Geographic information system‐based evaluation of spatial accessibility to maternal health facilities in Siaya County,Kenya

Maternal mortality is a major problem in middle‐income and low‐income countries, and the availability and accessibility of healthcare facilities offering safe delivery is important in averting maternal deaths. Siaya County, in Kenya, has one of the highest maternal mortality rates in the country—far more than the national average. This study aimed to evaluate geographic access to health facilities offering delivery services in Siaya County. A mixed‐methods approach incorporating geographic information system analysis and individual data from semi‐structured interviews was used to derive travel time maps to facilities using different travel scenarios: AccessMod5 and ArcGIS were used for these tasks. The derived maps were then linked to georeferenced household survey data in a multilevel logistic regression model in R to predict the probability of expectant women delivering in a health facility. Based on the derived travel times, 26 per cent (13,140) and 67 per cent (32,074) of the estimated 46,332 pregnant women could reach any facility within one and two hours, respectively, while walking with the percentage falling to seven per cent (3,415) and 20 per cent (8,845) when considering referral facilities. Motorised transport significantly increased coverage. The findings revealed that the predicted probability of a pregnant woman delivering in a health facility ranged between 0.14 and 0.86. Significant differences existed in access levels with transportation‐based interventions significantly increasing coverage. The derived maps can help health policy planners identify underserved areas and monitor future reductions in inequalities. This work has theoretical implications for conceptualising healthcare accessibility besides advancing the literature on mixed methodologies.     

Efficient Nonprofits?

This article looks at efficiency as it relates to nonprofit activities. I argue that average return-on-investment measures are inadequate for nonprofit organizations, and that nonprofits should seek instead to measure marginal returns to investments in nonprogram areas, such as administration and fundraising. Using a national sample of approximately two hundred fifty thousand nonprofits from 2002, I find that some types of organizations spend their nonprogram funds efficiently, while other types do not. These findings have implications for nonprofit management.     

Using AMOEBA to Create a Spatial Weights Matrix and Identify Spatial Clusters

The creation of a spatial weights matrix by a procedure called AMOEBA, A Multidirectional Optimum Ecotope-Based Algorithm , is dependent on the use of a local spatial autocorrelation statistic. The result is (1) a vector that identifies those spatial units that are related and unrelated to contiguous spatial units and (2) a matrix of weights whose values are a function of the relationship of the ith spatial unit with all other nearby spatial units for which there is a spatial association. In addition, the AMOEBA procedure aids in the demarcation of clusters, called ecotopes, of related spatial units. Experimentation reveals that AMOEBA is an effective tool for the identification of clusters. A comparison with a scan statistic procedure (SaTScan) gives evidence of the value of AMOEBA. Total fertility rates in enumeration districts in Amman, Jordan, are used to show a real-world example of the use of AMOEBA for the construction of a spatial weights matrix and for the identification of clusters. Again, comparisons reveal the effectiveness of the AMOEBA procedure.     

The End of Art: A Philosophical Defense

This essay constructs philosophical defenses against criticisms of my theory of the end of art. These have to do with the definition of art; the concept of artistic quality; the role of aesthetics; the relationship between philosophy and art; how to answer the question “But is it art?”; the difference between the end of art and “the death of painting”; historical imagination and the future; the method of using indiscernible counterparts, like Warhol's Brillo Box and the Brillo cartons it resembles; the logic of imitation—and the differences between Hegel's views on the end of art and mine. These defenses amplify and fortify the thesis of the end of art as set forth in my After the End of Art: Contemporary Art and the Pale of History (1997).