Mapping FaithBased Health Care Networks in Tanzania

1
Mapping Faith-Based Health Care Networks in
Tanzania
- Franklin Baer- Simon Haule- Scott Todd
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What is your comfort level with software programs?

• EMAIL
• Word Processing
• Excel Spreadsheets
• Databases
• GIS Mapping
• Mapping should be to health planning
• what Word Processing is to Report Writing
• and Spreadsheets are to Budgeting

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GIS Mapping and FBOs

• GIS Mapping is a planning tool that
  can improve FBO-MOH coordination of
  a national health system
  
• GIS Mapping is an advocacy tool that can
  help put FBOs on the map and at the
  partners table.

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If a picture is worth a thousand words . . .
a good map may be worth a thousand thousand
dollars.
The threat of a Transition Gap
as INGOs phase out
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GRHAMGlobal Religious HealthAssets Mapping
Putting FBO networks and Christian Health
Associations "on the map"
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www.CCIH.org/grham
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(No Transcript)
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Mapping Faith-Based Health Care Networks
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Mapping Faith-Based Health Care Networks in
TanzaniaSimon Haule, Petro Pamba, Glen Brubaker
Franklin Baer
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Why Partnership?

• Health services demand is huge
• Capacities in delivering quality health services
  is limited
  
• Poor infrastructures in the health facilities
• Requires joint planning, budgeting,
  implementation and M E

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The Need to Improve Partnerships

• FBOs are the most important partner with MOHs to
  provide health services.
  
• Christian Social Services Commission a FBO
  network
  
• CSSC manages
• 35 of health facilities and human resources
• 56 rural health services
• 41.5 of beds
• 17.7 of total health facilities in Tanzania
• Coordination with the MOH is often more
  parallel than integrated.
  
• Improving our respective information systems can
  help improve our partnering with the MOH.

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CSSC Goals

• To Develop
• Geographic Information Systems (GIS)
• Human Resource Information System (HRIS)
• Planning How many health workers are needed?
• Developing Where are they needed?
• Supporting How can we keep them there?

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Why Mapping?

• Geographic access to health care services is key
  to service delivery
  
• Defining population catchment areas
• Avoiding duplication or gaps in health service
• Elements of geographic access can best be
  understood through maps
  
• Mapping can be an effective advocacy, planning
  and ME tool.
  

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Basic Principles of GIS

• GIS provides a way to look at health data
  geographically
  
• GIS builds on traditional mapping systems.
• GIS software makes it possible to add and combine
  layers of information

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GIS consists of layering information
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Basic Principles of HRISHuman Resource
Information System

• Human Resource data is extremely difficult to
  collect and maintain.
  
• A HRIS creates a large database of records one
  for per health worker.
  
• When linked to a GIS, HRIS data can also be
  mapped, viewed, and analyzed and geographically.
  
• HRIS should be one component of a comprehensive
  Health Management Information System (HMIS)

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Conceptual Framework for HMISHealth Management
Information System
MOH HMIS FBO HMIS National HMIS
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HRIS and GIS Mapping is a tool for

• Advocacy to put FBOs on the map and at the
  partners table.
  
• Planning to improve FBO and MOH coordination of a
  national health system
  
• Monitoring for the implementation of primary
  health care interventions.

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CSSC Partners for GIS HRIS

• Interchurch Medical Assistance (coordination)
• The ACCESS project (FANC training)
• The CAPACITY Project (HR interest)
• Global Mapping International (TA in GIS)
• Christian Connections for Intl Health (GRAHM)
• USAID (funding for all of the above)

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Hospitals of TanzaniaComparing Potential
Referral Areas
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A Typical HR Question

• Is understaffing a problem in CSSC facilities?
• In which CSSC zone (and region) is this problem
  most apparent?
  
• Prepare a map to help explain the situation.
• Note Assume that each clinic should have
• 2-4 health professionals.

