F1000Research F1000Research 2046-1402 F1000 Research Limited London, UK 10.12688/f1000research.140107.4 Research Article Articles Investigate the efficiency of primary care facilities in emergency situations by application of geographical and demographic standards using GIS

[version 4; peer review: 2 approved, 2 approved with reservations]

 Jarghon Ali E. M. Conceptualization Data Curation Formal Analysis Investigation Methodology Validation Writing – Original Draft Preparation Writing – Review & Editing https://orcid.org/0009-0006-2040-3474 1 Damayanti Nyoman Anita Conceptualization Supervision Validation Writing – Review & Editing a 1 Dhamanti Inge Conceptualization Data Curation Supervision Validation Writing – Review & Editing https://orcid.org/0000-0003-2347-8771 1 Awad Anas M. M. Formal Analysis Methodology Software Writing – Original Draft Preparation Writing – Review & Editing https://orcid.org/0000-0002-1553-1707 2 Faculty of Public Health, Airlangga University, Surabaya, East Java, 60114, Indonesia Faculty of Geodesy and Geomatics Engineering, Bandung Institute of Technology, Bandung, West Java, 40132, Indonesia nyoman.ad@fkm.unair.ac.id

No competing interests were disclosed.

 19 12 2025 2023 12 1579 8 12 2025 Copyright: © 2025 Jarghon AEM et al. 2025 This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background

This study applied geographical standards (coverage distance) and demographic standards to investigate the capabilities of primary healthcare facilities to cover the largest area of the study area and the service area that can be accessed. This study aimed to determine the number of primary healthcare (PHC) centres required to ensure adequate healthcare coverage for the entire community.

 Methods

Data was obtained by applying geographic information system (GIS) techniques, including proximity analysis, spatial overlay, and network analysis, to analyze primary care facilities using the demographic and geographic standards for primary care facilities. The study was conducted in Sleman District, Yogyakarta, Indonesia, using ArcGIS 10.5 and QGIS software for spatial analysis.

 Results

PHC centers cover 79% of the study area according to the geographical standard. The study area needs 41 additional centers to cover the shortfall in service provision per the demographic and geographic standards.

 Conclusions

A significant deficiency in the number of primary care centers found in the study area compared to the large population at the geographical and demographic standards level.

 Primary health care emergencies geographical standard demographic standard GIS Coverage The author(s) declared that no grants were involved in supporting this work. Amendments from Version 3

This new version of the article includes several improvements and clarifications compared to the earlier version. The methods section has been made clearer by adding more explanation about how the GIS analysis was done, including road network preparation, delay time calculation, and how final travel time was computed. More details were also added to explain how the network dataset was built and how service areas were analyzed. Several figures, tables, and descriptions have been updated to make the results easier to understand, especially the maps showing PHC coverage, population density, and underserved areas. The demographic analysis was also clarified to show more clearly how the number of required PHC centers was calculated. The discussion section has been strengthened to better explain what the findings mean for healthcare planning and emergency preparedness. The recommendations have been simplified and made more practical for policymakers. Overall, this version provides clearer explanations, improved analysis, and more useful conclusions, making the study easier to follow and more informative.

 Introduction

The pre-disaster phase of the disaster management (DM) process is based on examining the current readiness of facilities and services related to disaster risk reduction and identifying and addressing deficiencies and weaknesses for providing the needs and requirements for the success of the DM process. 1 The spatial evaluation process for the sites of services and facilities needed for DM examines readiness in the study area using geographic information system (GIS) techniques and spatial analysis. 2 – 4

Geographical standards (coverage distance) and demographic standards show the capabilities of primary health center facilities to cover the largest area of the study area and the service area. In addition, we analyze the population’s suitability with the number of facilities available in the study area to find out if it is sufficient to provide services to the entire community according to the standards required. 5 – 8

Planning standards for primary care centers

Primary health care (PHC) is a crucial component of health systems and communities’ social and economic development. 9 – 11 PHC is responsible for providing health services and responding to emergencies at each sub-region level. 11 – 16 Sleman District was chosen as the study area because it has a high population density, mixed urban and rural areas, and a high disaster-risk level. There are 26 centers in Sleman District, Indonesia, distributed over 17 sub-regions. 12

The study utilized demographic and geographic Standards as variables, gathering data from the District Health Office. It adhered to the Ministry of Health’s regulations to assess their applicability within the study area.

 Methods Study area

The study was conducted in Sleman District, Yogyakarta City, Indonesia, which comprises 26 Primary Health Care (PHC) centers distributed across 17 sub-regions. Sleman District has the highest disaster risk index in Yogyakarta, with a score of 97. 17 This study utilized ArcGIS 10.5 to analyze the distribution and accessibility of PHC facilities based on demographic and geographic standards, aiming to identify shortages, assess needs, and propose solutions and recommendations. 18 – 21

The GIS-based analytical approaches employed in this study depend on the availability of spatial and non-spatial data. 22 – 24 According to the geographical standard, each sub-district should have one PHC, and urban facilities should have a service scope within specific distances: 5 km for hospitals, 2.5 km for schools, and 2 km for markets. Non-spatial data, such as population demographics, were also considered to estimate healthcare demand. 25 , 26

Furthermore, the study utilized statistical data to measure the need for new PHC centers based on the population data. The Ministry of Health set the standard where each PHC has to provide services for 20,000 people. 27

Data collection and preparation Astronomical location

Sleman District is located between 110° 13′ 00″ to 110° 33′ 00″ east longitude and 7° 34′ 51″ to 7° 47′ 03″ south latitude (see Figure 1).

