Travel time to Nutrition Rehabilitation Centers: Measuring equity of access using road network data in Nandurbar district and implications for public health service design

Abstract Background Maharashtra’s Nandurbar district, a predominantly tribal and hilly region, faces high child undernutrition and access barriers to facility-based care. Families and providers cite distance, transport constraints, and terrain as major obstacles to nutritional rehabilitation center (NRC) use and follow-up. This study aimed to measure spatial access to NRCs and identify gaps in geographical coverage and accessibility in Nandurbar district in Maharashtra. Methods We conducted a district-wide drive-time analysis using Google road network data to estimate minutes to the nearest NRC for every village. Villages were classified into 30/60/90/120-minute driving bands and child burden. NRC facility and villages were mapped, and numbers of children with severe acute malnutrition (SAM) were obtained from a district-wide joint screening in April 2025. Numbers of children admitted to NRC were obtained from district health records. Results The mean drive time to the nearest NRC was 41 minutes (range: 2–228). The analysis was conducted for a sample of 2804 children with SAM across 952 villages. 19.2% of villages and 23.7% (665 children) of SAM cases were ≥ 60 minutes from an NRC; 4.4% of villages and 7.3% (205 children) of SAM cases were ≥ 90 minutes. Clusters of high SAM and long travel were concentrated in Akrani, Shahade, and Akkalkuwa. The admissions/SAM ratio varied widely—Akkalkuwa 0.37, Akrani 0.32, Nawapur 0.31, versus Shahade 0.11 and Taloda 0.09 (the latter with the highest SAM burden). The analysis highlighted villages where setting up treatment centers based at primary health centers and provision of referral transport could yield immediate gains. Conclusions Drive-time modeling reveals actionable geographic inequities in access to NRCs in Nandurbar. Travel time is one aspect of the challenges families face, as many people do not have access to vehicles or financial resources to pay for easy transport. Establishing additional treatment options at select PHCs in far–high-burden corridors, strengthening transport, and coordinating care at border areas of the district can reduce time-to-care for severely malnourished children.