Mapping Patient Journeys to Improve Healthcare Access, Quality, and System Design

A research by the World Bank offers an in-depth, practice-oriented guide to understanding and redesigning health systems through the lens of Patient Pathway Analysis (PPA). Developed with research contributions from the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), IQVIA, the University of Ghana School of Public Health, and Sambodhi in Gujarat, India, the research presents both theoretical foundations and field-tested examples from LMICs. These studies, which cover urban slums in Bangladesh, rural and tribal districts in India, and decentralized health systems in Ghana, explore how patients seek care, interact with providers, and navigate complex or fragmented health environments. The goal is clear: to improve service delivery by understanding the real-world journeys of patients and identifying where systems fail to meet their needs.

Understanding Patient Pathways in Real Terms

Patient Pathway Analysis examines the actual flow of individuals through the health system, focusing on “touchpoints” such as initial consultation, diagnosis, treatment initiation, and ongoing management. This approach treats the patient not just as a recipient of care but as an active decision-maker navigating a web of services. Data is collected from both the demand side (what patients experience) and the supply side (what health services are available). This dual perspective is vital in identifying mismatches between need and provision. In the PPA conducted in Bangladesh by icddr,b, nearly 6,000 individuals from low-income communities in Dhaka and Chattogram were surveyed about their care-seeking behavior for non-communicable diseases (NCDs) like diabetes and hypertension, as well as maternal and newborn health (MNH) services. Results showed that a large proportion of patients relied on pharmacies for disease management, while NGOs were often the first point of contact for pregnant women. These findings were visualized using Sankey diagrams to show the flow of patients across various provider types and levels.

Profiling Health Providers to Reveal Gaps

One of the most innovative contributions of the volume is the use of provider profiling alongside patient surveys. In Case Study 1B, researchers mapped over 900 health facilities in urban Bangladesh using semi-structured interviews with managers and owners. Facilities were categorized by type (hospital, pharmacy, traditional healer), sector (public, private, NGO), and level of care (community, primary, secondary, tertiary). This inventory allowed researchers to analyze service availability, such as the presence of diagnostic tools or emergency obstetric care. When combined with patient pathway data, this supply-side mapping revealed gaps in service alignment. For example, although most patients began their care in pharmacies or informal clinics, these providers often lacked diagnostic capacity. This misalignment contributes to delays, misdiagnosis, and poor continuity of care. Similar profiling was conducted by Sambodhi in Gujarat, India, where the sampling approach also incorporated socio-economic indicators to identify underserved blocks. Provider data was used to evaluate facility bypassing and the reasons why patients chose certain types of care.

Tracking Delays and Diagnostic Gaps

The guide devotes a full module to delays in care, a critical factor in health outcomes. In China, a PPA focused on tuberculosis (TB) uncovered significant “Long Diagnostic Delays” (LDDs), defined as more than two weeks between first provider contact and confirmed diagnosis. This delay was most common among patients who initiated care at low-level facilities (L0 or L1), which lacked proper diagnostic tools. Despite freedom to choose their provider, patients often made decisions based on convenience or familiarity, not diagnostic quality. Many were misdiagnosed with pneumonia and treated with antibiotics before eventually reaching TB treatment centers. These findings underscore the need for improving provider awareness and redistributing diagnostic equipment. The study utilized both primary interviews and secondary data from health records and national databases to quantify delays and identify systemic causes.

The Financial Cost of Care-Seeking

Costs are another powerful barrier to care, and the guide dedicates significant attention to how financial burdens shape patient pathways. In Case Study 4, a longitudinal TB patient cost study in four African countries adapted the WHO’s TB Patient Cost Survey to track expenses over time. Patients were surveyed at different treatment stages, from diagnosis through follow-up, capturing both direct costs (medication, transport) and indirect costs (lost wages, caregiving time). In Kenya, a qualitative case study explored how cancer patients and their families bore enormous economic strain, often incurring debt, selling assets, or forgoing other essentials. Even with national insurance (NHIF), coverage was incomplete, especially for diagnostics and medications. Participants cited gaps in benefit awareness, and those enrolled post-diagnosis still faced catastrophic health expenditures. These studies illustrate that both qualitative and quantitative methods are needed to grasp the full socioeconomic impact of illness.

Spatial Access and Sustainability Dimensions

The integration of geospatial mapping adds a further layer of sophistication to PPA. In Bangladesh, researchers used Euclidean distance calculations to assess how far patients traveled for care. Other case studies from Uganda and Namibia incorporated seasonal travel barriers like flooding, which drastically affected accessibility. This spatial data helped inform decisions about facility placement and service availability. In an innovative twist, the guide also introduces carbon accounting within PPAs, assessing the environmental footprint of patient journeys. By calculating emissions from travel and facility use, researchers highlighted the need for sustainable care models that not only improve access but also reduce ecological impact.

The research is more than a manual; it’s a roadmap for health system transformation. It emphasizes that real improvements begin with understanding patient behavior and decision-making, not just measuring institutional performance. Through case studies, analytical frameworks, and methodological innovations, the guide positions Patient Pathway Analysis as a cornerstone of responsive, equitable, and sustainable health systems across the globe.