Astronomical site of Sleman district. Population

Sleman had a population of 1,206,714, comprising 608,968 males and 597,746 females, within an area of 574.82 km 2. The population density was 2,099 people per km 2. Notably dense districts include Depok (5,359 people per km 2), Mlati (4,049 people per km 2), Gamping (3,771 people per km 2), and Ngaglik (3,194 people per km 2) in 2018. 28

Population density

Figure 2 shows the population density distribution across Sleman District. High-density areas in the central and southern sub-districts indicate greater service demand, supporting the demographic finding that 41 additional PHCs are needed.

Population density in Sleman district. Data collection, processing, and analysis

Proximity Analysis: Assessed the accessibility of PHC facilities by measuring distances or travel times from specific locations, considering transportation networks and road conditions to determine ease of access during emergencies.

Spatial overlay: Combined spatial data layers to identify relationships and patterns, such as overlaying facility locations with demographic data to pinpoint areas with a critical need for primary care. This overlay identified gaps by linking population data to service coverage zones, helping to pinpoint critical need areas. Additional overlays for schools and markets (within 2.5 km and 2 km, respectively) were also applied to measure secondary accessibility standards.

Network analysis: Optimized routes and travel times using transportation networks, aiding in the identification of efficient emergency service routes and areas requiring improved infrastructure or additional facilities. Routes were calculated considering road types, traffic patterns, and transportation networks, which enabled the identification of underserved areas and assessment of infrastructure improvement needs. 29 , 30

This study improves travel-time estimation by adding delay time into the ArcGIS network analysis ( Figure 3). Previous calculations only used the road length and speed, which often produced inaccurate results during emergencies.

Network analysis.

Delay time is calculated using Equation (1). It represents the additional time caused by obstacles, traffic, and road conditions.

The base travel time is calculated using Equation (2), and both values are combined to obtain the final travel time. Delay Time = Length of Each Part in the Road Network ∑ Length of Road × 100 × Down Time Travel Time second = ∑ Length of Road km speed on the road km / h × 3600 s / h ÷ 1000 m / km

Dataset generation for network analysis

The GIS network analysis used Sleman’s road network data obtained from the Regional Disaster Management Agency (RDMA). This road network forms the basis for modelling disaster-response accessibility. Roads in Indonesia are classified by speed and status—National (100 km/h), Provincial (80 km/h), City (50 km/h), and Other Roads (30 km/h)—following national transport guidelines.

The road database was processed in ArcGIS 10.5 to correct topological errors such as gaps and breaks. Additional attribute fields were created, including road type, direction, speed, length, delay time, travel time, and road condition. These parameters support network restrictions and determine how each road segment contributes to travel time, service area, and emergency response analysis. Road direction was classified as one-way or two-way, while road condition was categorized as very good, good, bad, or very bad.

The correctness of facilities’ locations were verified through maps using Google Earth and WorldWindEarthExplorer. Using the ArcGIS 10.5 program and Arc Analysis tools, the study area is derived based on arial images, identified by comparing it with the arial images obtained from Indonesian Disaster Management Agency. The extracted data sets were then transferred to Microsoft Excel 2013, using the network analysis in Arc GIS 10.5 (open source alternative: QGIS) to analyze and determine the scope of service of PHC. Spatial analysis of the location regarding PHC needed in the study area depended on geographical standard and demographic standards. By applying these standards, we can inquire about PHC capabilities to cover the study field and the service area that could be accessed. In addition to analyzing the population’s suitability with the number of PHCs available in the study area, is it sufficient to provide primary healthcare services to all, at the time and standard required? The analysis started by obtaining the map of 26 PHC centres distributed over 17 sub-regions as shown in Figure 4.

Primary healthcare center distribution in Sleman district. Results Geographical standard (coverage distance)

According to the geographical standard, each sub-district must have one PHC and urban facilities, including a scope of service within 5 km, a school within 2.5 km, a market within 2 km, and a hospital within 5 km. 31 The service area of PHCs in the study area, based on these geographical standards, is illustrated below:

 Geographical standard, availability of hospital within 5 km

The PHC service areas in the study area are defined by a 5 km radius from hospitals. Figure 5 shows the availability of hospitals within this radius. It was found that 24 health centers met the specified standard in the presence of a hospital (represented in green), while two health centers did not meet the standard (represented in red).

Illustrates the service area of primary healthcare (PHC) in the study area, based on a geographical standard of 5 km from the hospitals. The scope of service within 5 km

The PHC service area based on a 5 km radius is further detailed in Figure 6. According to the Indonesian Ministry of Health standards, health centers are required to provide services within a 5 km distance. The 5 km radius for healthcare service coverage is chosen to enhance accessibility and equity, ensuring patients can reach healthcare within a manageable distance, especially in rural and semi-urban areas (Regulation of the Minister of Health of the Republic of Indonesia Number 43 Year 2019 Concerning Public Health Centers, 2019).

The service area of PHC in the study area based on the geographical standard (5 km).

In Sleman District, health centers cover an area of 454.10 km 2 out of 574.25 km 2, serving approximately 79% of the study area. The unserved area totals 120.15 km 2, primarily in the northern (Cangkringan, Pakem, Turi, Tempel) and southern (Prambanan, Berbah, Gamping) districts. Detailed coverage for each district is provided below:

Cangkringan District: One PHC covers 24.24 km 2 out of 44.72 km 2 (45% unserved).

Pakem District: One PHC covers 25.98 km 2 out of 52.70 km 2 (50.7% unserved).

Turi District: One PHC covers 22.90 km 2 out of 40.50 km 2 (43.4% unserved).

Tempel District: Two PHCs cover 28.45 km 2 out of 32.33 km 2 (12% unserved).

Prambanan District: One PHC covers 14.25 km 2 out of 40.62 km 2 (64.9% unserved).

Berbah District: One PHC covers 17.0 km 2 out of 25.85 km 2 (24.2% unserved).

