Cost effectiveness and strategic planning (WHO-CHOICE)


The geographic location of health services can have a direct impact on health outcomes within countries, by affecting how quickly patients can seek care when faced with illness and injuries. Improved understanding of geographic variation and related inequity in access to resources within countries is increasingly being recognized as central to meeting development goals in the context of universal health coverage.

Measures of accessibility and availability of 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.

In recognition of the key impact that Emergency Obstetric Care (EmOC) can have on maternal mortality and safe birth outcomes, recent analysis in four countries (Burkina Faso, Cambodia, Lao People’s Democratic Republic and Malawi) uses the AccessMod© software to assess availability and accessibility coverage to EmOC.

The analysis aims to:

  • Measure 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.
  • Measure geographic coverage (availability) at subnational level to determine whether sufficient resources are available to provide the required health services.
  • Compare estimates of accessibility and availability with actual service utilization in order to assess potential bottlenecks to effective coverage.
  • Design 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.


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