Assessing Population-level Accessibility to Medical College Hospitals in India: A Geospatial Modeling Study

Background: While studies have investigated the availability of Medical College Hospitals (MCHs) in India, data on geographical accessibility is limited. Our study looks at the current geographical accessibility to these MCHs across 36 states and union territories (UTs) and 735 districts. Methods and Findings: We provided and validated the MCH data acquired from the National Health Profile Report 2022. We took motorized and walking travel-time friction surface rasters from the Malaria Atlas Project 2019 and high-resolution population estimates from WorldPop 2020. Using these, we examined the density of MCHs per million population and the median travel time to the nearest MCH. We assessed the Access Population Coverage (APC), defined as the proportion of the population within 30, 60, 90, and 120 minutes by motorized transport and within 30 and 60 minutes from the nearest MCH by walking. In 2022, India had an average density of 0.47 MCHs per million. The median travel time to the nearest MCH was 67.94 minutes by motorized transport and 589.82 minutes by walking. 71.76% of the population could access the nearest MCH by motorized transport within 60 minutes (range across districts: 0-100%). 4.22% of the population could access the nearest MCH by walking within 30 minutes (range across districts: 0-71.86%). The APC was 62.20% within 60 minutes by motorized transport in rural vs. 92.34% in urban areas. The APC within 60 minutes by motorized transport for public MCHs was 63.62%, while that for private was 45.95%. These estimates do not account for resource availability at the hospitals or vehicular ownership in the population. Conclusions: Median travel time and APC are useful for assessing geographical accessibility. Our study found a wide disparity in MCH access across Indian states and rural vs. urban areas. These analyses can guide the optimal placement of new MCHs.