Quantifying the impact of health service delivery barriers on access to healthcare: a case study of antiretroviral therapy in Mali

Article Article scientifique Article Quantifying the impact of health service delivery barriers on access to healthcare: a case study of antiretroviral therapy in Mali eng 2026-06-19 2026-06 author Timoner Pablo 0000-0003-4757-4928 GeoHealth Group, Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Institute of Environmental Sciences, University of Geneva, Geneva, Switzerland.,Health Resources and Services Availability Monitoring System (HeRAMS) Initiative, World Health Organization, Geneva, Switzerland. 562495 Services communs de l'Institut des sciences de l'environnement (ISECO) author Hierink Fleur 0000-0002-2727-0540 GeoHealth Group, Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland fleur.hierink@unige.ch.,Institute of Environmental Sciences, University of Geneva, Geneva, Switzerland. 917598 Institut de santé globale (COSPR) author Ray Nicolas 0000-0002-4696-5313 GeoHealth Group, Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Institute of Environmental Sciences, University of Geneva, Geneva, Switzerland. 126189 Institut de santé globale (COSPR) author Toure Ousmane Health Resources and Services Availability Monitoring System (HeRAMS), World Health Organization, Bamako, Mali. author Cissé Hamsatou Unité de Mise en Oeuvre du Renforcement du Système de Santé, Gouvernement du Mali Ministère de la Santé et du Développement Social, Bamako, Mali. author Sy Ousmane Direction Générale de la Santé et de l'hygiène Publique, Gouvernement du Mali Ministère de la Santé et du Développement Social, Bamako, Mali. author Fuhrer Caroline Health Resources and Services Availability Monitoring System (HeRAMS) Initiative, World Health Organization, Geneva, Switzerland. author Petragallo Samuel Health Resources and Services Availability Monitoring System (HeRAMS) Initiative, World Health Organization, Geneva, Switzerland. 640027 e019476 10.1136/bmjgh-2025-019476 42320937 2059-7908 PMC13289087 https://gh.bmj.com/lookup/doi/10.1136/bmjgh-2025-019476 Achieving universal health coverage is a key component of the Sustainable Development Goals, focusing on equitable access to quality health services and minimising financial hardship. While strategies often target the demand-side, supply-side barriers such as travel time and facility-level constraints are often overlooked. Accurately quantifying who is affected by these barriers and identifying their locations and specific barriers is critical to improving service delivery. This study examines these barriers in Mali, a country with significant health system challenges exacerbated by high fertility rates and political instability. Using the WHO's Health Resources and Services Availability Monitoring System, we conduct an analysis of the geographic accessibility of antiretroviral therapy (ART) services. Our aim is to estimate the number of people affected by supply-side barriers by using a geographic accessibility model that calculates travel time to facilities with ART services. The analysis applies a least-cost path algorithm to assess accessibility, where ART services are defined as accessible within 2 hours travel time. People within this range with available services have access while those outside are geographically constrained. For those within 2 hours but without ART access, we identified and quantified facility-specific barriers. The results show that nearly 2.7 million Malians do not have timely access to ART within 2 hours. For about 70%, distance is the main barrier, while the rest face facility-level issues such as the fact that the service is not being planned in the facility, lack of medical supplies and lack of training. This study offers important insights for targeted interventions to scale up ART provision and provides a scalable model for other health services and contexts. Africa South of the Sahara Delivery of Health Care Geographic information systems Health Services Accessibility Health services research Dewey 613 Dewey 333.7-333.9 66 Institut de santé globale 22A1 18 Institut des sciences de l'environnement 0DB false 941 ISE Pôle Informatique environnementale 1275 GeoHealth: approches géospatiales et environnementales en santé globale 1000 1057 TIGERS BMJ global health 11 6 63de7a83-8b42-49ac-a8be-6c0e389ee737 Article (Published version) Public TImoner_et_al_BMJ_2026.pdf 1114049 application/pdf CC BY-3.0 a07e20089fab99e3a8fc996d3c123119abc1bfd70ca3fd54106b7859a01ba453 d6b95d63-602f-490e-8208-af92d5a399ea Supplemental data Public inline-supplementary-material-1.pdf 2771905 application/pdf 4a146a1fb99b58ccdec5181f9aa2d0f3537137c9b8d46a7771e7eca5244eb1d0 16ea47b9-4601-437f-8cb2-054d5227259b Appendix Public inline-supplementary-material-2.pdf 63690 application/pdf 5c01a1f4d7bd75e9cfdc73763057e8c1fb32a701fce12fe29bfe457e564efd71 Vignette Public Screenshot 2026-06-20 at 09.48.41.png 166285 image/png openAccess Faculté de médecine / Section de médecine clinique / Département de santé et médecine communautaires / Institut de santé globale Centres et instituts / Institut des sciences de l'environnement

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Quantifying the impact of health service delivery barriers on access to healthcare: a case study of antiretroviral therapy in Mali	BMJ global health			2026	5	5

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Petragallo, Samuel