In conclusion, the study area has a service coverage deficiency of 21%. This highlights the need for additional primary healthcare centers (PHCs) in districts that face shortages. These districts have high population densities and are also located in close proximity to natural disaster sources, such as volcanoes, floods, and landslides. Inadequate PHC coverage can lead to serious health outcomes, including delayed treatment, increased cases of preventable diseases, and higher maternal and child mortality rates. During disasters or emergencies, limited access to healthcare may also result in greater vulnerability and poorer recovery among affected populations.

 Geographical standards, availability of schools with 2.5 km

The service area of the PHC center is defined as a 2.5 km radius from the schools. Figure 7 illustrates the availability of schools within this 2.5 km radius. A service scope within 2.5 km of the primary care centers has been implemented. In Figure 7, 26 PHC centers met the specified standard in the presence of a school, indicated by the green color.

The service area of the PHC centre (2.5 km from the schools). Geographical standards, availability of market within 2 km

The service area based on a 2 km radius from markets is shown in Figure 8. Out of 26 PHCs, 23 met the standard (indicated in green), while three did not (indicated in red). Three PHC centers did not meet the specified standard in the presence of a market, indicated by the red color.

The service area of the PHC centre in the study area based on the geographical standard (2 km from the market). Demographic standard

Table 1 provides an explanation of the individuals who receive services and those who do not receive services through the PHC center in Sleman District, based on the demographic standard. The location of the PHC center is determined by the population distribution in the region, following the demographic standard set by the Indonesian Ministry of Health, which specifies serving a population of 20,000 people per PHC. 32 After applying the demographic standards, the study yielded the following findings. The total population of the Sleman district is 1,206,714 people. Out of 26 PHCs, 520,000 individuals are receiving services in accordance with the prescribed criteria. The population without access to services amounts to approximately 686,714 people. According to the demographic standard, a larger percentage of the population should have access to PHC services. The shortage in health centers represents approximately 41 PHC centers. Statistical data indicates that the highest number of individuals lacking services in PHCs is found in the Depok region, with a shortage of 130,526 people. The construction of seven additional PHC facilities is necessary. In contrast, the percentage of individuals lacking access to PHC services in Cangkringan District is relatively small, necessitating the establishment of one new PHC.

Number of people who receive services and who do not receive services through PHC centre according to the demographic standard in Sleman District.
No. Sub-District Population (2018) No. of PHCs Served population Unserved population PHCs needed
1 Berbah 59,943 1 20,000 39,943 2
2 Cankringan 29,592 1 20,000 9,952 1
3 Depok 190,526 3 60,000 130,526 6-7
4 Gamping 110,288 2 40,000 70,288 3-4
5 Dodean 72,286 2 40,000 32,286 1-2
6 Kalasan 88,110 1 20,000 68,110 3-4
7 Minggir 29,929 1 20,000 9929 1
8 Mlati 115,466 2 40,000 75,466 3-4
9 Moyudan 31,536 1 20,000 11,536 1
10 Ngaglik 123,039 2 40,000 83,039 4
11 Ngemplak 66,899 2 40,000 26,899 1-2
12 Pakem 38,658 1 20,000 18,658 1
13 Prambanan 48,734 1 20,000 28,734 1-2
14 Seyegan 47,355 1 20,000 27,355 1-2
15 Sleman 68,480 2 40,000 28,480 1-2
16 Tempel 50,844 2 40,000 10,844 1
17 Turi 34,489 1 20,000 14,489 1
Total 17 1,206,714 26 520,000 686,714
Discussion

In this study, the researchers set a geographical standard to determine the service area of Primary Health Care (PHC) centers in the study area. The standard was based on a 5 km radius from the hospitals. 25 According to the findings presented in the study, it was observed that 24 health centers met the specified standard for service area coverage in the presence of a hospital. This discrepancy between compliant and non-compliant health centers may have important implications for healthcare accessibility in the region. The availability of PHC services within a 5 km radius from hospitals could significantly impact the ease of access to healthcare for the population living in those areas. The PHC centers that fall within the service area are better positioned to serve their communities effectively, ensuring that a larger population has access to essential healthcare services. Factors such as distance, transportation infrastructure, and population density could play a role in determining the feasibility of establishing PHC centers in those regions. 33 , 34 Policymakers and healthcare administrators may need to consider additional measures to address the accessibility challenges faced by these areas, potentially by improving transportation options or establishing additional health facilities to fill the service gap.

Overall, this study provides valuable insights into the distribution of PHC services based on geographical standards in the study area. The findings can serve as a foundation for healthcare planning and resource allocation, aiming to enhance healthcare accessibility and ultimately improve the overall health outcomes for the population in the region. However, further research and collaboration between various stakeholders, including government agencies, healthcare providers, and community representatives, will be necessary to address the challenges highlighted by the study and ensure equitable access to healthcare services for all residents.

The variations in PHC coverage across different sub-districts signify the importance of localized and targeted healthcare planning and resource allocation. It is evident that certain areas are more underserved than others, requiring specific attention and efforts to improve healthcare accessibility in those regions.

The study’s findings can serve as a foundation for evidence-based decision-making in healthcare planning and policy development. By identifying the areas with the greatest need for additional healthcare resources, policymakers can prioritize their interventions to achieve more equitable healthcare distribution and improve the health outcomes of the population in the study area. The implementation of a service scope based on a 2.5 km radius from schools is a commendable step towards improving healthcare accessibility and promoting the well-being of the school community.

It also encourages early intervention and preventive healthcare practices, which can contribute to better health outcomes among the school community.

The implementation of a service scope based on a 2 km radius from markets is a promising initiative to enhance healthcare accessibility in the study area. 25 The findings in Figure 8 underscore the importance of such approaches in healthcare planning. However, it is crucial to continue evaluating and refining the service area to ensure that healthcare services effectively reach all populations, particularly those residing near markets. By addressing the challenges and disparities identified in the evaluation process, healthcare providers and policymakers can work together to build a more inclusive and accessible healthcare system, ultimately contributing to the improvement of community health and well-being.

