Footprints and Cartwheels on a Pixel Road: On the Applicability of GIS for the Modelling of Ancient (Roman) Routes

GIS-based digital modelling tools, such as the well-known least cost paths (LCP), have been widely used in archaeology in recent years as ways of approaching forms of mobility in the past. Roman roads are among the best-known examples of ancient networks of paths and have been widely studied using such approaches. In this paper, we shall make a general reflection on the applicability of those tools for the modelling and analysis of ancient routes, with a special focus on Roman roads. Drawing from a case study in the NW Iberian Peninsula, we shall discuss certain aspects related to the potential and limits of Cumulative Costs, LCP and other related tools for the modelling and analysis of ancient roads. We will illustrate how the use of tools which explore potential mobility in less restricted ways can help to overcome some of the limitations of LCP

Geographical access to care at birth in Ghana: a barrier to safe motherhood

Background: Appropriate facility-based care at birth is a key determinant of safe motherhood but geographical access remains poor in many high burden regions. Despite its importance, geographical access is rarely audited systematically, preventing integration in national-level maternal health system assessment and planning. In this study, we develop a uniquely detailed set of spatially-linked data and a calibrated geospatial model to undertake a national-scale audit of geographical access to maternity care at birth in Ghana, a high-burden country typical of many in sub-Saharan Africa. Methods: We assembled detailed spatial data on the population, health facilities, and landscape features influencing journeys. These were used in a geospatial model to estimate journey-time for all women of childbearing age (WoCBA) to their nearest health facility offering differing levels of care at birth, taking into account different transport types and availability. We calibrated the model using data on actual journeys made by women seeking care. Results: We found that a third of women (34%) in Ghana live beyond the clinically significant two-hour threshold from facilities likely to offer emergency obstetric and neonatal care (EmONC) classed at the ‘partial’ standard or better. Nearly half (45%) live that distance or further from ‘comprehensive’ EmONC facilities, offering life-saving blood transfusion and surgery. In the most remote regions these figures rose to 63% and 81%, respectively. Poor levels of access were found in many regions that meet international targets based on facilities-per-capita ratios. Conclusions: Detailed data assembly combined with geospatial modelling can provide nation-wide audits of geographical access to care at birth to support systemic maternal health planning, human resource deployment, and strategic targeting. Current international benchmarks of maternal health care provision are inadequate for these purposes because they fail to take account of the location and accessibility of services relative to the women they serve. <br/