Primary health care (PHC) is the first point of contact people have with a health system. As such access to PHC services is an important factor to ensure good health of a community. While the need to provide equal and easy access to PHC is well understood, the approaches informing the decision-making process to improve the access tend to face a number of challenges in the developing world. Use of conventional Information and Communication Technologies (ICTs) comes with requisite financial costs which Free and Open Source Software (FOSS) ICT technologies have the potential to help lower among other benefits. In this study, the confluence of spatial accessibility tools provided by FOSS technologies, specifically PostgreSQL/PostGIS and QGIS, was explored to inform decision making in PHC accessibility in Zomba, Malawi. The results show that the household population (P) that is within the threshold time was 82,863, representing 59% of all households having access to health care. The mean accessibility score for the district was 0.010 and ranged from 0.00 to 0.231. While the findings provide, arguably, spatially objective PHC accessibility data to inform policy direction and also reveals accessibility to PHC in Malawi to be lower than reported, the study also reveals the usefulness of FOSS technologies, in the developing world. Use of FOSS facilitated incremental setup of the model thereby allowing to run the model with limited processing power. That notwithstanding, the study adds to the formal scientific research on the use of relational spatial analysis in the developing world.
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