{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T13:41:55Z","timestamp":1792417315563,"version":"4.4.0"},"reference-count":4,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T00:00:00Z","timestamp":1786320000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Embassy of Sweden"},{"name":"People at the Centre"},{"name":"Zambian Ministry of Health"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,19]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>In many low- and middle-income countries, inequities in maternal health outcomes are linked to disparities in spatial access to essential health services. In Zambia, significant portions of the rural population reside &amp;gt;5 km from the nearest health facility. This contributes to the \u2018three delays\u2019 of maternal mortality: delay to seek care, delay to reach a health facility, and delay to receive care from a skilled health provider. Consequently, at 187 per 100 000 live births, Zambia\u2019s maternal mortality ratio is above the global target of &amp;lt;70. This paper describes the application of a geospatial prioritization approach used by the Ministry of Health to guide investments in new maternal health infrastructure (mothers\u2019 waiting homes and maternity annexes) and upgrades to existing facilities. Using cross-sectional data from 692 public health facilities in Eastern and Southern Provinces, the approach integrates routine service and maternal mortality data from the national Health Management Information System , with facility infrastructure assessments and geospatial analysis. Facilities were screened using binary eligibility criteria based on recorded maternal deaths and then ranked using a weighted scoring model reflecting infrastructure readiness gaps for continuity of maternal care. Findings indicate widespread facility coverage for labor and delivery services, contrasted against inadequate capacity for the recommended 48-hr postnatal observation care. Maternal deaths were concentrated in 28% of facilities in Eastern and 19% in Southern Province. Applying the prioritization framework reduced the potential scope of infrastructure investment from 606 facilities to 27 high-priority sites, lowering projected investment costs from US$41.8 million to \u223cUS$2 million. The approach demonstrates how targeted infrastructure investments, informed by geospatial and routine health system data, can improve equity and continuity of care and optimize impact from limited resources. This applied framework offers a practical and scalable model for evidence-informed infrastructure planning in resource-constrained settings.<\/jats:p>","DOI":"10.1093\/heapol\/czag099","type":"journal-article","created":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T11:08:52Z","timestamp":1786100932000},"page":"1596-1602","source":"Crossref","is-referenced-by-count":0,"title":["Maternal health infrastructure investments in Zambia: leveraging geospatial evidence to inform planning and prioritization"],"prefix":"10.1093","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-9967-3354","authenticated-orcid":false,"given":"Emmanuel","family":"Katyoka","sequence":"first","affiliation":[{"name":"Clinton Health Access Initiative , Strengthening Accountability for Program Coordination and Acountability (SA&C) for the PeaCe health program, PO Box 51071, Ridgeway, Lusaka ,","place":["Zambia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8061-1332","authenticated-orcid":false,"given":"Kutha","family":"Banda","sequence":"additional","affiliation":[{"name":"Clinton Health Access Initiative , Strengthening Accountability for Program Coordination and Acountability (SA&C) for the PeaCe health program, PO Box 51071, Ridgeway, Lusaka ,","place":["Zambia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason","family":"Wamulume","sequence":"additional","affiliation":[{"name":"Ministry of Health, Department of Policy and Planning - Infrastructure Unit, Lusaka ,","place":["Zambia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patson","family":"Mwanza","sequence":"additional","affiliation":[{"name":"Ministry of Health, Department of Policy and Planning - Infrastructure Unit, Lusaka ,","place":["Zambia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fredrick","family":"Mumba","sequence":"additional","affiliation":[{"name":"Clinton Health Access Initiative , Strengthening Accountability for Program Coordination and Acountability (SA&C) for the PeaCe health program, PO Box 51071, Ridgeway, Lusaka ,","place":["Zambia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ibrahim","family":"Abdallah","sequence":"additional","affiliation":[{"name":"Clinton Health Access Initiative , Strengthening Accountability for Program Coordination and Acountability (SA&C) for the PeaCe health program, PO Box 51071, Ridgeway, Lusaka ,","place":["Zambia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hilda","family":"Shakwelele","sequence":"additional","affiliation":[{"name":"Clinton Health Access Initiative , Strengthening Accountability for Program Coordination and Acountability (SA&C) for the PeaCe health program, PO Box 51071, Ridgeway, Lusaka ,","place":["Zambia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olatubosun","family":"Akinola","sequence":"additional","affiliation":[{"name":"Clinton Health Access Initiative , Strengthening Accountability for Program Coordination and Acountability (SA&C) for the PeaCe health program, PO Box 51071, Ridgeway, Lusaka ,","place":["Zambia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rabson","family":"Zimba","sequence":"additional","affiliation":[{"name":"Clinton Health Access Initiative , Strengthening Accountability for Program Coordination and Acountability (SA&C) for the PeaCe health program, PO Box 51071, Ridgeway, Lusaka ,","place":["Zambia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,8,10]]},"reference":[{"key":"2026101908522010200_czag099-B1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0052110","article-title":"Distance to care, facility delivery and early neonatal mortality in Malawi and Zambia","volume":"7","author":"Lohela","year":"2012","journal-title":"PLoS One"},{"key":"2026101908522010200_czag099-B2","doi-asserted-by":"publisher","first-page":"1091","DOI":"10.1016\/0277-9536(94)90226-7","article-title":"Too far to walk: maternal mortality in context","volume":"38","author":"Thaddeus","year":"1994","journal-title":"Soc Sci Med"},{"key":"2026101908522010200_czag099-B3","author":"The DHS Program - Zambia: DHS"},{"key":"2026101908522010200_czag099-B4","volume-title":"Trends in Maternal Mortality 2000 to 2017: Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division","author":"World Health Organization"}],"container-title":["Health Policy and Planning"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/heapol\/advance-article-pdf\/doi\/10.1093\/heapol\/czag099\/70605294\/czag099.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/heapol\/article-pdf\/41\/9\/1596\/70605294\/czag099.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/heapol\/article-pdf\/41\/9\/1596\/70605294\/czag099.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T12:52:29Z","timestamp":1792414349000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/heapol\/article\/41\/9\/1596\/8758530"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,10]]},"references-count":4,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,8,10]]},"published-print":{"date-parts":[[2026,10,19]]}},"URL":"https:\/\/doi.org\/10.1093\/heapol\/czag099","relation":{},"ISSN":["0268-1080","1460-2237"],"issn-type":[{"value":"0268-1080","type":"print"},{"value":"1460-2237","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,10]]},"published":{"date-parts":[[2026,8,10]]}}}