The study highlights the importance of adhering to demographic standards to ensure that a larger percentage of the population has access to PHC services. There is a shortage of 41 PHC centers, based on the demographic standard of 20,000 people per PHC. This shortage of health centers directly affects the number of individuals who lack access to healthcare services in the region. Moreover, shortfalls indicate that a considerable portion of the population lacks timely access to essential healthcare, potentially leading to adverse health outcomes such as delays in medical interventions, and overall diminished quality of care. The underserved populations are especially vulnerable in emergencies, where delays in accessing healthcare can exacerbate injury or illness outcomes.

The study’s results have significant implications for healthcare planning and resource allocation in Sleman District. Policymakers and healthcare authorities need to take into account the demographic standards and the actual healthcare needs of the population when planning the distribution and establishment of PHC centers.

The study identifies significant gaps in healthcare access for a substantial portion of the population. Addressing these disparities requires careful planning, resource allocation, and the establishment of new PHC centers, particularly in regions with the greatest need. By addressing the shortages and expanding healthcare infrastructure, policymakers can work towards achieving a more equitable healthcare system that caters to the healthcare needs of all individuals in the district. Based on the findings, policymakers should prioritise establishing new PHC centres in underserved sub-districts such as Cangkringan, Pakem, Turi, and Prambanan, where healthcare access remains limited. These areas face high population density and disaster risk. In addition, alternative healthcare delivery models such as mobile clinics and telehealth services should be used to improve access in remote and disaster-prone locations. Implementing these strategies will strengthen healthcare accessibility, reduce preventable health problems, and improve community resilience.

 Conclusion

In conclusion, there is a significant deficiency in the number of PHCs in the study area compared to the large population, both at the geographical and demographic standards level. The region is in urgent need of filling these gaps by establishing new PHC centers to meet the population’s needs and provide high-quality PHC services in line with international standards. This will also help alleviate the burden on central hospitals in the region.

Recommendations

Policymakers should consider expanding infrastructure by establishing additional PHC centers in densely populated, underserved areas, thus improving service reach. Additionally, enhancing community engagement through health education and preventive care programs can lower disease incidence, helping to manage healthcare demand in high-need areas. Improving transportation routes to PHCs would further facilitate access for those in distant regions. Finally, adopting a data-driven approach to resource allocation, utilizing GIS data, will ensure that health infrastructure evolves to meet population changes and emerging needs, creating a resilient and equitable healthcare system.

 Data availability

The data for this study are owned by the Indonesian Disaster Management Agency, Statistics Indonesia (BPS), and the Sleman District Health Office, it can be obtained here:

Click the following link, change language to English, click download publication, input your E-mail, and the file will be downloaded https://slemankab.bps.go.id/publication/2019/08/16/c400805c8dee98a3d701ea33/kabupaten-sleman-dalam-angka-2019.html

https://geoportal.slemankab.go.id/; to access the data, use the direct link as following: https://geoportal.slemankab.go.id/layers/geonode_data:geonode:a__3404_50KB_PT_SEBARAN_RUMAH_SAKIT_SLEMAN_20 https://geoportal.slemankab.go.id/layers/geonode_data:geonode:a__3404_50KB_PT_PUSKESMAS_SLEMAN_2020

Acknowledgements

The authors would like to thank the health district office in the City of Yogyakarta for insightful suggestions and advice.

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Inquiry (United States). 2023;60:004695802211460. 36629371 10.1177/00469580221146041 PMC9837279 Roy P Chandran A : Applications of geographical information system and spatial analysis in Indian health research: A systematic review. BMC Health Serv. Res. 2024;24:1448. 39574096 10.1186/s12913-024-11837-9 PMC11580228 10.5256/f1000research.174054.r356660 Reviewer response for version 3 Roy Pankaj 1 Referee https://orcid.org/0000-0003-1244-0081 Central University of Karnataka, Kalaburagi, India

Competing interests: No competing interests were disclosed.

 11 1 2025 Copyright: © 2025 Roy P 2025 This is an open access peer review report distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. recommendation approve-with-reservations

Critical Review of the Article: "Investigate the Efficiency of Primary Care Facilities in Emergency Situations by Application of Geographical and Demographic Standards Using GIS"

1. Title Evaluation: The title reflects the core focus of the study, emphasising both the geographical and demographic dimensions of primary healthcare facility accessibility in emergency contexts. However, it could be more concise by removing redundant phrasing such as "by application of geographical and demographic standards" and simplifying it to suggested below.

Suggestion: One of the best fitted titles may be "Evaluating the Efficiency of Primary Healthcare Facilities in Emergency Situations: A GIS-Based Geographical and Demographic Analysis"

2. Abstract Review: The abstract provides a clear overview of the study, including the background, methods, results, and conclusions. However, it lacks specificity regarding the geographical area and demographic standards applied. Including more details about the study area (Sleman District, Indonesia) and the GIS tools utilised would enhance clarity.

Suggestions:

Specify the key GIS tools and methods in the abstract.

Highlight the critical finding that 41 additional primary healthcare centres (PHCs) are required.

 3. Introduction Analysis:The introduction outlines the importance of primary healthcare in emergencies and introduces GIS as a tool for spatial analysis. However, the rationale behind choosing Sleman District as the study area is poorly elaborated. The introduction would benefit from a more detailed discussion of the region's specific healthcare challenges and the relevance of demographic standards in healthcare planning.

Suggestions:

Provide a stronger justification for selecting Sleman District.

Include more citations to recent studies on GIS applications in healthcare.

 4. Methodology Review: The methodology section describes the use of ArcGIS 10.5 for analysing the distribution of PHC facilities. It also outlines the applications of geographical standards (coverage distance) and demographic standards (population served per PHC). However, the methodology lacks detailed explanations of the GIS network analysis process, and no clear technical roadmap is provided for replicating the study.