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Total Staff by Facility Type
In which CSSC zone (and region) is under-staffing
of clinics a problem. Each clinic should have 2
-4 health professionals.
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How Faith-Based Networks can use HRIS GIS

• Dialogue and advocacy
• District Level planning
• Managing human resources
• Monitoring health programs
• Coordination with partners
• Project development management

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Mapping Faith-Based Health Care Networks
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Mapping Faith-BasedHealth Care Networks in
TanzaniaGIS Software Overview
Christian Connections for International Health
Annual Conference May 26 28, 2007 Scott A. T
odd
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Mapping Faith-BasedHealth Care Networks in
TanzaniaGIS Software Overview
Christian Connections for International Health
Annual Conference May 26 28, 2007 Scott A. T
odd
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What is GIS (Geographic Information System)

• Geographic ? Maps
• Information ? Database
• System ? Hardware, Software, Data,
• People, Plans/Programs

GIS combines the intuitive visual clarity of a
map together with the information structuring,
searching and analyzing power of a database.
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What is not GISGPS - The Global Positioning
System
A GPS receiver is a tool used for data
collection, determining your position on the
earth, or wayfinding GPS coordinates can be a t
ype of data input for a Geographic Information
System
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Data The Main Ingredient
How GIS Works. . .
Features, Attributes Operations

• Vector points, lines, polygons (areas)
• Raster images (aerial photos), grids
• Tabular databases, spreadsheets

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Features (Vector data)

• Points Village, Facility, Household, Patient
• Lines Roads, Rivers, Utility Line
• Polygons Country Boundary, Census Tract,
  Service Area

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GIS Features
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Attributes (Tabular Data)

• Events/Objects Village name, Facility type,
• Household size, Patient condition
• Route/Network Road capacity, River name,
• Sewer main size, Boundary length
• Area/Region Country Population, Demographics,
• Service Area (number of patients)

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Attributes
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Operations - Geoprocessing

• Data Integration Collection, Conversion,
  Rectification,
  
• Correlation/Confirmation
• Management Data update/maintenance, Joining w/
  
  
• other databases, Merge data sets
• Analysis Selection/Extraction, Proximity,
  Distribution,
  
• Relationships, Overlay, Change/Trends
• Reporting Printed Maps, Tabular Reports

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GIS Operations
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Who Uses GIS

• Archaeology
• Agriculture
• Banking
• Defense and Intelligence
• Education
• Electric and Gas
• Engineering
• Fire/EMS/Disaster/Homeland Security
• Forestry
• Government (Federal, State, County, Local)
• Health and Human Services
• Insurance
• Landscape Architecture
• Law Enforcement and Criminal Justice

• Libraries and Museums
• Location Services
• Logistics
• Marine, Coast and Oceans
• Marketing
• Media
• Mining and Earth Sciences
• Natural Resources
• Petroleum
• Real Estate
• Retail Business
• Telecommunications
• Transportation
• Universities
• Water and Wastewater
• Weather

Source Environmental Systems Research Institute
Geography Matters, White Paper, 2002
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More than just mapping.

• A Geographic Information System is not just a
  fancy tool for making attractive, detailed maps.
  
• GIS provides a dynamic visual representation of
  the information contained in a database, along
  with the power to query and manage the database.
  
• GIS tools support the creation and integration of
  various kinds of data sets to analyze and better
  understand existing patterns, distributions and
  relationships between features.
• GIS analysis can generate new data to support
  clearer insight and communication for needs
  assessment, decision making for strategic
  planning and data management for implementation,
  monitoring and evaluation of programs and
  initiatives.

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GIS Acquisition

• Software Options

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GIS AcquisitionSoftware Distribution
ModelsFree, Open Source, Commercial
Commercial ()
Free
Issue
Open Source (Also Free)
Installation
Moderate
Complex
Moderate
Features
Limited
Extensive
Extensive
Maintenance
Limited, Free
Complex, Free
Full, Easy,
Interoperability
Limited
Open
Compliant
Market
Industry Specific
Broad
Big Org, Govt, Univ.
User Experience
Low to Moderate
Advanced
Low to Advanced
User Support
Limited
Via Community
Free Install, then
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Definitions

• In general, Open Source refers to any program
  whose source code is made available for use or
  modification as users or other developers see
  fit. (Historically, the makers of proprietary
  software have generally not made source code
  available.) Open source software is usually
  developed as a public collaboration and made
  freely available.home.comcast.net/mtsonata/Final
  Project/glossary.html
• Computer software source code that is released
  under an open-source license or to the public
  domain. Open source licenses include the GNU
  General Public License. Popular open-source
  software includes Apache, PHP, Mozilla Firebird
  and the Linux kernel.www.aardvarkmedia.co.uk/glos
  sary.html
• Free software is a matter of liberty, not price.
  To understand the concept, you should think of
  free as in free speech, not as in free beer.
  
