Socio-Spatial Equity and Resilience of the Healthcare Network Under Flood Hazard: A Multicriteria Spatial Analysis in Santiago de Cali, Colombia

Abstract

Traditional flood risk assessment of health infrastructure focuses primarily on direct structural building damage, frequently overlooking the logistical functional isolation caused by road network disruption. This study aimed to quantify the spatial distribution of physical–social vulnerability and functional isolation across licensed healthcare facilities in Santiago de Cali, Colombia, evaluating whether flood risk exposure associates with institutional care complexity. A geospatial multicriteria decision analysis based on the Analytic Hierarchy Process integrated water hazard, area-level social vulnerability, and road isolation into a synthetic risk index for 863 licensed provider institutions. The association between complexity level (I, II, III) and risk category (1 to 5) was evaluated using the Monte Carlo χ2 test of independence, Cramér’s V, and the adjusted Pearson residuals. Systemic accessibility resilience was modeled via a network-based travel time degradation analysis. No statistically significant association was observed between institutional complexity level and flood risk category (χ2 = 12.69, df = 8, p = 0.122; Cramér’s V = 0.086). Public facilities exhibited a higher descriptive exposure share in high-risk categories (45.5%) compared to private facilities (4.3%). Functional isolation affected facilities across all complexity tiers, with severe travel time increases to advanced care concentrated in specific peripheral hotspots (comuna 22: +210.6%, comuna 1: +189.1%, comuna 20: +155.5%), whereas 82% of the urban population experienced negligible transit delays. Flood exposure across the municipal healthcare grid appears to be driven by pre-existing urban socioeconomic and topographic gradients rather than deliberate risk-sensitive institutional siting. These empirical insights highlight the value of incorporating network accessibility into resilient, equity-oriented urban health planning aligned with Sustainable Development Goals 3, 10, 11, and 13.