Abstract / Summary
Abstract Background Timely access to Comprehensive Emergency Obstetric and Newborn Care (CEmONC) is important for preventing maternal and neonatal deaths. Although Nepal has made substantial progress in reducing maternal and neonatal deaths over recent decades, there is still a lack of granular subnational evidence on progress, equity, and physical access to (CEmONC) services especially in geographically diverse and inaccessible areas. Limited subnational evidence on spatial accessibility to CEmONC facilities constraints effective Health system Planning and referral networks. Methods This study assessed geographical accessibility to CEmONC facilities across Nepal using GIS- based travel-time modelling. Locations of CEmONC facilities were integrated with a motorized friction surface to estimate least-cost travel times. Areas with no population of women aged 15–49 years were masked using a gridded population layer. Travel times were categorized into five ranges: 0–30 minutes, 30–60 minutes, 60–120 minutes, 120–240 minutes, and > 240 minutes). data. Geographical accessibility inequalities were quantified using the Lorenz curve, Gini coefficient and Theil L index. Results Geographical accessibility to CEmONC facilities varied significantly across Nepal. Shorter travel times (≤ 30 minutes) were concentrated in the Tarai region and major urban corridors of Hilly region such as Kathmandu, Pokhara, while many areas of Hill and Mountain regions experienced travel times exceeding 60 minutes. The median travel time was approximately 64.73 minutes, indicating that half of the population resides beyond accepted thresholds for timely access to Comprehensive emergency obstetric care. Population-weighted analysis showed that 52.4% of women aged 15–49 years were within 30 minutes of the nearest CEmONC facility, 30.1% within 30–60 minutes, 14.9% within 60–120 minutes, and 2.6% required more than 120 minutes. Inequality analysis of the travel-time surface masked to areas containing women aged 15–49 years showed a Gini coefficient of 0.65 and a Theil L index of 0.86, indicating substantial spatial inequality in geographical accessibility. Conclusion Despite the national progress in Maternal and Newborn health outcomes, CEmONC services in Nepal remain markedly uneven. GIS-based travel-time modelling revealed substantial geographical inequities, particularly in remote and mountainous regions. These findings provide substantial evidence to support equitable Health service planning, strengthen referral networks and improving Safe Motherhood and Sustainable Development Goal targets.