• Free software is a matter of the users' freedom
  to run, copy, distribute, study, change and
  improve the software. More precisely, it refers
  to four kinds of freedom, for the users of the
  software
• 1. The freedom to run the program, for any
  purpose.
  
• 2. The freedom to study how the program works,
  and adapt it to your needs. Access to the
  source code is a precondition for this.
  
• 3. The freedom to redistribute copies so you
  can help your neighbor.
  
• 4. The freedom to improve the program, and
  release your improvements to the public, so
  that the whole community benefits. Access to
  the source code is a precondition for this.
• Commercial Software is available by purchasing a
  license to use it and abiding by the license
  restrictions which limit modification or
  transfer.

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Health Geography

• It is useful to divide the geography of health
  into two interrelated areas
  
• The geography of disease, which covers the
  exploration, description and modelling of the
  spatio-temporal (space-time) incidence of disease
  and related environmental phenomena, the
  detection and analysis of disease clusters and
  patterns, causality analysis and the generation
  of new disease hypotheses
• The geography of healthcare systems, which deals
  with the planning, management and delivery of
  suitable health services (ensuring among other
  things adequate patient access) after determining
  healthcare needs of the target community and
  service catchment zones.

Source Boulos, Kamel MN - Geographic Informatics
in Health, School for Health, University of Bath
Bath BA2 7AY, UK
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GIS Software used in Healthcare
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EpiInfo / EpiMap

• About EpiInfo / EpiMap
• Created by the Centers for Disease Control (CDC),
  in 1985
  
• Latest Version Epi Info Version 3.3.2,
  released Feb 2005
  
• Over 1,000,000 downloads in 180 countries
• Public Health Needs Capable of Addressing
• Meets most needs in epidemiological studies, such
  as disease outbreaks or other public health
  analysis
  
• Software is Free
• Data Format Support
• Import and modify shapefiles
• Compatible with ESRI ArcView, MS Access, Excel,
  dBase, CSV, XML
  
• System Requirements (Windows 95/NT/98/2000/Me/XP)
  
  

Source Alsahhar, Belew, Getachew, McElroy - GIS
in Public Health, University of Dallas, Oct 2005
44

CDC EpiInfo/EpiMap

• Advantages of EpiInfo
• Meets most needs in epidemiological studies
• Free, can be downloaded from CDC WebPages
• With a little computer experience can do simple
  useful analysis
  
• Disadvantages of EpiInfo
• Lacks statistical spatial data analysis
• EpiInfo and EpiMap are two stand-alone programs
• Data not provided with software
• Publicly funded programs
• Limited Technical support - reference to
  available manual

Source Alsahhar, Belew, Getachew, McElroy - GIS
in Public Health, University of Dallas, Oct 2005
45
EpiInfo / EpiMap
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WHO HealthMapper

• About HealthMapper
• Original version 1993 by World Health
  Organization
  
• Supports range of infectious diseases in over 60
  countries
  
• Public Health Needs Capable of Addressing
• Analysis of disease outbreaks, chronic diseases,
  injuries
  
• Limited health resources distribution management
• Software is Free
• Data Format Support
• Import and modify shapefiles
• Import and Link Excel, Access, dBase, .CSV,
  .REC (EpiInfo)
  
• System Requirements Windows (98/NT/2000/Me/XP)

Source Alsahhar, Belew, Getachew, McElroy - GIS
in Public Health, University of Dallas, Oct 2005
47

WHO HealthMapper

• Advantages
• Free can be downloaded from WHO website
• Very useful in supporting health
  surveillance, disease
  
• prevention and control
• Disadvantages
• Limited complex statistical capabilities
• Limited data provided with software
• Publicly funded programs
• Limited Technical support

Source Alsahhar, Belew, Getachew, McElroy - GIS
in Public Health, University of Dallas, Oct 2005
48

WHO HealthMapper
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GRASS (Geographic Resource Analysis Support
System)

• About GRASS
• Originally developed by the U.S. Army
  Construction Engineering Research Laboratories
  (USA-CERL, 1982-1995), a branch of the US Army
  Corp of Engineers, as a tool for land management
  and environmental planning by the military, GRASS
  has evolved into a powerful utility with a wide
  range of applications in many different areas of
  scientific research.
• Public Health Needs Capable of Addressing
• Primarily used in Academic, Government and Large
  Research Institutions
  