Strengths:

The use of proximity analysis, spatial overlay, and network analysis is appropriate.

The study adheres to Indonesian Ministry of Health regulations.

 Weaknesses:

Insufficient detail on data collection and GIS processing steps.

Lack of clarity on using the network analysis in QGIS as an open source alternative of Arc GIS 10.5.

Lack of population density maps for better visualisation.

 Suggestions:

Include a technical roadmap or flowchart to illustrate the methodology including the GIS analyses.

Provide population density maps to complement the spatial analysis.

 5. Results and Analysis:

The results highlight that PHC centres cover 79% of the study area, leaving a significant portion underserved. The analysis identifies a need for 41 additional PHCs to meet the demographic standards set by the Ministry of Health. The spatial distribution maps and network analysis effectively demonstrate the gaps in healthcare access.

Strengths

Clear identification of underserved areas.

Effective use of GIS-based maps to visualise healthcare coverage.

 Weaknesses

The results section focuses strongly on geographical coverage without delving deeply into the demographic implications.

Limited discussion on the socioeconomic impact of healthcare access disparities.

 Suggestions

Provide more detailed demographic analysis, including the age and gender distribution of underserved populations.

Discuss the potential health outcomes resulting from inadequate PHC coverage.

 6. Discussion and Recommendations: The discussion section explores the implications of the findings, emphasizing the need for more PHC centers in underserved areas. However, the recommendations lack depth and fail to address practical solutions for improving healthcare accessibility.

Strengths:

The discussion recognises the need for targeted healthcare planning.

The recommendations highlight the importance of data-driven decision-making.

 Weaknesses:

Recommendations are too general and lack actionable steps.

The discussion does not consider alternative solutions, such as mobile clinics or telemedicine.

 Suggestions:

Provide specific recommendations for policymakers, such as prioritising regions for new PHC centres.

Explore alternative healthcare delivery models, like mobile clinics and telehealth services.

 7. References:

The references cited are relevant and credible. However, the article would benefit from more recent studies and a broader range of sources, particularly in GIS applications and healthcare planning.

Strengths:

The references are appropriate and related to the study's focus.

The citation style is consistent.

 Weaknesses:

The references list lacks recent studies.

Some key studies on healthcare access models are missing.

 Suggestions:

Include more recent references, especially from the last five years.

Expand the references to cover healthcare access models and disaster preparedness.

Include more references to recent studies on GIS applications in healthcare.

 8. Grammatical and Stylistic Errors:

Upon review, several areas in the article could benefit from grammatical and stylistic improvements to enhance readability and clarity. Below are the sampled grammatical errors identified:

Sentence Length

Many sentences are lengthy and could be split for better readability.

Example: "The article presents a valuable analysis of healthcare accessibility using GIS, specifically focusing on the spatial distribution of primary healthcare centres and the gaps in service coverage in the Sleman District of Indonesia."

Suggested Revision: "The article presents a valuable GIS-based analysis of healthcare accessibility. It specifically focuses on the spatial distribution of primary healthcare centres and the service gaps in the Sleman District of Indonesia."

9. Passive Voice:

The article uses passive voice frequently, which can make the writing less direct.

Example: "The study was conducted to find out the sufficient number of primary healthcare (PHC) centres required."

Suggested Revision: "The study aimed to determine the number of primary healthcare (PHC) centres needed."

Redundancy:

Some phrases are redundant and can be simplified.

Example: "The article claims that all source data are available through relevant government agencies and geoportals."

Suggested Revision: "The article states that all source data are available through government agencies and geoportals."

Word Choice:

Certain words and phrases could be more precise or formal.

Example: "The citations provided are relevant to the topic, particularly in the use of GIS in healthcare planning."

Suggested Revision: "The citations are relevant, particularly GIS applications in healthcare planning."

Critical Questions for Improvement

How can the study incorporate socioeconomic data to provide a more comprehensive analysis of healthcare access disparities?

What alternative healthcare delivery models can be explored to address the shortfall in PHC centres?

How can the findings of this study be integrated into national healthcare planning and policy frameworks?

 Overall Evaluation

The article presents a valuable analysis of healthcare accessibility using GIS. However, it could be strengthened by addressing the methodological gaps and providing more practical recommendations. The study's relevance to healthcare planning is clear, but it requires more in-depth exploration of demographic and socioeconomic factors to maximize its impact.

Final Suggestions

Include a more detailed methodology section.

Provide comprehensive demographic analysis.

Offer specific, actionable recommendations for policymakers.

Explore alternative solutions for improving healthcare access.

By addressing these areas, the article can significantly enhance its contribution to healthcare planning and GIS applications.

Is the work clearly and accurately presented and does it cite the current literature?

Partly

If applicable, is the statistical analysis and its interpretation appropriate?

I cannot comment. A qualified statistician is required.

Are all the source data underlying the results available to ensure full reproducibility?

Yes

Is the study design appropriate and is the work technically sound?

Yes

Are the conclusions drawn adequately supported by the results?

Partly

Are sufficient details of methods and analysis provided to allow replication by others?

Partly

Reviewer Expertise:

Geography, Geoinformatics, Spatial Analysis, Public Health

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

Jarghon Ali Public Health Faculty, Airlangga University, surabaya, EastJava, Indonesia

Competing interests: I declare that I have no competing interests that could influence my judgment or the validity of this article.

 6 12 2025

1.Title Evaluation

 Reviewer Comment: The title should be more concise.

 Response: Thank you for the suggestion. We agree the proposed title is clearer, but since the article is already published under the current title, it cannot be changed now. We will consider this recommendation for future work.

2.Abstract Review

 Reviewer Comment: The abstract lacks details about the study area and GIS tools used.

Response: Thank you for this helpful suggestion. We have revised the abstract by specifying the key GIS tools (ArcGIS 10.5 and QGIS) and the main analytical methods applied, including proximity analysis, spatial overlay, and network analysis. We also added the study area, Sleman District, Indonesia, and highlighted the critical finding that 41 additional primary healthcare centers (PHCs) are required to meet both demographic and geographic standards.

