Evaluating the Alignment Between National Health Infrastructure Expansion and Population Health Needs in Côte d'Ivoire: A Spatial and Organizational Planning Assessment

Introduction Despite ongoing investments in health infrastructure across Côte d’Ivoire, disparities in health outcomes persist, particularly in rural and high-burden regions. This study evaluated the alignment between national health infrastructure expansion and population health needs using a spatial and organizational planning lens.  Methods A mixed-methods approach was employed, combining quantitative data analysis with geospatial mapping. Data were collected from 400 participants across three districts using structured facility surveys, demographic questionnaires, and national health databases. GIS tools (ArcGIS, QGIS) were used to map disease burden against facility density, while correlation and regression analyses assessed relationships between infrastructure indicators and health outcomes. Facility readiness was assessed through standardized scoring across five domains.  Results and Findings The study found significant spatial mismatches: District B, with the highest maternal mortality (780/100,000) and malaria cases (45,000), had the lowest facility density and longest travel times (85 minutes). In contrast, District C, with a lower burden, had more facilities and shorter access times. Readiness assessments revealed that urban facilities scored above 85% in service availability, while rural counterparts averaged below 60%. A positive correlation (r = +0.45) between travel time and maternal mortality and a strong negative association between facility density and disease burden (r = –0.62) confirmed misalignment. Political influence was a significant predictor of infrastructure allocation.  Conclusion: The study concluded that health infrastructure expansion in Côte d’Ivoire has not been equitably aligned with population health needs. Spatial, functional, and governance-related disparities persist, underscoring the need for data- driven, equity-focused health planning reforms.