• Resource Analysis Support System
• Predictive Modeling in Health Insurance Industry
• Data Format Support
• Direct read and import capabilities of many
  different formats, including rasters, vectors and
  topologic data
  
• System Requirements Linux, Unix, Cygwin, Mac OSX

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GRASS (Geographic Resource Analysis Support
System)

• Advantages
• Offers a broad GIS platform with functions for
  statistical spatial data analysis integrated into
  the program
  
• Creates geographical layers based on geographic
  data from GPS receivers and a variety of other
  sources
  
• Effective Command line processing functionality
• Fully Open-Source and Free
• Disadvantages
• It has limitations in editing geographic
  databases
  
• Map publishing and production tools are less
  intuitive
  
• Best functionality is via command line interface
• Maintenance Technical support via Discussion
  forum or emails or reporting errors or
  recommendations
  
• Requires substantial commitment to Open-Source
  platforms and sophisticated administration
  capacity
  

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GRASS (Geographic Resource Analysis Support
System)
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ESRI ArcGIS

• About ESRI ArcGIS
• Company started in 1969, founded by Jack and
  Laura Dangermond, privately held company
  
• ArcView 1.0 for Windows released in 1992
• Public Health Needs Capable of Addressing
• Analysis of disease outbreaks, chronic diseases,
  injuries
  
• Effective for health resources distribution
  management
  
• Data Format Support
• Direct read and import capabilities of more than
  70 different formats, including rasters (images),
  vectors and ODBC
  
• Import, edit, and export of shape files and many
  other formats
  
• Price Single user license 1500
• Annual Maintenance 500 to 3,000
• System Requirements Windows (98/NT/2000/Me/XP)

Source Alsahhar, Belew, Getachew, McElroy - GIS
in Public Health, University of Dallas, Oct 2005
53
ESRI ArcGIS

• Technical Assistance
• Free for initial year of purchase
• Advantages
• Industry leader in Public health sector
• Many extensions built on ArcGIS
• Base data provided with software
• Software is scalable
• Custom Scripting Capabilities - in VB, C,
  .NET
  
• Disadvantages
• Expensive application and maintenance package
• Not specifically oriented toward Health
  Applications
  
• Need to have hands-on experience and/or training

Source Alsahhar, Belew, Getachew, McElroy - GIS
in Public Health, University of Dallas, Oct 2005
54
ESRI ArcGIS
55
GMI Global Ministry Mapping System

• About GMI- GMMS
• Company started in 1980 as a research project at
  US Center for World Mission and grew to become a
  non-profit research and technical assistance
  organization
• Software uses ArcView as primary GIS engine
• Public Health Needs Capable of Addressing
• Analysis of disease outbreaks, chronic diseases,
  injuries
  
• Effective for health resources distribution
  management
  
• Data Format Support
• Direct read and import capabilities of more than
  70 different formats, including rasters (images),
  vectors and ODBC
  
• Import, edit, and export of shape files and many
  other formats
  
• Price Single user license range from 750 in
  Developed Countries to under 300 in Developing
  Countries
  
• Annual Maintenance varies based on license
• System Requirements Windows (98/NT/2000/Me/XP)

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GMI Global Ministry Mapping System

• Technical Assistance
• Technical support is free but limited by
  organizational size
  
• Broad and diverse GMMS user community
• Advantages
• Built on ArcGIS architecture
• Simplified GUI and map-making wizards
• Extensive Global Base Data provided with
  software
  
• Software is scalable
• Custom Scripting Capabilities - in VB, C,
  .NET
  
• Disadvantages
• Not specifically oriented toward Health
  Applications
  
• Only available to Christian NPOs and NGOs
• Need to have hands-on experience and/or training

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GMI Global Ministry Mapping System
58
Comparison Matrix
59
GIS Demonstration
60
Sources
Contact

• Scott A Todd
• scott_at_gmi.org
• 610-617-0195
• Global Mapping International
• 15435 Glen Eagle Drive, Suite 100
• Colorado Springs, CO 80921 USA
• info_at_gmi.org

• Alsahhar, Belew, Getachew, McElroy - GIS in
  Public Health
  
• University of Dallas, Oct 2005
• Boulos, Kamel MN - Geographic Informatics in
  Health
  
• School for Health, University of Bath, Bath BA2
  7AY, UK