Modeling Mobile Health Service Delivery To Syrian Migrant Farm Workers Using Call Record Data

Abstract

A significant number of Syrian refugees under temporary protection in Turkey work in agriculture seasonally in various rural areas during several months a year. These migrant farm workers and their families are deprived of access to the regular health care system and preventive services due to their remote locations. The government supports the delivery of different types of mobile health care services, such as vaccination for children, reproductive health and screening services. While planning the mobile health care service delivery, it is critical to know where the refugees will work during what time frame; hence the demand for the services. By analyzing the call record data of a major mobile network operator in Turkey, we quantify the increase in the volume of calls made by Syrian refugees in various agricultural areas during the harvesting season of local crops. This information helps us to forecast spatial and temporal distribution of demand for mobile health care services at a fine granularity. Taking demand over multiple periods as input into a mathematical programming model, we optimize the routing of mobile clinics that visit locations close to where refugees are concentrated over the given planning horizon. We consider three hierarchical objectives. Given the availability of a number of mobile clinics at community health centers in the districts, the first objective aims to maximize the percentage of refugees that can benefit from each service type within pre-defined close distances. The second objective minimizes the number of clinics needed while covering the maximum percentage of refugees. The third objective minimizes the total travel distance of the clinics, while keeping the maximum coverage level using a minimum number of clinics to achieve this level. We quantify the benefits of centralized planning (by the province directorate) over decentralized planning (by each district separately). We also show the trade-off between the required number of clinics and coverage of potential patients. © 2020 Elsevier Ltd