Cost effectiveness and strategic planning (WHO-CHOICE)


As countries progress towards Universal Health Coverage (UHC), there is a need for geographic information regarding the spatial distribution of available health services in relation to population health needs. The geographic location of health services has a direct impact on health outcomes within countries, by affecting how quickly patients can seek care when faced with illness and injuries.

Measuring the availability of and the physical accessibility to health services contributes to understanding the performance of health systems which facilitates the development of evidence based health policies. WHO-CHOICE supports the use of Geographic Information Systems (GIS) to analyse physical accessibility to health services, linking the results to national planning and costing processes, and policy discussions on how to optimise investments in the health system and addressing inequities in service access.


AccessMod is a free toolbox that has been developed by WHO in order to assist countries to examine the geographic aspects of their health system. It specifically addresses the first three layers of a well-known framework developed by Tanahashi (1978) to evaluate health service coverage (the specific three layers being: the target population, availability coverage and accessibility coverage).

AccessMod uses the analytical capacities of GIS and assists data visualization, by:

  • Assessing travel time and thereby how physically accessible existing health services are to the target population - Physical accessibility analysis
  • Taking into account the coverage capacity of each health facility to estimate the share of the target population that could be seen with a certain quantity of inputs (i.e., health workforce, infrastructure). As a next logical step, determining whether coverage capacity is (in)sufficient to provide care to everyone living within the facility’s catchment area - Geographic coverage analysis
  • Calculating distance and travel time between different types of health system infrastructure - Referral analysis
  • Estimating the percentage share of the population with coverage in each sub national division to examine inequities - Zonal statistics
  • Identifying the optimal location for building new health facilities - Scaling up scenario analysis

Version 5.0 of AccessMod is packaged as a stand-alone open source application that can run on different platforms (Windows, Linux, Mac) through the use of a virtual machine (VirtualBox) and allows the use of geospatial data created by different GIS software (ArcGIS, QGIS, GRASS,...) Version 5.0, can be downloaded together with a user manual, sample datasets and examples of application in countries, from here: Download AccessMod 5.0.

Country reports

In recognition of the key impact that Emergency Obstetric Care (EmOC) can have on maternal mortality and safe birth outcomes, the WHO-CHOICE project has supported the use of AccessMod to examine geographic accessibility to EmOC services in four countries (Burkina Faso, Cambodia, Lao People’s Democratic Republic and Malawi).

More specifically, the analysis aimed at:

  • Measuring accessibility coverage at subnational level to determine how physically accessible resources are for the population, specifically the percentage of births where the household can access EmOC within 2 hours of travel time.
  • Measuring geographic coverage (availability) at subnational level to determine whether sufficient resources are available to provide the required health services.
  • Comparing estimates of accessibility and availability with actual service utilization in order to assess potential bottlenecks to effective coverage.
  • Designing scenarios to model an increase in accessibility and geographic coverage that would occur from specific investments aimed at increasing the number and/or capacity of EmOC facilities. This can inform investment strategies with an associated estimated cost to increase coverage and improve maternal health outcomes.

Link to country reports:


  • Health Systems Financing
    Cost-effectiveness analysis and its implementation via CHOICE is part of health systems financing.