Distance to healthcare facilities, healthcare use and health outcomes: The case of Papua New Guinea

Papua New Guinea (PNG) has among the worst maternal and child health (MCH) outcomes in the Asia-Pacific region. Improving population access to and use of health services is a key government priority. However, it is unclear from the international evidence whether the observed inverse relationship between distance to health facilities and health outcomes is due to health service use. This article first seeks to estimate the relationship between distance to health facilities, the use of MCH services and health outcomes in PNG. The second goal is to assess whether the observed relationship between distance to health services and health outcomes occurs due to health service use. Cross-sectional data from the Demographic and Health Survey 2016-18 for PNG were used to estimate the association between distance to health facilities, indicators of health service use and indicators of child health outcomes, using regression methods. Causal mediation methods were used to assess whether the observed associations between health outcomes and distance to health facilities were explained by health service use, or not. We find an inverse association between distance to health facilities and utilisation of MCH services; and between distance to health facilities and child health. However, our analyses do not support causal mediation via impact of distance on health service use. At odds with a large literature that implicitly assumes that health service use improves health outcomes, our findings reflect broader concerns about quality of care in PNG.