Spatial Analysis of Health Centers in the Governorate of Amman, Jordan Mahmoud Abdullah Al-Habees*1 Abstract Objective: This study aimed at shedding light on the health centers in the Health Directorate of Amman, Jordan. That is, it explained the spatial analysis of the primary health centers in order to show the quantitative and qualitative spatial distribution of the existing health centers in the study area, analyze the spatial variation of the characteristics of the health centers, and introduce some recommendations allowing decision makers to make the optimal use of these health centers. Methods: This study adopted the inductive approach for the special and statistical properties of health services. The community consisted of all official health centers in the Health Directorate of Amman. There are 58 health centers that are comprehensive, primary, or secondary. The study used the appropriate statistical equations and methods appropriate to answer its specific questions. Results: The study concluded that there is a lack of medically qualified and specialized staff in the majority of health centers, and there is a considerable variation in the pattern of distribution of health centers in general. That is, the spatial distribution is concentrated to some urban areas. Besides that, the concentration ratio of health services indicates that the concentration ratio of the recipients of health services is not balanced with the concentration ratio of doctors. Keywords: Spatial analysis of health centers, the capital city. (J Med J 2013; Vol. 47 (1):44- 56) Received Accepted August 8, 2010 October 2, 2011 Introduction communities. Thus, the process of providing developed health services for those in need Investigating health services is of importance becomes a primary responsibility of in civilized societies and developed countries governments, which should provide them to since it assesses the government programs to their citizens.1 achieve the social and economic goals. It is significant and of particular interest in the Some attempts have been carried out to policies of developing countries since it is a define public health, including, within its developing and planning tool for the recent framework, Winslow’s definition advancement of both individuals and which states that public health practice is the 1. Department of Regional Planning, College of Planning & Management, Al-Balqa Applied University, Al-Salt, Jordan. * Correspondence should be addressed to: Mahmoud A. Al-Habees P. O. Box: 19117, Al-Salt E-mail: [email protected] © 2013 DAR Publishers∕ University of Jordan. All Rights Reserved. Spatial Analysis of Health Centers in the Governorate of Amman, Jordan… Mahmoud A. Al-Habees science of disease prevention and health because of unclear symptoms of the disease promotion through the organized efforts of to determine the appropriate treatment, (2) the community to ensure a healthy the preventive services presented by taking environment, the prevention of disease, the necessary precautions to fight diseases, and organization of medical and nursing services, (3) the rehabilitation services associated with and the development of social conditions.2 natural or rehabilitative treatment.8 Another definition can be set for the public health, in which it includes the protection and The Problem sanitation of the environment in addition to the treatment of water and pollutants that The study problem is summarized in threaten human life.3 Therefore, certain answering the following questions: measures should be developed for disease prevention and the risk of injury to improve 1. Do the health centers cover all the public health. As defined by some,4,5 public communities in the study area? health is the need for health, being deprived 2. What is the nature of the spatial variation of disorder in human health and life, which of the health centers? requires medical attention. The World Health 3. What is the pattern of the spatial Organization defines health as a state of distribution of health centers in the study physical, mental, and social adequacy, not area? merely the inability or absence of disease. From a different perspective, public health The Significance provides health insurance to the community to ensure reducing the rates of disease and The study is significant since it highlights the death tolls, sustaining the community, importance of the Amman Governorate, improving efficiency, and providing people which is the largest governorate in terms of with the best quantity and quality of the population in addition to the existence of the service through health institutions. In spatial diversity, where the urban and rural addition, it is also a basic demand for human areas of the city of Amman are. Certainly, needs that must properly be met in a way such a spatial diversity is accompanied by a which is consistent with health planning due variation in the level of services performed to specific planning standards to ensure the by health facilities in hospitals and health health of a community.6 centers. In addition, this study is of