3.Introduction Analysis:

viewer Comment: The rationale for selecting Sleman District is limited, and more recent GIS studies should be cited.

Response: Thank you for this helpful suggestion. Sleman District was chosen as the study area because it has a high population density, mixed urban and rural areas, and a high disaster-risk level. Similar studies have also used GIS to analyze healthcare accessibility and planning

4. Methodology Review: 

1- Reviewer  Comment: Include a technical roadmap or flowchart to illustrate the methodology including the GIS analyses.  

Response: Thank you for the suggestion. I have added a methodology flowchart to clearly present the GIS analysis process.

2- Reviewer  Comment: Provide population density maps to complement the spatial analysis.

Response:

We thank the reviewer for this helpful suggestion. A population density map has now been added to the Results section to enhance the spatial analysis and support the demographic assessment of PHC service needs.

5.  Results and Analysis:

1-Reviewer  Comment: Provide more detailed demographic analysis, including the age and gender distribution of underserved populations.

Response: Thank you for this helpful suggestion.This study had two goals: a geographical goal to measure PHC coverage distance and area, and a demographic goal to identify the total population served. We did not include age or gender details because this requires field surveys and was outside our scope.

2-  Reviewer Comment: Discuss the potential health outcomes resulting from inadequate PHC coverage.

Response: Thank you for this important suggestion. Inadequate PHC coverage can lead to serious health outcomes, including delayed treatment, increased cases of preventable diseases, and higher maternal and child mortality rates. During disasters or emergencies, limited access to healthcare may also result in greater vulnerability and poorer recovery among affected populations.

6. Discussion and Recommendations:

Reviewer Comment: The recommendations are too general and need more practical solutions for improving healthcare accessibility.

Response: Thank you for this valuable suggestion. 

I have revised the Discussion and Recommendations section to include specific actions for policymakers and alternative healthcare delivery options.  Policymakers prioritize the establishment of new PHC centers in underserved sub-districts such as Cangkringan, Pakem, Turi, and Prambanan, where service coverage and accessibility are lowest. In addition, I have added recommendations to explore mobile health clinics and telehealth services as complementary solutions to reach remote or disaster-prone communities where building new PHCs may not be immediately feasible. 

7. References:

Reviewer Comment: References

Response: Thank you for this helpful. I have updated the reference.

8. Grammatical and Stylistic:

 Several areas in the article could benefit from grammatical and stylistic improvements to enhance readability and clarity.

Response: I appreciate the reviewer’s observation. The manuscript has been carefully revised to improve clarity.

9. Passive Voice:

Reviewer Comment:

The article uses passive voice frequently, which can make the writing less direct.

Response:

We appreciate this suggestion. The manuscript has been carefully revised to reduce the use of passive voice and make sentences more direct and active

 10.5256/f1000research.174054.r351971 Reviewer response for version 3 Denny Hanifa 1 Referee https://orcid.org/0000-0002-9359-3153 Public Health, Universitas Diponegoro, Semarang, Central Java, Indonesia

Competing interests: No competing interests were disclosed.

 28 12 2024 Copyright: © 2024 Denny H 2024 This is an open access peer review report distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. recommendation approve

Dear authors,

Thank you for your thorough and thoughtful revisions. I have reviewed your responses and the updated manuscript, and I find that you have sufficiently addressed all the comments and suggestions provided. The additional citations, methodological clarifications, and expanded discussions enhance the manuscript's quality and relevance.

I have no further suggestions at this time, and I am satisfied with the revisions made.

Best regards,

Reviewer

Is the work clearly and accurately presented and does it cite the current literature?

Partly

If applicable, is the statistical analysis and its interpretation appropriate?

Yes

Are all the source data underlying the results available to ensure full reproducibility?

Yes

Is the study design appropriate and is the work technically sound?

Yes

Are the conclusions drawn adequately supported by the results?

Yes

Are sufficient details of methods and analysis provided to allow replication by others?

Yes

Reviewer Expertise:

NA

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

 10.5256/f1000research.168658.r328429 Reviewer response for version 2 Li Jianwei 1 Referee Northwest University, Xi'an, Shaanxi, China

Competing interests: No competing interests were disclosed.

 28 10 2024 Copyright: © 2024 Li J 2024 This is an open access peer review report distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. recommendation approve-with-reservations

The manuscript, based on demographic data and utilizing GIS spatial network analysis, effectively reveals the spatial alignment between the service coverage of primary healthcare (PHC) centers in the Sleman region of Indonesia and the local population's medical needs. This provides valuable guidance for improving real-world healthcare facilities. However, there are still some shortcomings that need further improvement:

The manuscript should clearly explain the GIS network analysis process and include a technical roadmap to help readers better understand the entire data processing procedure.

The manuscript should provide a population density map of the study area, enabling readers to better understand the spatial distribution of PHC center services in relation to population density in the region.

It is recommended to more comprehensively discuss, in conjunction with the research conclusions, how to improve the PHC service system and propose appropriate research strategies to strengthen the impact of the research conclusions.

Is the work clearly and accurately presented and does it cite the current literature?

Yes

If applicable, is the statistical analysis and its interpretation appropriate?

Partly

Are all the source data underlying the results available to ensure full reproducibility?

Partly

Is the study design appropriate and is the work technically sound?

Partly

Are the conclusions drawn adequately supported by the results?

Partly

Are sufficient details of methods and analysis provided to allow replication by others?

Partly

Reviewer Expertise:

Urban and Regional Planning Studies

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

Jarghon Ali Public Health Faculty, Airlangga University, surabaya, EastJava, Indonesia

Competing interests: I declare that I have no competing interests that could influence my judgment or the validity of this article.

