Spatial Accessibility of Health Facilities and Implications for Nutrition and Health Emergency Preparedness in Flood-Affected Districts of Pakistan: A GIS-Based Ecological Study

Abstract

Background: Climate-induced flooding poses a significant threat to health systems by disrupting access to healthcare, emergency referrals, and essential nutrition services. Pakistan experiences recurrent monsoon floods that disproportionately affect vulnerable populations, highlighting the need for evidence-based preparedness planning. Spatial accessibility analysis offers a valuable approach for identifying districts where limited healthcare access may compromise emergency response and continuity of nutrition and public health services. This study assessed the spatial accessibility of health facilities in flood-affected districts of Pakistan and identified priority areas for disaster preparedness. Methods: An ecological cross-sectional study was conducted using publicly available secondary datasets. Geographic Information System (GIS) techniques were applied to integrate district flood status, mapped health facility locations, and population data. District-level health-site density per 10,000 population, nearest-hospital distance, and population burden were calculated. Flood-affected and non-flood-affected districts were compared using descriptive statistics, Wilcoxon rank-sum tests, and Welch's t-tests. A composite preparedness priority score incorporating flood exposure, population burden, health facility density, and geographic accessibility was developed to identify districts requiring enhanced preparedness. Results: Flood-affected districts did not demonstrate uniformly lower health-facility density than non-flood-affected districts. Instead, considerable geographic heterogeneity was observed. While flood-affected districts generally had higher median health-site density and shorter median distance to the nearest hospital, several districts exhibited substantial preparedness gaps due to high population burden, limited population-standardized facility availability, and reduced geographic accessibility. Faisalabad, Muzaffargarh, Bahawalpur, Gujranwala, Multan, Nushki, Rajanpur, and Khairpur emerged as the highest-priority districts for preparedness interventions. The findings indicate that preparedness planning based solely on flood exposure may overlook districts with critical healthcare accessibility constraints. Conclusion: Integrating geospatial accessibility indicators with flood exposure and population burden provides a practical framework for prioritizing disaster preparedness in Pakistan. The identified priority districts should be considered for strengthening referral systems, deployment of mobile health and nutrition teams, pre-positioning of emergency medical and nutrition supplies, and improving continuity of essential health and nutrition services before future monsoon seasons. GIS-based evidence can support climate-resilient health and nutrition planning and contribute to more equitable emergency preparedness in disaster-prone settings.