BACKGROUND Repeated outbreaks of emerging pathogens underscore the need for preparedness plans to prevent, detect, and respond. As countries develop and improve National Action Plans for Health Security, addressing subnational variation in preparedness is increasingly important. One facet of preparedness and mitigating disease transmission is health facility accessibility, linking infected persons with health systems and vice versa. Where potential patients can access care, local facilities must ensure they can appropriately diagnose, treat, and contain disease spread to prevent secondary transmission; where patients cannot readily access facilities, alternate plans must be developed. Here, we use travel time to link facilities and populations at risk of viral hemorrhagic fevers (VHFs) and identify spatial variation in these respective preparedness demands. METHODS AND FINDINGS We used geospatial resources of travel friction, pathogen environmental suitability, and health facilities to determine facility accessibility of any at-risk location within a country. We considered in-country and cross-border movements of exposed populations and highlighted vulnerable populations where current facilities are inaccessible and new infrastructure would reduce travel times. We developed profiles for 43 African countries. Resulting maps demonstrate gaps in health facility accessibility and highlight facilities closest to areas at risk for VHF spillover. For instance, in the Central African Republic, we identified travel times of over 24 h to access a health facility. Some countries had more uniformly short travel times, such as Nigeria, although regional disparities exist. For some populations, including many in Botswana, access to areas at risk for VHF nationally was low but proximity to suitable spillover areas in bordering countries was high. Additional analyses provide insights for considering future resource allocation. We provide a contemporary use case for these analyses for the ongoing Ebola outbreak. CONCLUSIONS These maps demonstrate the use of geospatial analytics for subnational preparedness, identifying facilities close to at-risk populations for prioritizing readiness to detect, treat, and respond to cases and highlighting where gaps in health facility accessibility exist. We identified cross-border threats for VHF exposure and demonstrate an opportunity to improve preparedness activities through the use of precision public health methods and data-driven insights for resource allocation as part of a country's preparedness plans.

中文翻译：

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前往可能发生疫情的地区的医疗机构的旅行时间：指导当地准备和应对的地图。

背景新出现的病原体的反复爆发强调了制定预防、检测和应对准备计划的必要性。随着各国制定和完善国家卫生安全行动计划，解决国家以下地区的准备差异问题变得越来越重要。防备和减轻疾病传播的一方面是卫生设施的可及性，将感染者与卫生系统联系起来，反之亦然。在潜在患者可以获得护理的地方，当地机构必须确保他们能够适当诊断、治疗和遏制疾病传播，以防止二次传播；如果患者无法方便地使用设施，则必须制定替代计划。在这里，我们利用旅行时间将有病毒性出血热 (VHF) 风险的设施和人群联系起来，并确定这些各自的准备需求的空间差异。方法和结果我们利用旅行摩擦、病原体环境适宜性和卫生设施的地理空间资源来确定一个国家内任何有风险地点的设施的可达性。我们考虑了暴露人群的国内和跨境流动，并强调了现有设施无法进入的弱势群体，而新的基础设施将减少出行时间。我们为 43 个非洲国家制定了概况。生成的地图显示了卫生设施可及性方面的差距，并突出显示了最靠近 VHF 溢出风险区域的设施。例如，在中非共和国，我们发现前往医疗机构的旅行时间超过 24 小时。尽管存在地区差异，但一些国家的出行时间普遍较短，例如尼日利亚。对于一些人群（包括博茨瓦纳的许多人）来说，进入全国范围内有 VHF 风险的地区的机会很少，但接近邻国适当的溢出地区的机会却很高。其他分析为考虑未来资源分配提供了见解。我们为当前埃博拉疫情的这些分析提供了一个当代用例。结论 这些地图展示了地理空间分析在地方一级准备工作中的应用，确定了靠近高危人群的设施，优先考虑检测、治疗和应对病例的准备情况，并强调了卫生设施可及性方面存在的差距。我们确定了 VHF 暴露的跨境威胁，并展示了通过使用精确的公共卫生方法和数据驱动的资源分配见解来改善备灾活动的机会，作为国家备灾计划的一部分。