How Long Do You Have to Travel to Access a Palliative Care Service in Colombia?

Abstract

Geographic accessibility is a key determinant of equitable palliative care delivery, yet objective national estimates remain limited in Latin America. To quantify motorized travel time to the nearest palliative care service in Colombia and identify subnational disparities in spatial accessibility. We conducted a population-based spatial analysis using 1 km² WorldPop population data and a national registry of 657 active palliative care services (2024). Motorized travel times were modeled using 2019 Malaria Atlas Project friction surfaces. The Dijkstra algorithm computed the least travel time from each grid cell to the nearest service. Accessibility thresholds of 30, 60, and 120 minutes were applied, and population weighted coverage proportions were estimated nationally and by department. Nationally, 65.24% of the population lives within 30 minutes of a palliative care service, increasing to 75.52% within 60 minutes, and to 86.93% within 120 minutes. However, 13.07%-approximately one in seven people-reside more than two hours from care. Marked subnational inequities were observed. Three departments (Amazonas, Vaupés, Vichada) have no registered services. In contrast, highly urbanized territories such as Bogotá demonstrate near universal coverage within 30 minutes. Notably, higher service density did not consistently translate into shorter travel times, reflecting internal territorial concentration of services within departments. Despite moderate national service density, substantial geographic inequities persist in Colombia. Travel time modeling reveals rural and peripheral disadvantage and highlights the importance of spatial distribution, not merely service quantity, in advancing equitable palliative care access.