Improving accessibility to rural health services: The maximal covering network improvement problem

Accessibility to health facilities is a critical factor in effective health treatment for people in rural areas of lesser-developed countries. In many areas accessibility is diminished by the lack of all-weather roads, making access subject to weather conditions. Location-allocation models have been used to prescribe optimal configurations of health facilities in order to maximize accessibility, but these models are based on the assumption that the underlying transport network is static and always available. Essentially, past work has ignored the potential impacts of improvements to the transport system in modeling access. In this paper we propose a model that treats the opposite side of the location/transport equation; that is, a model that treats existing facility locations as fixed and improves health service accessibility by upgrading links of the transport network to all-weather roads. This new model, called the Maximal Covering Network Improvement Problem (MC-NIP) is formulated as an integer-linear programming problem. An application of the MC-NIP model to the Suhum District of Ghana is presented, which shows that even a modest level of road improvement can lead to substantial increases in all-season access to health service.     

A Hybrid model for locating new emergency facilities to improve the coverage of the road crashes

We propose an emergency facility-locating model aimed at increasing the coverage of emergency demand throughout the city. The proposed model takes into account the status and location of the emergency facilities in the network and identifies locations suitable for the construction of new facilities. Here, Data Envelopment Analysis (DEA) and Maximum Coverage Location Problem (MCLP) have been combined in a single model. To do so, design problem and evaluation problem are considered concurrently to maximize the efficiency of services provided by emergency facilities across the city in response to the demand. Moreover, the total emergency demand in each district was considered in relation to the population density, the fatal, injurious, and property damage only (PDO) crashes. The coverage area of each emergency facility was assumed to be proportional to the average ambulance speed in the surrounding road network during rush hours. The available budget was included in the model to let the model function under various fiscal conditions. Model input variables consisted of average number of mortalities, injuries and PDO crashes as well as the population density of each urban district. The output variables of the model included the coverage share of proposed emergency centers and hospitals equipped with ambulances. The model was tested on the network of Tehran (Iran). It is recommended to add the location of some emergency centers and hospitals to the network. Moreover, the results showed that ten urban districts had efficiency problem in provision of emergency services.     

Leveraging multi-tier healthcare facility network simulations for capacity planning in a pandemic

The COVID-19 pandemic has placed severe demands on healthcare facilities across the world, and in several countries, makeshift COVID-19 centres have been operationalised to handle patient overflow. In developing countries such as India, the public healthcare system (PHS) is organised as a hierarchical network with patient flows from lower-tier primary health centres (PHC) to mid-tier community health centres (CHC) and downstream to district hospitals (DH). In this study, we demonstrate how a network-based modelling and simulation approach utilising generic modelling principles can (a) quantify the extent to which the existing facilities in the PHS can effectively cope with the forecasted COVID-19 caseload; and (b) inform decisions on capacity at makeshift COVID-19 Care Centres (CCC) to handle patient overflows. We apply the approach to an empirical study of a local PHS comprising ten PHCs, three CHCs, one DH and one makeshift CCC. Our work demonstrates how the generic modelling approach finds extensive use in the development of simulations of multi-tier facility networks that may contain multiple instances of generic simulation models of facilities at each network tier. Further, our work demonstrates how multi-tier healthcare facility network simulations can be leveraged for capacity planning in health crises.     

Network flow-based strategies for identifying rail park-and-ride facility locations

Many cities are considering introducing or expanding rail service in an effort to diversify their modal splits. Park-and-rides are integral to this strategy because they represent private auto users’ access points to the system. Proper placement of such facilities is a strategic location decision, as it can conceivably decrease vehicular traffic on congested roadways while benefiting users. This paper models the decision to locate park-and-ride facilities in a network flow-based framework. From this perspective, optimal placement occurs at locations where vehicles will encounter facilities early during their journeys to a centralized area or major activity center. Locating park-and-rides in this fashion maximizes the chances of removing users from the network. These elements are demonstrated in three hypothetical placement scenarios that make use of synthetic network and traffic flow data. Results illustrate the functionality of our approach for identifying park-and-ride candidate locations. Lastly, implications of our work are discussed in light of broader planning concerns and practical demands on rail facility location.     

