A capacity-aware GIS approach to assess and improve spatial accessibility to primary healthcare facilities: Western Türkiye case study
Abstract
Objective: This study aimed to quantify primary healthcare service deficits in Western Türkiye by comparing accessibility with capacity-adjusted coverage for Family Health Centers (FHCs), identify optimal, equity-focused locations for new FHCs using capacity-aware location-allocation modeling; and present a validated, reproducible Geographic Information Systems (GIS) based framework applicable to diverse national contexts.
Method: Observational geographic analysis. GIS, location-allocation modeling, and joinpoint regression were applied across 11 Western Türkiye provinces. Accessibility, based on a 15-minute walking threshold was evaluated first. Coverage was then recalculated, incorporating FHC capacity, which is defined as a maximum of 2,500 people per Family Physician Unit. A scale-up analysis identified optimal locations to achieve 70% capacity-constrained coverage. Joinpoint regression assessed facility expansion efficiency.
Results: While potential 15-minute walking accessibility appeared high in urban centers (e.g., Bursa 73.4%, İzmir 72.6%), enforcing capacity constraints drastically reduced effective coverage (e.g., Bursa 49.4%, İzmir 50.4%), revealing an average coverage gap exceeding 20 percentage points and exposing severe service pressure. Profound deficits were observed in rural districts (<20% coverage). Optimal locations for 1,074 new FHCs were identified. Gaps in absolute and percentage terms are summarized. Joinpoint analysis confirmed diminishing returns on expansion. Capacity gaps and geographic inequities remained robust in sensitivity analyses.
Conclusion: Facility capacity, alongside proximity, determines effective PHC access in Western Türkiye, exacerbating urban-rural inequities. Planning based solely on distance is inadequate; incorporating capacity constraints is essential for assessment and equitable resource allocation. The demonstrated geospatial methodology provides a robust, adaptable normative tool for national PHC network planning.
Ethical Statement
Ethics approval was not required for this ecological study as it analyzed publicly available, aggregated data without individual identifiers, in compliance with institutional review board guidelines.
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Details
| Primary Language | English |
|---|---|
| Subjects | Preventative Health Care, Social Determinants of Health |
| Journal Section | Research Article |
| Authors | |
| Submission Date | May 2, 2025 |
| Acceptance Date | September 1, 2025 |
| Publication Date | April 7, 2026 |
| DOI | https://doi.org/10.20518/tjph.1689443 |
| IZ | https://izlik.org/JA55FB85PB |
| Published in Issue | Year 2026 Issue: 1 |
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Turkish Journal of Public Health – Author Guidelines Addendum
In line with the principles and recommendations of the Committee on Publication Ethics (COPE), the Turkish Journal of Public Health (TJPH) recognizes the increasing use of Artificial Intelligence (AI) tools in academic writing and research. However, the use of AI must comply with ethical publishing standards to ensure transparency, accountability, and integrity.
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It aims to safeguard the integrity, confidentiality, and fairness of the editorial and peer review process, define appropriate and transparent use of Artificial Intelligence (AI) tools in editorial and review workflows, and promote accountability, transparency, and trust in scholarly publishing.
2. Fundamental Ethical Principles
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• Confidentiality: Unpublished material must not be disclosed or used for personal advantage.
• Transparency: Use of AI systems must be declared, traceable, and limited to ethically acceptable purposes.
• Fairness and Impartiality: Reviews and editorial decisions must be free from bias related to authors’ gender, nationality, institutional affiliation, or research field.
3. Responsibilities of Section Editors
• Editorial Oversight and Decision-Making
• Section Editors are responsible for ensuring a fair and timely peer review process. Final decisions on acceptance or rejection of manuscripts must always be made by a human editor. No AI tool may autonomously determine manuscript outcomes. Editors must evaluate AI-generated recommendations critically and ensure human oversight in every step of the decision process.
• Use of AI Tools
• Editors may use AI-assisted tools only for supportive functions, such as reviewer matching, plagiarism detection, or language checks. AI tools must not be used for making final editorial decisions, generating decision letters, or evaluating novelty and validity without human judgment.
• Confidentiality and Data Protection
Editors must not upload manuscripts or reviewer comments to public or non-secure AI systems.