 6 12 2025

1. Reviewer Comment:

The manuscript should clearly explain the GIS network analysis process and include a technical roadmap to help readers better understand the entire data processing procedure.

Response:

Thank you for the comment. We have revised the methods to explain the GIS network analysis more clearly and added a small technical roadmap to show the main steps.

2. Reviewer Comment:

The manuscript should provide a population density map of the study area, enabling readers to better understand the spatial distribution of PHC center services in relation to population density in the region

Response:

Thank you for the suggestion. I have added a population density map to the Results section so readers can clearly see the population distribution and how it relates to PHC service coverage.

3. Reviewer Comment:

It is recommended to more comprehensively discuss, in conjunction with the research conclusions, how to improve the PHC service system and propose appropriate research strategies to strengthen the impact of the research conclusions.

Response:

Thank you for the recommendation. I have expanded the discussion to explain more clearly how the PHC service system can be improved based on the study’s findings. I also added simple research strategies to strengthen the impact of the conclusions.

 10.5256/f1000research.168658.r325253 Reviewer response for version 2 Denny Hanifa 1 Referee https://orcid.org/0000-0002-9359-3153 Public Health, Universitas Diponegoro, Semarang, Central Java, Indonesia

Competing interests: No competing interests were disclosed.

 10 10 2024 Copyright: © 2024 Denny H 2024 This is an open access peer review report distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. recommendation approve-with-reservations

1. Clarity and Accuracy of Presentation and Literature Citations

The manuscript is generally well-written, and the topic is clearly defined. It focuses on primary healthcare (PHC) center distribution in Sleman District, Indonesia. The research is relevant, especially in public health and healthcare infrastructure planning, and it aligns with current literature on disaster management, GIS application in healthcare, and accessibility standards.

However, there are instances where the literature citations could be more comprehensive. Some key studies, such as those on healthcare access models or the role of GIS in disaster preparedness, could be expanded. The inclusion of more recent studies on GIS applications in emergency healthcare systems would strengthen the discussion. Reviewers also recommended citing relevant literature, which has been partially addressed but could be further improved by adding these references to reinforce the findings.

2. Study Design and Academic Merit

The study's design is appropriate for the research question. By using geographical and demographic standards and GIS, the study provides an insightful approach to assessing PHC center coverage and identifying gaps in service. The integration of GIS-based tools is a strong aspect of the research.

However, some methodological details, such as the choice of specific geographical and demographic standards, could be justified more explicitly. The reasoning behind the selection of a 5 km radius for service coverage, for example, could be explained with more references to health policy or geographical accessibility standards. Despite this, the study has solid academic merit as it tackles an important issue in public health infrastructure.

3. Sufficient Details of Methods and Replicability

The methods section is fairly detailed, especially with the use of GIS and demographic data. The revisions made after peer review have improved the clarity of the methodology, making it easier to follow. However, there are still areas that would benefit from more explicit descriptions. For example: 1). More detailed steps on how the network and proximity analyses were conducted. 2). Clear justification for the use of specific GIS tools and how data layers were integrated.

Providing these details would enhance the study's replicability by other researchers.

4. Statistical Analysis and Interpretation

The study does not heavily rely on complex statistical analysis, as its focus is more on spatial data and accessibility measures. That said, the interpretation of the spatial data is appropriate. The visual representations (maps) of PHC service areas help in understanding the disparities in healthcare coverage.

One area that could be enhanced is a more in-depth statistical interpretation of the population that remains underserved. While the demographic shortfall is identified, further analysis of its implications on healthcare outcomes would add depth to the interpretation of the results.

5. Source Data Availability and Reproducibility

The manuscript claims that all data sources are available, including links to the Indonesian Disaster Management Agency and Sleman District's geoportal. This ensures reproducibility for other researchers wishing to replicate the study. To fulfill this criterion, these links must remain accessible. The manuscript also lists detailed instructions on how to access the relevant datasets.

6. Conclusions Supported by Results

The study's conclusions are largely supported by the data presented. The manuscript clearly identifies a significant shortfall in PHC centers in the study area, both geographically and demographically. The need for 41 additional centers is well-justified based on the analyzed data.

However, a more comprehensive discussion of potential solutions or next steps, such as how local policymakers could address these shortfalls, would strengthen the conclusions' impact. This could include considerations on resource allocation, funding, or the integration of these findings into broader public health planning frameworks.

Summary of Improvements:

a. Expand the citation of relevant literature, particularly recent studies on GIS in healthcare and disaster management.

b. Justify the selection of specific geographical standards (e.g., 5 km radius) more clearly.

c. Add further details in the methods section to improve replicability.

d. Enhance the discussion on the implications of the demographic shortfalls and provide more recommendations for future action.

Is the work clearly and accurately presented and does it cite the current literature?

Partly

If applicable, is the statistical analysis and its interpretation appropriate?

Yes

Are all the source data underlying the results available to ensure full reproducibility?

Yes

Is the study design appropriate and is the work technically sound?

Yes

Are the conclusions drawn adequately supported by the results?

Yes

Are sufficient details of methods and analysis provided to allow replication by others?

Yes

Reviewer Expertise:

Public Health

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

Jarghon Ali Public Health Faculty, Airlangga University, surabaya, EastJava, Indonesia

Competing interests: No competing interests to disclose

 6 11 2024

Thank you so much for your comments and suggests.

1. Reviewer comment:

Expand the citation of relevant literature, particularly recent studies on GIS in healthcare and disaster management.

Author comment: Citation have added upon request.

2. Reviewer comment:

Justify the selection of specific geographical standards (e.g., 5 km radius) more clearly.

Author comment: added in Result section, third paragraph (The scope of service within 5 kmThe scope of service within 5 km). The 5 km radius for healthcare service coverage is chosen to enhance accessibility and equity, ensuring patients can reach healthcare within a manageable distance, especially in rural and semi-urban areas. (Regulation of the Minister of Health of the Republic of Indonesia Number 43 Year 2019 Concerning Public Health Centers, 2019). 

