GIS-based assessment of spatial equity in primary healthcare accessibility in Kassala City, Sudan

Despite the growing use of geographic information systems (GIS) in public health, Kassala State, Sudan, has not previously been the subject of GIS-based assessments of the spatial organization of primary healthcare facilities. This study analyzed the distribution and accessibility of primary healthcare centers in Kassala City, with particular attention to disparities between its eastern and western banks. Using a GIS-based service area, buffer, kernel density, and location–allocation analyses, we integrated geocoded facility locations, the urban road network, and small-area population statistics to evaluate the adequacy of current coverage and identify underserved neighborhoods. The results reveal marked spatial inequities: several densely populated residential clusters are located beyond the effective catchment area of any public primary healthcare center, while other facilities exhibit overlapping catchment areas and overcrowding, contributing to inefficiencies and reduced quality of care. Quantitatively, approximately 333,419 residents are assigned to primary healthcare catchments, of whom approximately 82% are served by centers whose population load exceeds 10,000 people, while an estimated 156,069 inhabitants lack access to any formal services outside morning opening hours. Based on these findings, a spatial information system for health services in the Kassala locality was established, including a digital health facility map and an associated geographic and statistical database. This study proposes candidate locations for additional backup health centers that comply with the Federal Ministry of Health’s siting guidelines and improve coverage of vulnerable populations. It concludes by recommending the institutionalization of GIS-based spatial planning within the Ministry of Health, including the creation of a dedicated spatial management unit and the adoption of national and international standards for the equitable allocation of health services.