importance because of the paucity of the Investigating health services is considered an planning studies of the health services in important study in the geography of services Amman. because it touches an important side in the research concerning spatial and urban areas Methods and because it is related to the health of the individual and society and represents one of The study was based on the inductive or the criteria of measuring the progress of the deductive approach to the spatial and state in providing health care services.7 statistical properties of health services, along Health services are provided in three ways: with the application of some equations and (1) the treatment services which are provided statistical methods to highlight different to the patient in health institutions in which correlations. patients’ diseases are diagnosed and which provide extra laboratory testing needed 45 J Med J 2013; March: Vol. 47 (1) http:∕∕dar.ju.edu.jo∕jmj Spatial Analysis of Health Centers in the Governorate of Amman, Jordan… Mahmoud A. Al-Habees Study Community Equation 4: This is for the method of nearest-neighbor (for more details, look at The study community consisted of all of the Khair Safouh, 1990, p. 341) 12, which refers official health centers in the Amman to the distribution pattern based on the Governorate, which exceeded 58 health following equation: centers and in which the number of doctors S = 2P N / ST was 439 in 2009.9,10 where S = the pattern of distribution P = the average of the distance Statistical Methods between each health center and the nearest residential area The study used the analytical descriptive N = number of health centers statistical method and used the following St = size of the area of Amman equations: Governorate Equation 1: Pearson's correlation coefficient The Limitations was calculated to measure the relationship between population size and the number of The study is limited by the review of related health staff in the study area by applying the literature. The spatial studies related to the following equation: health services at the international level are N mg X Y _ (mg X) (mg Y) varied and can be classified according to R= [(N mgX2) + (mg X2)] *[(N mgY2) + (mg Y2)] several categories as follows: where R = Pearson's correlation coefficient 1. Certain studies were interested in N= number of health centers in Amman investigating the geographical Governorate distribution of health services based on X= number of recipients of health services in statistical methods. What distinguishes each health center this group of studies was the attempt to Y= the number of medical staff in each promote health services through site health center. planning, investigate their recipient’s properties, and analyze barriers that Equation 2: This is the equation of change affected the efficiency and effectiveness percentage which is: G = p1 –p0 *100 p0 of health services. Of these important where G = the change percentage during the studies are: Schneider (1967), 13 Bashhur period for which the spatial variation will be and Scott (1970), 14 Abernathy and measured Hershey (1970), 15 Calvo and Marks P0 = the number in the previous year (1999) (1973), 16 Hetzel (1978), 17 and Brvida P1= the number in the following statistical and Wan (1981). 18 year (2009) 2. Other studies focused on the spatial distribution of health services, based on Equation 3: This is the concentration the rates of population growth, the percentage (for more details, look at Ahmed increase of health services, and the size of Al-Jarallah, 1997, p. 13, quoted by Abed- the workforce. Of these important studies AlMohsen Zinni, 1974) 11 are the study by Taylor (1980), 19 which The number of variable elements in the region focused on the variation problem in the The concentration percentage =100 distribution of public services and The number of variable elements in all regions accessibility, especially in rural areas, and 46 J Med J 2013; March: Vol. 47 (1) http:∕∕dar.ju.edu.jo∕jmj Spatial Analysis of Health Centers in the Governorate of Amman, Jordan… Mahmoud A. Al-Habees it emphasized the importance of The Study Area investigating the spatial distribution of health centers. This agreed with what was The Amman Governorate is considered the concluded by Shannon and Dever (1974) largest governorate of Jordan in terms of 20, which stated that the quantitative and population which is nearly 2,315,600 people qualitative spatial distribution for the (38.7% of the total population) of whom sources of health services was regarded 2,177,100 live in urban regions, compared to as one of the fundamentals of an effective the total population of Jordan which is delivery of health services. 5,980,000. The total area of the Amman 3. The developing countries were interested Governorate is 7,579 km² which is 8.54 % of in studies related to health services, the total area of the state.35 The Amman particularly those evaluating the status of Governorate witnessed a rapid population the services and compared them with growth during the second half of the those in developed countries.