Assessing Geographic Accessibility to Emergency Obstetric and Newborn Care in Kwara State, Nigeria: A Travel-Time and Referral Network Analysis

Abstract Objective To quantify Emergency Obstetric and Newborn Care (EmONC) geographic accessibility across Kwara State, Nigeria, and characterise referral connectivity between Basic EmONC (BEmONC) and Comprehensive EmONC (CEmONC) facilities. Methods Travel-time surfaces were computed using AccessMod version 5, a WHO-endorsed least-cost path modelling platform, with a validated facility dataset, satellite-derived land cover, road network data, hydrological barriers for the Kainji Lake system, and WorldPop 2020 population estimates across all 16 LGAs. Transport speed parameters were established through a participatory Travel Scenario Workshop. Population coverage was estimated at 30-, 60-, and 120-minute thresholds; referral travel times were computed for active BEmONC-to-CEmONC pathways. Results Against a state population of 3,205,923, only 7.0% could reach an EmONC facility within 30 minutes, rising to 24.7% within 60 minutes and 56.9% within 120 minutes; 43.1% (approximately 1.38 million) remained beyond two hours. LGA-level disparities were extreme: 120-minute coverage was only 30% in Baruten, 38% in Ifelodun, 53% in Kaiama, and 58% in Patigi, while Ilorin South achieved 100% coverage within 60 minutes. The referral analysis identified 205 active pathways with a mean travel time of 28.3 minutes; 22% exceeded 60 minutes. Conclusion Kwara State has a severe EmONC accessibility deficit requiring urgent investment. The primary challenge is not referral efficiency but the fundamental absence of any accessible first-contact facility across most of the state. Geospatially guided facility investment in Baruten, Kaiama, Ifelodun, and Patigi, combined with formalised emergency transport and integration of geospatial evidence into health planning, is necessary.