Sectoral - Spatial Hierarchy of Health Services in Taiz Governorate, Yemen

Abstract

The study offered a detailed overview of the hierarchical structure of healthcare services in Taiz Governorate, focusing on eighteen components within public and private sectors. It employed quantitative methods and Scale Drawing Analysis (Scalogram Analysis) alongside Geographic Information Systems (GIS) for spatial analysis. The results revealed that, in the public sector, nursing personnel, physicians, and medical units dominated the first level, while in the private sector, pharmacies and drug stores led, with hospitals, optometry centers, and radiology centers at the lowest tier. Spatially, Al-Shamayatayn district ranked highest in the public sector, while Al-Ta\'ziyah, Jabal Habashe, Al-Wazi\'yah, and Mawzaa were at the bottom. In the private sector, Al-Qahirah, Salh, and Al-Mudaffar districts excelled due to comprehensive service coverage, whereas Al-Silw, Sama\'a, and Bab Al-Mandab lagged, with services limited to pharmacies. This highlights the centralization and inadequacies in healthcare policy and planning within Taiz Governorate.

Introduction

1. Importance of Healthcare Services

• Healthcare systems are vital to urban structure, quality of life, and reflect the effectiveness of governance.

• A mutual relationship exists between healthcare providers and users, shaped by comfort, quality, and service environment.

• Hierarchical and scalogram analyses help classify and assess the geographic distribution of services, revealing disparities in access and demand.

2. Study Objective

• The study evaluates the distribution and hierarchy of health services in Taiz Governorate, Yemen.

• It analyzes 18 health service components across 23 districts — 7 public and 11 private — using scalogram analysis.

• The goal is to identify which districts have better or worse health service provision, showing functional gaps and spatial-service imbalances.

3. Public vs Private Health Sectors

• Public sector includes: urban/rural hospitals, healthcare centers, primary units, doctors, nurses, and beds.

• Private sector includes: hospitals, clinics, pharmacies, drugstores, labs, radiology, dental services, ambulance services, optical shops, and beds.

• Each sector is analyzed separately, then compared to reveal the overall spatial-sectoral hierarchy.

4. Study Area: Taiz Governorate

• Located in southwestern Yemen, covering 9,587.6 km² with a 2014 population of nearly 2.93 million.

• Known as Yemen’s cultural capital, Taiz is a strategic hub linking major transport routes.

5. Methodology

• Used quantitative analysis, relying on data from the Public Health Office, hospital reports, and field visits/interviews.

• Scalogram technique was applied to visualize and compare the availability of health services across districts.

• GIS tools were also employed for spatial mapping and validation.

6. Outcomes

• The scalogram analysis revealed:

  • A clear spatial and sectoral hierarchy of public health services.

  • Significant variations in service availability and centrality of districts.

  • Some centers were better equipped, while others had notable functional service gaps.

Conclusion

The Scalogram analysis provides a comprehensive overview of the hierarchical structure of healthcare components in Taiz Governorate for the year 2014. This analysis reflects the prevailing conditions and the level of healthcare service delivery during the pre-civil war period, as outlined below: 1) Spatial Hierarchical Structure: The analysis reveals eight spatial hierarchical levels across both public and private sectors, highlighting significant centralization issues, as well as deficiencies in governance and health planning in the provision of healthcare services in Taiz Governorate. Taiz City, comprising the three districts of Al-Qahirah, Al-Mudaffar, and Salh, is identified as the highest tier in the spatial health hierarchy, with a relative weight of 13%. This tier encompasses 12 out of 13 health service components, with the exception of one component: the rural hospital. Conversely, the Sama\'a district ranks lowest, incorporating only five components of the general healthcare services. 2) Sectoral Hierarchical Levels: The analysis identifies eight sectoral hierarchical levels for the components of general healthcare services in both the public and private spheres. The initial level comprises four elements: nursing staff, pharmacies, drug stores, physicians, medical units, and medical centers. Collectively, these components account for an estimated 35.7% of the total healthcare service components within the governorate. At the final sectoral level, optometry and radiology represent the most limited components of healthcare services. 3) Public Healthcare Sector Hierarchy: Within the public healthcare sector, a hierarchy of four levels has been established. The first level includes nursing staff, physicians, medical units, and medical centers. Notably, the governorate hospital is positioned at the fourth level due to its absence across nineteen directorates. In contrast, the private healthcare sector is characterized by seven hierarchical levels, wherein pharmacies and drug stores occupy the foremost level, while optometry and radiology are relegated to the seventh level. 4) Spatial Hierarchical Structure of Public Sector Services: The spatial hierarchy in the public sector encompasses three hierarchical levels, with the Al-Shamayatayn district leading the first level by including all components of government healthcare services. In comparison, the last level consists of the directorates of Al-Ta\'ziyah, Jabal Habashe, Al-Wazi\'yah, Mawza\'a, Mashrah and Hadnan, and Sama\'a. For the private sector, the spatial hierarchy consists of eight levels, with the districts of Al-Qahirah, Salh, and Al-Mudaffar at the top level for encompassing all components of private healthcare services. Conversely, the districts of Al-Silw, Sama\'a, and Bab Al-Mandab are categorized at the lowest level, where private healthcare services are limited to a single component: pharmacies and drug stores.

References

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Copyright

Copyright © 2025 Ahlam M. Anaam, Parag A. Khadke. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.