A multiobjective modeling approach to locating incinerators

The location of hazardous material incineration facilities is an important problem due to the environmental, social, and economic impacts that they impose. The costs associated with the facilities and the risks placed on nearby populations are important concerns as are the distributions of these costs and risks. This paper introduces a mixed-integer, multiobjective programming approach to identify the locations and capacities of such facilities. The approach incorporates a Gaussian dispersion model and a multiobjective optimization model in a GIS-based interactive decision support system that planners can access via the Internet. The proposed approach is demonstrated via a case study in central Portugal where the national government has decided to locate a large facility for the incineration of hazardous industrial waste. Due to intense local and national opposition, construction of the facility has been delayed. The system has been designed so that it can be used by decision makers with no special training in dispersion modeling, multiobjective programming, or GIS.     

Sequential facility location with distance dependent demand

Systems providing identical service to many population centers frequently face the issue of where to locate the next retail outlet, branch, store, etc. In such systems the demand for the facilities' service depends mainly on the distance between facilities and customers. It is assumed that there are already m facilities located on a network to respond to the demand at the nodes. The paper addresses the problems of finding a location on the network for the (m +1 )st facility corresponding to a given total expected demand and of determining which demand points will be served by which facility. Also the range of the total expected demand values that can be realized along each link in the m +1 facility system is determined. Examples and a discussion of the results are provided.     

Provisioning health care infrastructure in communities: Empirical evidences from West Bengal,India

We developed a framework to reinvigorate communities in terms of public health care infrastructure provisioning for outpatient needs within the neighborhoods. The health care seeking episode is often influenced by the physical and health care infrastructure availability within the neighborhood, need of the health care seeker as well as personal, household, occupational, and latent perception of the users. This empirical study has been developed for two different groups in West Bengal India, firstly based on location and secondly based on the choice of the health care seeker. In case of resident based approach, we focused on the revisit decision of the rural inhabitants who sometime tend to travel to the regional facilities in urban areas. Facility based approach analyzed the people who were at the regional facilities for health care services. We devised scenarios ascertaining improvisation in service delivery, emergency facility and mobility ease at local public facilities might reduce regional tours and instigate higher utilization of the neighborhood health care facility. We develop integrated choice and latent variable models to incorporate latent perception in choice of scenario for instigating revisit decision. Results showed choice of development scenarios have association with the household structure, social network, locational and infrastructural impedance. This framework lead to two distinct outcomes: (1) method to identify programs, those are essential to by initiate_revisit_to the health care facility (2) perception based assessment of the current mobility and health care infrastructure of the region, which could be instrumental in developing the overall health care infrastructural planning policy as a whole.     

Location and service mix decisions for a managed health care network

For managers of managed health care organizations, the problem of designing a competitive multiple facility network cannot be solved by existing mathematical models. This paper thus presents a nonlinear integer model for determining a facilities design strategy that embodies the economic tradeoffs encompassed in a competitive strategy: minimizing cost and maximizing market share. The integrated location and service mix model determines the number, location and service offerings of facilities that maximize profitability in a two-level hierarchical referral delivery network where an organization's market share is represented by a multiplicative competitive interaction model. To demonstrate the usefulness of the proposed integrated model, a series of problems is solved by an interchange heuristic and compared to the solutions derived by a simpler approach that ignores market competition.     

A goal programming model for facility location planning

The paper presents a goal programming model for facility location planning. Often the location-decision is coupled with multiple objectives, at times conflicting among themselves. Specifically the model considers the four major objectives: (i) necessary locations, (ii) maximum number of locations, (iii) capacity restrictions and (iv) transportation cost/walking distance minimization, simultaneously and proposes optimal locations in conjunction with the existing facilities in the region. The model developed has been illustrated with an example considering the location of community storage facilities in a specified region.     

