or 5km to a clinic. The individuals that travel 10km
use private care or an ambulance to get to the clinic. 10 km is a long distance for
anyone to walk to a primary health care facility.

31
From 10 to 25km was seen as an unsuitable distance for any individual to walk to a
primary health care clinic. Such individuals were classified as those who did not have
access to primary health care facility clinics.

Figure 10: Great Tubatse Euclidean distance of clinics

The map above shows the available clinics, the villages, and the computed
Euclidean distance buffer zones. It is seen that many of the villages do have access
to primary health care (clinics). However, only a few villages fall under the zone
unsuitable for anyone to travel to a clinic. The area of interest in Leboeng falls under
the range of suitable distance traveling to primary health care. This shows how the
Study area has an even distribution of primary healthcare facilities (clinics). Though
there is an even distribution of primary healthcare facilities, an uneven distribution of
secondary health facilities (Hospitals) is seen in the study area.

32
Figure 11: Great Tubatse Euclidean distance of hospitals

The map above shows the calculations of Euclidean distance of Hospitals in the area
of Study area in which it was seen that the placement of the hospital was done
looking at the population number and the distribution of villages as the hospitals
were seen in the clustered villages and the more disadvantaged villages were left
more disadvantaged with no access to the secondary health care facility. The village
of Leboeng is found in the range of 30 to 40km away from the nearest secondary
health care facility hospital

Symbol Range (m) m to km km

0 - 10 000 10000/1000 10
10 000 - 20 000 20000/1000 20
20 000 - 30 000 30000/1000 30
30 000 - 40 000 40000/1000 40
40 000 - 50 000 50000/1000 50
.

33
Figure 12: Symbology of classes converted from m to km

The Euclidean distance units of calculation take the units of the layer's projection. In
this case, the Hospitals projection (WGS 1984 UTM zone 35s) uses a meter (m) as
its calculation unit. Figure 12 is the conversion of Euclidean distance calculation
units from meters (m) to kilometers (km). It was seen from the map that the health
care facilities were distributed unevenly leading to the most disadvantaged villages
having no access to secondary health care (Hospital). People from the village of
Leboeng have to travel 40km to a secondary health care facility. However, the South
African guideline for the provision of social facilities states that 30km is still a suitable
distance for an individual to travel to a secondary health care facility which cannot
apply to villages like Leboeng, which have poor infrastructure, poor transport
networks, and poor area or population and considering the elders.

34
4.3. Accessibility of transport considering the Cost distance.

Figure 13: The cost distance relationship between the hospital and the Leboeng
region.

The cost distance analysis was used to determine the cost of distance from the
hospital to the Leboeng region. Output was raster data and was reclassified into five
classes, 0-5km,5km-10m,10-15km,15km-20km, and 20-25km, to get cost distance
within the Tubatse municipality using a spatial analyst tool. The total distance and
time spent traveling differ significantly( Loh et al., 2009). According to (Who,2016),

35
the most reasonable cost to travel to the health care facility is 5km. Figure 13
indicates that it is very costly, considering the distance from the Leboeng region to
the hospital. The transport from the residential area has to cover a distance of 15km-
20km to access the hospital in the district. It exceeds the guideline of the acceptable
travel distance of 5km.

36
Figure 14: The cost distance relationship between the Leboeng clinic and the
Leboeng households.

The cost distance from the household to the nearest clinic was measured. It
indicates that people living far from the chosen household must travel to the clinic for
a distance of <10km. With the acceptable traveling duration being 30 minutes. The
calculation using a kilometers conversion tool helps determine the time traveled in
kilometers. Therefore, traveling for more than 5km, the typical walkable minute is
45minutes and more. To access healthcare, the distance increases as a person
move away from the clinic. The geographic distance has been used extensively as a
proxy for transport cost under an assumption that transport increase monotonically
over space-time (Tanaka, 2010), the two being proportional to the distance unless
encountered by a barrier. According to (Warntz,2005), the accumulated travel cost of
moving through any location is variable, which means that the other paths of
movement cost more than others. 10-15km spend more cost to travel to the clinic
compared to people living in a 0-5km radius. They have less time to get to the clinic
and are within an acceptable walkable distance of 5km (WHO,2016), with a travel
time of 30 minutes or less.

4.4 Site suitability analysis for the construction of a hospital.

Suitability Analysis enables a researcher to qualify, analyze, and rank potential sites
based on how closely they comply with the criteria a researcher chooses and
establish. The criteria chosen for a site suitability analysis included roads, rivers,
slopes, land cover, and geology.

37
Figure 15: Site suitability analysis reclassified criteria layers.

Figure shows the criteria layers that resulted in the site suitability map. The road
criteria were reclassified according to how the hospital will use the roads, including
ambulance use, transport of medication, and road network for public transportation.
Criteria selection of roads was streets, secondary roads, arterial routes, other access
roads, and main roads were seen as suitable roads that a hospital could use daily.
These roads were given a value of 1 as suitable. The track footpath was given a
value of zero (0) as unsuitable. This is because track footpath roads cannot support
all the transport services of a hospital for a day-to-day function.

For geology, the criteria were chosen due to the rock type in which a hospital can be
constructed. More research showed that suitable rock types for construction included
Diabase, Gabbro, and Tuff, all of which were given a value of one (1) for suitability.
This is because these rocks are used for building and roadbeds, which are essential
for the construction of a hospital as new roads and buildings will be built. The
geology layer has many classes in which the rest of those classes were given a

38
value of zero (0), unsuitable as they cannot support the construction of the hospital.
For example, metamorphosed mudstone is a soft rock that can be easily broken and
cannot be used in hospital construction.