• Accountability and Transparency
Editors remain accountable for all outcomes of AI-assisted decisions. Any use of AI in editorial workflows must be disclosed internally and traceable. Editors must justify all decisions, including AI-supported analyses.
• Managing Ethical Concerns
Editors must act promptly when ethical issues are identified. AI outputs suggesting ethical breaches should be verified manually before action is taken, following COPE’s procedures.
4. Responsibilities of Peer Reviewers
• Reviewers should accept invitations only if they have the necessary expertise and can complete the task impartially and on time.
• Manuscripts under review are confidential and must not be shared or uploaded to AI tools.
• Reviewers may use AI only for language or grammar assistance and must disclose any such use in their review.
• Reviewers must provide objective, constructive, and respectful feedback, focusing solely on scientific merit.
• If ethical misconduct is suspected, reviewers should report it confidentially to the Section Editor without public accusations.
5. Handling of AI-Related Issues
If a reviewer or editor suspects that AI tools were misused in manuscript preparation, review, or decision-making, they should report the concern confidentially to the Editor-in-Chief.
TJPH will maintain records of AI-related incidents and update policies accordingly.
6. Transparency Toward Authors
Authors have the right to know whether AI-assisted systems were involved in manuscript handling (e.g., plagiarism checks, reviewer matching).
Any AI use in decision support should be described transparently in the journal’s editorial policies.
This guideline will be reviewed annually based on new COPE or other recommendations and technological developments.
References
• COPE Council. Artificial Intelligence (AI) in Decision Making – Discussion Document. Version 1, 2021.
• COPE Council. Ethical Guidelines for Peer Reviewers. Version 2, 2017.
• Adapted for institutional use by the Turkish Journal of Public Health Editorial Board, 2025.
Advertising Policy
The Turkish Journal of Public Health is the official publication of the Halk Sağlığı Uzmanları Derneği. The journal maintains its publication activities independently of any commercial advertising or sponsorship agreements, in order to preserve its academic integrity.
All editorial decisions are made solely based on academic standards, scientific merit, and a rigorous peer review process, without any commercial or financial influence. The journal operates in accordance with the financial and publication policies of the Halk Sağlığı Uzmanları Derneği, with a commitment to serving the public interest and advancing scientific knowledge.
In line with these principles, the journal does not publish commercial advertisements or sponsored content; it is dedicated exclusively to disseminating academic and scientific material. Ethical publishing practices and editorial independence are upheld throughout all stages of the publication process.
Appeals and Complaints
Appeal and complaint cases are handled within the scope of COPE guidelines by the Editorial Board of the journal. Appeals should be based on the scientific content of the manuscript. The final decision on the appeal and complaint is made by Editor in Chief. In case, an ombudsperson or the external ethical editor is assigned to resolve cases that cannot be resolved internally. Authors should get in contact with the Editor in Chief regarding their appeals and complaints via e-mail at yucel.demiral@gmail.com .
Handling of Unethical Publishing Behaviour
The publisher will take all appropriate measures to modify the article in question, in close cooperation with the editors, in cases of alleged or proven scientific misconduct, fraudulent publication, or plagiarism. This includes the prompt publication of an erratum, disclosure, or retraction of the affected work in the most severe case. Together with the editors, the publisher will take reasonable steps to detect and prevent the publication of articles in which research misconduct occurs and will under no circumstances promote or knowingly allow such abuse to occur.
Fundamental Errors in Published Works
Authors are obliged to notify the journal's editors or publisher immediately and to cooperate with them to correct or retract the article if significant errors or inaccuracies are detected in the published work. If the editors or publisher learn from a third party that a published work contains a material error or inaccuracy, the authors must promptly correct or retract the article or provide the journal editors with evidence of the accuracy of the article.
Price Policy
All articles published in the Journal are open access and freely available online. Currently, Turkish Journal of Public Health charges no publication fee from the authors.
Journal Boards
Editor in Chief
Editör Kurulu
Editor in Chief
Section Editors
Experienced Faculty Member with a demonstrated history of working in the professional research, training & coaching industry. Skilled in Analytical Skills, Coaching, Epidemiology, Research Design, and Lecturing.