3. Reviewer comment:

Add further details in the methods section to improve replicability.

Author comment: Added in method section in red font,  Data collection, processing, and analysis , basically Spatial Overlay and Network Analysis.

 

4. Reviewer comment:

Enhance the discussion on the implications of the demographic shortfalls and provide more recommendations for future action.

Author comment:  comment upon request, which is now added in the sixth paragraph and highlighted in red font. Additionally, the recommendations have been incorporated as requested.

 

10.5256/f1000research.168658.r299981 Reviewer response for version 2 Taran Ayed 1 Referee https://orcid.org/0000-0002-7691-4648 Al al-Bayt University, Al-Mafraq, Jordan

Competing interests: No competing interests were disclosed.

 24 7 2024 Copyright: © 2024 Taran A 2024 This is an open access peer review report distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. recommendation approve

No or only minor changes are required. This means that the aims and research methods are adequate; results are presented accurately; and the conclusions are justified and supported by the data or supporting material.

Is the work clearly and accurately presented and does it cite the current literature?

Partly

If applicable, is the statistical analysis and its interpretation appropriate?

Partly

Are all the source data underlying the results available to ensure full reproducibility?

Yes

Is the study design appropriate and is the work technically sound?

Partly

Are the conclusions drawn adequately supported by the results?

No

Are sufficient details of methods and analysis provided to allow replication by others?

No

Reviewer Expertise:

His research interests include transport services planning and management, the socio-economic impacts of transportation congestion, and urban planning applications, transportation geography, Transport models integrated in the GIS environment for accessibility and management of port systems, GIS and Remote Sensing, Transportation Planning and urban sustainable planning, transport services planning.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

 10.5256/f1000research.153436.r253431 Reviewer response for version 1 Taran Ayed 1 Referee https://orcid.org/0000-0002-7691-4648 Al al-Bayt University, Al-Mafraq, Jordan

Competing interests: No competing interests were disclosed.

 27 6 2024 Copyright: © 2024 Taran A 2024 This is an open access peer review report distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. recommendation approve-with-reservations

1. The paper addresses geographical and demographic criteria to verify the ability of primary health care facilities to cover the largest area of ​​the study area and accessible service area use GIS, The study found that there is a significant shortage in the number of primary health care centers in the study area compared to the large population, both on the geographical and demographic levels.

2. The paper deals with a very important topic.

3. There are technical issues with the arrangement of the paper as regards methodology, there are issues with presentation of data used and the subsequent methods used for the analysis of data. This includes missing methods. The paper also did not provide sufficient analysis that warrant a good discussion of results. The implications of findings are also missing.

4. I request the authors to cite the following references:

(i) Taran A (2023 [ref - 1]).  Measuring Accessibility to Health Care Centers in the City of Al-Mafraq Using Geographic Information Systems. ResearchGate. 2023; 19 (1): 43-55

(ii) Taran A et al. (2023 [ref - 2]).  The Temporal and Spatial Analysis of Corona Pandemic in Jordan using the Geographic Information System: An Applied Geographical Study. Indonesian Journal of Geography. 2023; 55 (1).

This is because it is relevant to the topic of study and can be benefited from.

5) All source data underlying the results are available to ensure complete reproducibility.

Dr. Ayed Taran

Al al-Bayt University

Is the work clearly and accurately presented and does it cite the current literature?

Partly

If applicable, is the statistical analysis and its interpretation appropriate?

Partly

Are all the source data underlying the results available to ensure full reproducibility?

Yes

Is the study design appropriate and is the work technically sound?

Partly

Are the conclusions drawn adequately supported by the results?

No

Are sufficient details of methods and analysis provided to allow replication by others?

No

Reviewer Expertise:

His research interests include transport services planning and management, the socio-economic impacts of transportation congestion, and urban planning applications, transportation geography, Transport models integrated in the GIS environment for accessibility and management of port systems, GIS and Remote Sensing, Transportation Planning and urban sustainable planning, transport services planning.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

References : Measuring Accessibility to Health Care Centers in the City of Al-Mafraq Using Geographic Information Systems. ResearchGate .2023;19(1) : 10.52939/ijg.v19i1.2499 43-55 10.52939/ijg.v19i1.2499 : The Temporal and Spatial Analysis of Corona Pandemic in Jordan using the Geographic Information System: An Applied Geographical Study. Indonesian Journal of Geography .2023;55(1) : 10.22146/ijg.73663 10.22146/ijg.73663 Jarghon Ali Public Health Faculty, Airlangga University, surabaya, EastJava, Indonesia

Competing interests: No competing interests to disclose

 29 6 2024

Response to Reviewer 

Thank you for your comments.

1. Thank you for your insightful comment. We have thoroughly addressed the geographical and demographic criteria to evaluate the coverage of primary healthcare facilities in the study area using GIS. Our study indeed found a significant shortage of primary healthcare centers relative to the large population, both geographically and demographically. 

2. Thank you for your positive feedback. We are pleased that you recognize the importance of the topic. Ensuring adequate coverage and accessibility of primary healthcare facilities is crucial for public health, and we hope our study contributes valuable insights to this significant issue.

3. Thank you for your constructive feedback. In response, we have extensively revised the methodology section to address the technical issues and improve the presentation of data and the methods used for analysis. Furthermore, we have expanded the analysis to provide a more thorough discussion of the results and their implications for healthcare accessibility and policy development. 

4. Thank you for your feedback. We have ensured that all source data underlying the results are available to guarantee complete reproducibility.

 Jarghon Ali Public Health Faculty, Airlangga University, surabaya, EastJava, Indonesia

Competing interests: No competing interests to disclose

 22 7 2024

Author response: 

Thank you for your insightful comments and expertise.