A hospital in a rural area with water scarcity would need to be close to a water body
that can supply the hospital with water or use it as a secondary water source.
Perennial rivers are good water sources for a hospital to be close to as they are
rivers that have water flowing throughout the year. In the reclassified rivers map,
perennial rivers were given a value of one (1) as they were seen as suitable given a
buffer zone in which the hospital should be to avoid floods. The non-perennial rivers
were given a value of zero as they were seen as unsuitable because water does not
flow throughout the year.

The slope is an essential criterion in site suitability analysis. In this case, the gentlest
slope was selected, which was 0 to 5%, given a value of (1) as suitable gentle slopes
are easy to work with and allow smooth flow and dispersant of water which makes it
a good slope for the site suitability analysis. Slope classes 5 to 25% were considered
steep and given a value of zero (0) as they will be challenging to work with, cost
much money, and may result in floods as they are associated with a high velocity of
flow of water.

The land cover criterion was based on the use of the land to select a site in which
the construction of the hospital will not impact the environment and the habitat of
other species. This ensures that land degradation is minimized by creating a criterion
that takes out sensitive environments and selecting a site that can allow
development with less environmental impact. Bare lands and open woodland are the
most suitable for the construction of a hospital as there will be less clearing of trees
and grassland, which are particularly important to the environment, which is why they
were given a value of 1 as suitable. Other classes were given a value of zero as
unsuitable.

39
Figure 17: Reclassified land cover map.

All these reclassified layers were overlayed using the (and) function to get the final
map showing suitable areas in the Study area where a hospital can be constructed.

40
Figure 18: Site suitability map.

Analysis of the relationship between health facilities and the population is essential
for all governments to empower policymakers and determine how best to meet basic
health needs for the population(Dutta,2001). Provider-to-population ratios are also
different between urban-rural areas and rural village areas which determine the
placement of health facilities. In figure , site suitability analysis focused on land
criteria, including land cover, geology, slope, rivers, and roads, without focusing on

41
population distribution. This was done to see all suitable available land for the
construction of hospitals for future suggestions to the municipality to reduce
inequality and the distance that small, disadvantaged villages with relatively low
populations get access to health care facilities at a suitable fair distance.

The green areas on the map show suitable areas for building a hospital selected
according to the criterion of all suitable classes given a value of one (1). The reason
for the large area of unsuitable land seen by a mass red color was due to the small
study area, which is a local municipality with clustered layers of buffered roads, an
exceedingly small area of suitable geology, and few slope areas of slope
corresponding with the other layer leaving a few areas to work with. All unsuitable
classes were given a value of zero (0) which were more than the suitable classes.

The results of this site suitability analysis

The problem of accessibility of secondary health care facilities in the Study area and
for the village of Leboeng can be solved by building two hospitals, one at point A and
another at point B, which will cover all the villages that do not have access to
hospitals.

42
5. Conclusion and Recommendation

5.1 Conclusion
Every individual in a country has the right to receive healthcare, healthcare is
essential for preserving life through its advanced medical technologies by preventing
illnesses from escalating and treating them for the betterment of the individual. Good
quality healthcare is measured by factors such as healthcare facilities infrastructure;
availability of medical equipment’s; the enough amount of healthcare professionals;
and physical access to healthcare facilities. Out of all these factors, the one with the
major effect is physical access to healthcare facilities. The literature review has
revealed that accessibility to healthcare facilities is an issue in many regions
worldwide and most provinces in South Africa. All these places have different laws;
policies as well as beliefs that are put in place, have one goal: to achieve balanced
access to all healthcare facilities.

In this study, spatial analysis; network analysis, and site suitability analysis were
conducted in the study area of Leboeng that is under the Great Tubatse local
municipality in the Limpopo province. Through the help of a software called
Geographic Information Systems (GIS) which has tools that help produce and
illustrate the distribution pattern of the healthcare facilities; the distance between the
healthcare facilities and the communities; the cost of traveling to the healthcare
facilities; as well as suitable land that may be used for the construction of more
healthcare facilities. Several studies also analyzed accessibility to healthcare
facilities through GIS and their results are like the results of the current study. The
results of the current study show that there is an unequal distribution of healthcare
facilities in the study area and the number of secondary (hospitals) healthcare
facilities and primary (clinics) healthcare facilities are unbalanced, there are more
hospitals than clinics in the study area however, located in one part of the study area
and terms of distance hospitals are too far and expensive to reach from other parts
of the study area. Throughout the results, site suitability map was created which
illustrated that there is still room for improvement. Whereby the study area could
construct more primary healthcare facilities to create a balance in terms of numbers
and at an accessible distance.

43
5.2 Recommendations
 To allocate mobile clinics with an appropriate physical environment, they must
have water, sanitation, and safe waste disposal, which are all functional,
dependable, and safe.
 Building a new hospital nearby, with well-trained staff who are consistent and
available to provide care.
 Availability of delivery models. This is vital in rural areas for the delivery of
medications and emergencies.
 Telemedicine solves the issue of patients travelling long distances to health
facilities.
 Improving rural healthcare and health disparities. It is vital for healthcare
industry leaders to improve healthcare in rural areas.
 Facilitate funding transportation transport, which will limit the cost burden for
residents to access the facilities.
 Coordinating a shared ride transportation program.
 Having community health workers visit residents to decrease frequent trips to
the healthcare facilities.

44
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