Critical infrastructure location under supporting station dependencies considerations

This paper develops a framework to locate critical infrastructure (CI) facilities to most fully capitalize on the supporting stations (SSs) they depend on for normal operation. CI facilities include health services, transportation and electricity; agencies that impact the national economy, security and the public's health and wellbeing. SSs are facilities that provide essential services for the regular operation of a CI. For instance, the power service, communication services and water supply services are SSs for Hospitals. In this paper SSs are independent from the CIs that they service and have a heterogeneous probability of failure that will cripple the dependent CI. The proposed framework ranks the SS according to its cost of providing service such that the rank-1 SS is the primary service provider and incorporates the probability of failure for the SS. The CI will be served from secondary SS if the primary fails due to a disaster. This formulation insures the continuous service to the CI from SS and determines both the optimal location of the CI and the optimal number of demands served. A mixed integer linear programming approach is applied to develop a Reliable Facility Location Problem considering Supporting Stations (RFLP-SS) to identify the optimal location to build a critical facility. In addition to that, The RFLP-SS determines the capacity of the optimally located facility and its allocated demands. This research highlights the importance of considering dependencies among the SSs that service CI. The paper presents a case study in Puerto Rico to demonstrate the applicability of the proposed framework. The case study investigates the status of health services in Puerto Rico, and identifies the optimal locations to establish new hospitals. The paper recommends 11 locations for new hospitals so that the people of Puerto Rico will be better served than they are currently.     

浅析市政道路给水管道设计施工方式

当前随着经济的发展,城市吸引了越来越多的人进入,各类配套设施都在不断增加以满足人民的需求,给水管道作为民生必须品也在增加.给水管道的设计施工与民生息息相关,十分重要.本文首先对市政道路给水管道设计应遵循的原则进行阐述,其次对如何选择与确定给水管网管径进行分析,之后讨论道路管线位置的确定与施工,最后结合了市政道路给水管道...     

Planning for equal transit-based accessibility of healthcare facilities: A case study of Shenzhen,China

Recent location-allocation studies have made considerable progress in optimizing the equality of facility accessibility but are focused on automobile transport to facilities. In cities, however, the transit-based accessibility of essential services is crucial for social equality and sustainable development. In this study, we develop a modified transit-based maximal accessibility equality (MAE) model for optimizing the equality of the transit-based accessibility of healthcare facilities. In this model, equality is quantified as the weighted mean absolute deviation (WMAD) of accessibility across locations. Two scenarios are set up to reallocate resources or allocate newly added resources. The results reveal that the equality of transit-based healthcare accessibility can be significantly improved in both scenarios. A dispersed planning strategy for facilities is suggested to achieve equal accessibility. However, the transit-based optimization results significantly differ from the car-based optimization results, with more supply allocated to facilities close to transit corridors. This finding implies that the traditional car-based MAE model might generate unequal healthcare accessibility for transit-dependent populations and thus lead to biased recommendations for healthcare planning. Furthermore, it shows that traditional car-based optimization may engender a misallocation of healthcare supply, exacerbating the inequality in healthcare accessibility. The necessity of incorporating public transit into public facility planning is highlighted. The improved MAE model can be applied in cities where the supply of public services is relatively adequate and public transit plays an important role in daily mobility.     

Capacitated heuristic program for multiactivity, multi-facility system designs

Multi-activity, multi-facility design systems occur in a wide variety of industrial and service applications: e.g.: regional health care centers with configurations of activities at each center, and multi-echelon inventory distribution systems. The problem in designing such systems is to determine from a candidate set of possible locations what facility locations should be opened and what types of activities should be carried out at each of the open facilities. This article presents an efficient heuristic procedure for such a problem.The heuristic procedure described can be used to solve both the uncapacitated and the capacitated problems where capacity is expressed in terms of the number of activities which can be supported by the facilities.Extensive computational experience with the heuristic is presented. The performance of the heuristic is compared against optimal solutions and the results look very encouraging.     

Reverse logistics optimisation for waste collection and disposal in health institutions: the case of Turkey

Waste management in health institutions has become important in recent years because of the increase in population and industrialisation. Waste generated from health institutions has risks for human health and the environment. Therefore, this paper presents a reverse logistics optimisation for waste collection and disposal in Turkish health institutions. A multiperiod, multitype product waste reverse logistics network was designed to build an effective collection and disposal system for waste generated from health institutions in Turkey. A mixed integer linear programming model was developed to determine the optimal number and locations of the facilities for efficient waste management in health care by minimising the total cost. In this context, a sensitivity analysis was conducted to examine the impact of the incremental changes of waste amounts on the optimal reverse logistics network. According to increasing waste amounts, the numbers of changes in facilities are analysed and strategies are specified.     

