Presented by Andrew Inglis, MEASURE Evaluation, at the June 2012 MEASURE GIS Working Group meeting.

1. Mapping health services using
old and new technology in a
limited resource environment:
Iringa Region, Tanzania
MEASURE GIS Working Group
June 2012
Andrew Inglis & Yohana Mapala

2. The Issue
 16% HIV prevalence
o Mobile workforce: migrant
workers, truck drivers
 Where are the prevention
services?
 Where are the transmission
hot spots?
 Are the right services in the
right places?
 Do we have adequate
coverage?

3. The Approach
 Map the prevention services and
their coverage
 Locate the transmission hot spots
(separate activity)
 Overlay service locations with
transmission hot spots

4. Map the prevention sites:
The tasks and constraints
 Include all USAID-supported prevention sites
 Prevention of Mother-to-Child Transmission (PMTCT)
 Voluntary Counseling and Testing (VCT)
 Treatment
 Male Circumcision (MC)
 Many located in remote rural areas
 Limited existing data (eg list of sites, population
data)
 Limited budget and short time frame

5. Map the prevention sites:
The Solution
 Old technology
o Interview key informant
o Use “Paper” district level maps to map out the
reach of the services
o New Technology
o Collect GPS location
o Digital photograph of map.
o Create digital map of the reach of facilities
o Calculate population within reach using digitized
area and Landscan population data

6. Map the prevention sites:
The Solution – Data collection
Prepare District Maps
Include Pre-marked
Georeference makers
Prepare data collection
procedures, forms and
training materials
Conduct training on data
collection using maps,
GPS, camera and forms

7. Map the prevention sites:
The Solution – Data collection
Visit District Health
Officer
Visit Heath Facility/Site
Take GPS reading and
Photograph site
Identify key informant

8. Map the prevention sites:
The Solution – Data collection
Visit Heath
Facility/Site
Identify key informant
Explain map and
data collection
method
Mark on map where
“most” clients come
from
Photograph the map

9. Map the prevention sites:
The Solution – Data collection
Visit Heath
Facility/Site
Identify key informant
Explain map and
data collection
method
Mark on map where
“most” clients come
from
Photograph the map

10. Map the prevention sites:
The Solution – Data processing
 Review Field data
 Use Quantum GIS for GIS data processing
o Georeference map images using Georeference
Plugin
o Digitize the reach of health facilities
o Estimate population within the reach of the health
facility
 Review result of calculation

11. Map the prevention sites:
The Solution – Data processing
Use Georeferencer
plugin
Use Pre-marked
georeference marks
on map image
Or, use major road
intersections
Minimum of 5 points
2% Residual error

12. Map the prevention sites:
The Solution – Data processing
Digitize sites and
reach of the site
Use Point to one
Plugin
Converts points in
Polygon
Convert projection
to UTM

13. Map the prevention sites:
The Solution – Calculating Coverage
 Use Landscan 2010 to estimate
the total population within the
Catchment Layer reach of the health facility
 Overlay reach polygon on the
Landscan Layer
Landscan layer
 Then divide the total pop. by the
Catchment Layer proportion of the target pop.
With Population
 Link the estimated population to
the site and it’s reach.

14. Map the prevention sites:
The Solution – Result
Combined data from all sites
• PMTCT
• VCT
• Treatment
• MC
Link with routine reporting data
• Estimate the coverage of the
prevention programs
Share maps results with key
stakeholders

15. Map the prevention sites:
Demonstration

16. Map the prevention sites:
Web demonstration

17. Limitations:
 Limited to the information collected.
 Relied heavily on each key informant’s knowledge of his/her
client base.
 Catchment areas and coverage are ONLY estimates
 Based on key informants and modeled populations data.
 Should be treated as approximate and not exact figures.
 Coverage maps only represent the pattern of USG-supported
HIV services being provided
 Does not take into account likely increases in coverage for sites
with shared/overlapping reach,
 Due to the limitations above, interpretation of the results should
focus on general patterns.

18. Map the prevention sites:
Lessons Learned
 Engage key staff
 Work closely with printing company
 Maintaining high data quality and organization
 Time field work around local conditions

19. CONCLUSIONS
 Demonstrated a straightforward, relatively
inexpensive method for identifying patterns and
examining prevention program coverage based
on key informant interviews at the service
delivery level.
 Such estimates can inform discussions on
service coverage patterns and support the
prioritization of resources for both fixed and
outreach health programs.

20. MEASURE Evaluation is a MEASURE project funded by the
U.S. Agency for International Development and implemented by
the Carolina Population Center at the University of North Carolina
at Chapel Hill in partnership with Futures Group International,
ICF Macro, John Snow, Inc., Management Sciences for Health,
and Tulane University. Views expressed in this presentation do not
necessarily reflect the views of USAID or the U.S. Government.
MEASURE Evaluation is the USAID Global Health Bureau's
primary vehicle for supporting improvements in monitoring and
evaluation in population, health and nutrition worldwide.