She is certified as Occupational physician (MoLSS), Occupational physician trainer(MoLSS), Sleep Medicine Physician (Turkish Thorasic Society), Mental Health Education and Management in Occupational Medicine(EASOM), ILO pneumoconiosis reader, Problem Based Learning and tutors’ trainer, Basic Occupational Health Services trainer of health care workers', and for advanced epidemiology, Occupational health crossing borders and BOH(Ludwig-Maximillian University), Systematic Review in Occupational Health (PEROSH and Cochrane Work group), Occupational and environmental determinants of disease: multidisciplinary approach as a key for research and prevention (Univ.Brescia), Occupational Health Cochrane Systematic Rewiew & Meta-analysis (GMU Cochrane Policy Center &IPH HU), Geographic Information Systems Usage in Healthcare Management (GMU, HSE-biz & IPH HU). GIS master course UofG Geomatics, Leadership and management skills training for Occupational Health Professionals-FOM, Exposure Management Training on Lead, Asbestos, IRR, HAVS of FOM at UofG HWL, Occupational Hygenist Exam Board Comissionar, certified by ICSF &AIDII (EU & ISOlevel), Qualitative research planning and analysis and Nvivo training (Nvivo-TR), Trainer of MoH Disaster and Emergency management for Health (MoH),She is a member of International Commission on Occupational Health (ICOH) since 2003.
Dr. Odabaş, 1991 Ankara Tıp mezunudur. Halk Sağlığı Uzmanlık eğitimini Prof.Dr.Arslan Tunçbilek danışmanlığında hazırlamış olduğu “Abidinpaşa Sağlık Grup Başkanlığı bölgesindeki liselerde gençlerin ergenlik dönemine ilişkin bilgi düzeylerini ve etkileyen faktörler” başlıklı tez çalışması ile Ankara Üniversitesi Tıp Fakültesi Halk Sağlığı Anabilim Dalında 1995’te tamamlamıştır. Akademik yaşam evrelerinin tamamını 1995–1999 yılları arasında uzman, 1999–2008 arasında yardımcı doçent, 2008–2014 doçent ve 2014 yılından bu yana profesör unvanlarıyla Ankara Tıpta gerçekleştirmiştir. Halen Ankara Üniversitesi Tıp Fakültesi Halk Sağlığı Anabilim Dalı Başkanı olarak görev yapmaktadır. Dr. Odabaş, 2002-2006 yılları arasında Halk Sağlığı Uzmanları Derneği (HASUDER) Yönetim Kurulu Üyesi olarak görev aldı. Nisan 2020-Mart 2024 yılları arasında Sağlık Bakanlığı COVID-19 Pandemi (Toplumda Salgın Yönetimi) Bilimsel Danışma Kurulu Üyesi olarak görev yapmıştır. Halen Sağlık Bakanlığında Okul Sağlığı, Obezite ve Çalışan Sağlığı Bilim Kurulu ve Türkiye Sağlık Enstitüleri Başkanlığı Aşı Enstitüsü Aşı Epidemiyolojisi Bilim Kurulu üyesi, HASUDER Sağlığın Geliştirilmesi ve Sağlık Okuryazarlığı Çalışma Grubu Başkanı, Çocuk ve Okul Sağlığı Çalışma Grubu Üyesi, Ankara Üniversitesi Bağımlılık ve Dopingle Mücadele Uygulama Araştırma Merkezi Müdür Yardımcısı, Ankara Üniversitesi Kanser Araştırma Enstitüsü Sigara Savaş Grubu (SİSAG) gönüllüsü ve Ankara Çocuk Koruma Grubu (AÇOK) Üyesi olarak çalışmalarına devam etmektedir.
Dr.Odabaş’ın 2026 Şubat ayı itibarıyla toplam 152 makalesi yayımlamıştır. Yayınlarına aldığı toplam 1617 atıf bulunmaktadır ve “h” indeksi 21’dir."
Gazi Üniversitesi Tıp Fakültesi Lisans Mezunu (2016)
Niğde Çiftlik Toplum Sağlığı Merkezi (2017)
Mersin Üniversitesi Tıp Fakültesi Halk Sağlığı AD. Tıpta Uzmanlık (2021)
Adıyaman Besni İlçe Sağlık Müdürü (2023)
Mersin Üniversitesi Tıp Fakültesi Halk Sağlığı AD. Dr.Öğ.Üyesi (2025-)
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