Optimising geographical accessibility to primary health care: a geospatial analysis of community health posts and community health workers in Niger

Background Little is known about the contribution of community health posts and workers (CHWs) to geographical accessibility primary healthcare (PHC) services at level strategies for optimising these services. Methods Using a complete georeferenced census CHWs in Niger other high-resolution spatial datasets, we modelled travel times between 2000 2013, accounting training, commodities maximum population capacity. We estimated additional needed optimise beyond reach existing post network. assessed efficiency targeting network compared with networks designed population, under-5 deaths Plasmodium falciparum malaria cases. Results The per cent within 60-minute walking nearest CHW increased from 0.0% 17.5% 2013. An 10.4 million people (58.5%) remained catchment posts. Optimal deployment 7741 could increase coverage 41.5% 82.9%. Geographical was inefficient but optimised improve by 32.3%–47.1%, depending on metric. Interpretations provide first estimates national scale Niger, highlighting improvements geographies where gaps approaches PHC level.