DEVELOPMENT GOES WIRELESS

This paper examines how the introduction of mobile phones has helped to alleviate poverty and improve the lives of the people of Botswana. Economic efficiency has been improved through lower communication costs, increased labour mobility, and wider access to both banking facilities and information on market prices. Liberalisation of the telecommunications market is needed to ensure that the sector remains responsive to end-user needs.     

Estimating debt capacity of New York State health facilities

A measure of the capacity to take on new debt is developed for health facilities. This measure is a function of the current financial position of the facility, future financial market conditions (interest rates and bond/loan maturities), and a policy variable (the debt service coverage ratio) to be set by state health policy makers. The quality of this measure was shown to depend on the quality of current health facility financial accounting data, on the quality of forecasts of interest rates and future cashflow, and on the appropriateness of the criterion debt service coverage ratio. Some of the limitations of the estimate are discussed. Consideration of the debt capacity estimate serves to highlight some crucial issues in imposing capital expenditure limits, namely the interrelationships between financial viability, interest rates and access to capital markets.     

城市人行天桥对道路交通的影响分析

人行天桥是行人过街的一种重要设施,它能够将人们步行交通与机动车、非机动车交通有效分离开来,从而缓解城市道路交通拥堵问题,保障行人过街的安全,提高人们出行的效率。文章通过交通调查城市人行天桥的配置选型,结合行人的过街行为和心理特征分析,采用统计分析方法探讨城市人行天桥对于城市道路交通的影响,发现城市人行天桥在道路交通运营中存在利用率低下、配置不合理、服务水平差等问题。因此,应该合理规划城市人行天桥的选址,人性化设计人行天桥结构,提高人行天桥的利用率、便捷性和舒适度,从而满足人们步行交通的需要,发挥人行天桥作为城市道路交通过街设施应有的作用。     

Modeling integrated supply chain logistics in real-time large-scale disaster relief operations

The goal of this research is to develop a comprehensive model that describes the integrated logistics operations in response to natural disasters. We propose a mathematical model that controls the flow of several relief commodities from the sources through the supply chain and until they are delivered to the hands of recipients. The structure of the network is in compliance with FEMA's complex logistics structure. The proposed model not only considers details such as vehicle routing and pick up or delivery schedules; but also considers finding the optimal locations for several layers of temporary facilities as well as considering several capacity constraints for each facility and the transportation system. Such an integrated model provides the opportunity for a centralized operation plan that can eliminate delays and assign the limited resources to the best possible use.A set of numerical experiments is designed to test the proposed formulation and evaluate the properties of the optimization problem. The numerical analysis shows the capabilities of the model to handle the large-scale relief operations with adequate details. However, the problem size and difficulty grows rapidly by extending the length of the operations or when the equity among recipients is considered. In these cases, it is suggested to find fast solution algorithms and heuristic methods in future research.     

Reconfiguring a set of coverage-providing facilities under travel time uncertainty

We study networks of facilities that must provide coverage under conditions of uncertainty with respect to travel times and customer demand. We model this uncertainty through a set of scenarios. Since opening new facilities and/or closing existing ones is often quite expensive, we focus on optimal re-configuration of the network, that is finding a facility set that achieves desired thresholds with respect to expected and minimal coverage, while retaining as many of the existing facilities as possible. We illustrate our model with an example of Toronto Fire Service. We demonstrate that relocating just a few facilities can have the same effect as opening a similar number of new ones. We develop exact and approximate solution approaches and test them with computational experiments. Algorithm based on Tabu Search (with certain novel components) appears to be particularly successful for this problem. We also analyze the multi-objective version of the problem, where the expected and minimum coverage levels are treated as objectives in addition to the objective of maximizing the number of pre-existing facilities in the final location set.     

Health care facility planning: some developmental considerations.

A model of the provision of health care facilities is outlined. This model is based on a framework developed in central place theory and is concerned with the scale, frequency and service area structure of health care facilities. Certain modifications to the model are proposed and this provides a framework for dealing with the problem of adjustment in systems of service provision. Three types of adjustment, all involving different degrees of centralization, are considered. Each type of adjustment results in a particular modification to the spatial structure of the hierarchical system. Consideration is then briefly given to a number of ways in which this general approach may be made more realistic, in order to deal with actual systems of service provision.