Developing and evaluating transit-based healthcare accessibility in a low- and middle-income country: A case study in Ulaanbaatar, Mongolia

This study examined transit-based accessibility to hospitals in Ulaanbaatar, the capital city of Mongolia, which is one of the low-and middle-income countries (LMICs). Promoting transit-based accessibility to hospitals is an important public health policy goal because limited accessibility can lead to adverse health outcomes. Public transit is especially crucial for people living in LMICs because many of them lack private vehicles. However, transit-based hospital accessibility has not been widely studied in LMICs. With the recent development of open -source transit analysis tools and standardization of schedule-based transit network data protocols, we could build Ulaanbaatar's schedule-based transit network dataset in great detail. We computed transit-based accessibility to hospitals from 128,032 residential parcels in Ulaanbaatar. Overall, transit-based accessibility to hospitals was higher in the central area than in the peripheral areas of Ulaanbaatar. Specifically, transit-based accessibility to hospitals was significantly lower in the ger area (settlements without central infrastructure connection to heat, water, and sewage) than in the non -ger area (apartment area). The results revealed that about 10% of people living in the study area have inadequate transit-based accessibility to hospitals. Our research is one of the first studies attempting to create a detailed schedule-based transit network and measure transit-based accessibility to hospitals in a rapidly growing, under-examined city in LMICs.