Disclaimer the boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. All reasonable precautions have been taken by WHO to produce this map. However this map is being distributed without warranty of any kind, either express or implied regarding its content. The responsibility for its interpretation and use lies with the user. In no event shall the World Health Organization be liable for damages arising from its use. © WHO 2012 All rights reserve Investing the marginal dollar for Maternal and New Born Health: Geographic Accessibility Analysis Edejer T., Stenberg K., Maliqui B., Ray N., Santiago H., Ben Hammadi I., Haj Assad A., Colombo R., Ebener S. The Study The Tool (AccessMod 4.0) Objective: Inform policy discussions on how to optimize or target the spending of the marginal dollar for maternal health at country level; in particular to examine the infrastructure requirements for scaling up coverage of institutional delivery with skilled attendance. Analysis: Use geographic accessibility to health infrastructure in 4 countries (Burkina Faso, Cambodia, Malawi and Zambia) as a proxy for access to health services when analyzing maternal health investments, thereby identifying local infrastructure constraints to scaling up maternal and newborn health care. A cost analysis subsequently estimates the marginal investment needed to expand coverage. First results (Cambodia and Malawi): In both countries, Accessmod has been used to estimate the total population having access to Emergency Obstetric Care (EmOC) in less than 1 or 2 hour of travel time. Comparing the results obtained with demographic and birth rates figures allows to identify in which districts physical accessibility to EmOC is the most difficult. These observations are then used by policy makers to adjust policies aiming at improving access to Maternal and new born health care services. Objective: Provide Ministries of health to benefit from the power of GIS to estimate physical accessibility to the existing health care provider network and propose options to scale it up if necessary. Functionalities: AccessMod 4.0 is a free extension to ArcGIS developped by WHO to provide users with the capacity to: 1.measure physical accessibility to health care 2.estimate geographical coverage (a combination of availability and accessibility coverage) of an existing health facility network 3.complement the existing network in the context of a scaling up exercise or to provide information for cost effectiveness analysis when no information about the existing network is available. Improvments compare to version Works under ArcGIS Additional statistical results - Improved user interface - Automatic installation package - Improved performances -Travelling scenario tables directly editable in ArcGIS Downloading AccessMod 4.0: The WHO permits the use of this extension in its present form for non-commercial (i.e. non-income generating) and non- promotional purposes. Version 4.0 can be downloaded from the Esri ArcScripts page: The mean travel time to reach the nearest CEmOC for the population of the district of Rumphi is of 3 ½ hours!... …while in the district of Zomba it is of 53 minutes!... 75% of the population from the province of Otdar Meanchey have to travel more than 2 hours to reach a CEmOC… …while 98% of the population of Phnom Penh can access one in less than 1 hour!