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This presentation was given at the technical mash-up meeting on "Mapping for Maternal and Newborn Health", hosted by ICS Integrare and the University of Southampton, with the support of the Norwegian Agency for International Development (NORAD) in Southampton (UK), 11-12th March 2013. Further details are available here http://integrare.es/?cat=33 The project described in this presentation looks at identifying local health system supply side constraints to scaling up maternal and newborn health care as well as estimating the marginal investment needed to expand coverage and uptake of services. By Steeve Ebener, Gaia Geosystems.
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Investing the marginal dollar for MNH: Geographic Accessibility Analysis in five countriesSouthampton, March 11th, 20131 |
Investing the marginal dollar for MNH: Geographic accessibility
analysis in five countries
Investing the marginal dollar for MNH: Geographic accessibility
analysis in five countries
Southampton, March 11th, 2013Southampton, March 11th, 2013
Steeve EbenerGaia GeoSystems
Steeve EbenerGaia GeoSystems
Investing the marginal dollar for MNH: Geographic Accessibility Analysis in five countriesSouthampton, March 11th, 20132 |
Context - Investing the marginal dollar for MNH
Context - Investing the marginal dollar for MNH
• Operationalizing the UN Secretary General’s Joint Action Plan for women and children’s health,
• Undertaken to inform policy discussions on how to optimize or target the spending of the marginal dollar for maternal health at country level,
• Examine the infrastructure requirements for scaling up coverage of institutional delivery with skilled attendance.
Investing the marginal dollar for MNH: Geographic Accessibility Analysis in five countriesSouthampton, March 11th, 20133 |
Pro
cess o
f serv
ice
pro
vis
ion
TARGET POPULATION
Availability Coverage
Accessibility Coverage
Acceptability Coverage
Contact Coverage
Effectiveness CoverageTarget population who do not
contact services
Coverag
e curve
Geographic aspect
Context - The Tanahashi framework
…
Investing the marginal dollar for MNH: Geographic Accessibility Analysis in five countriesSouthampton, March 11th, 20134 |
Approach – Geography and GISApproach – Geography and GIS
Geography
GIS
Investing the marginal dollar for MNH: Geographic Accessibility Analysis in five countriesSouthampton, March 11th, 20135 |
SpiderBuffers Network Surface
Approach – Geography and GISApproach – Geography and GIS
Investing the marginal dollar for MNH: Geographic Accessibility Analysis in five countriesSouthampton, March 11th, 20136 |
2002: Start of the activity within the context of the of a cost-effectiveness analysis
2003: Need to develop an automated module. First results obtained through the application of the extension developed for ArcView2004: Decision on the name for the extension: AccessMod. First publication based on the use of AccessMod (ESRI health user conference)
2005: Release of version 2.1
2008: Release of version 3.0 (anisotropic version for Arcview 3.2)
Tool – AccesMod (History)Tool – AccesMod (History)
2012: Release of version 4.0 (for ArcGIS 9.3.1) in the context of the Investing the marginal dollar for Maternal and Newborn Health project
10 years of development and use!
Investing the marginal dollar for MNH: Geographic Accessibility Analysis in five countriesSouthampton, March 11th, 20137 |
Tool – AccesMod (Download)Tool – AccesMod (Download)
Freely accessible for ArcView 3.2 and ArcGIS 9.3.1:
• Through the WHO web site (currently updated): http://www.who.int/kms/initiatives/accessmod/en/index.html
• ArcGIS online: http://www.arcgis.com/home/index.html (search for AccessMod)
Currently working at identifying sources of funding to generate a version that would run under ArcGIS 10
Investing the marginal dollar for MNH: Geographic Accessibility Analysis in five countriesSouthampton, March 11th, 20138 |
Population distribution
Inputscenario file
Combined Landcover
Health Facilities
Maximumtravel time
Coveragecapacity
DEM
ProcessingOrder
Isotropy / anisotropy
ToFrom
New health facility
information
Original Landcover
Barrier line (e.g Rivers)
Roads
Barrier polygon (e.g lake)
Investing the marginal dollar for MNH: Geographic Accessibility Analysis in five countriesSouthampton, March 11th, 20139 |
Type of infrastructures: BEmOC and CEmOC
Country covered: Burkina Faso, Cambodia, Laos, Malawi and Rwanda (+ Philippines)
1. Physical accessibility to EmOC: Proportion of births taking place within a given travel time to the nearest BEmOC or CEmOC
2. Comparison between the physical accessibility analysis and data on actual service utilization (all facilities for BeMOC, C-sections for CEmOC)
3. Accessibility coverage: Estimate the health system capacity that would be required to reach universal coverage for all the births located within 2 hours travel time from the nearest EmOC and initiate the policy dialogue with countries
4. Cost analysis: Define a scenario to scale up the existing coverage capacity of the EmOC network currently in place to reach universal coverage over the all country and estimate the corresponding cost for this scaling up
WHO MNH project – AnalysisWHO MNH project – Analysis
Analytical steps:
Investing the marginal dollar for MNH: Geographic Accessibility Analysis in five countriesSouthampton, March 11th, 201310 |
Input data - GIS
WHO MNH project – Example of implementation in Cambodia
WHO MNH project – Example of implementation in Cambodia
Location EmOC Admin boundaries
Hydro network Road network
DHS clusters DEM Births distribution
Landcover
Investing the marginal dollar for MNH: Geographic Accessibility Analysis in five countriesSouthampton, March 11th, 201311 |
At the national level - Total and urban/rural Crude Birth Rate (CBR); - Maximum expected travel speed on the different road types
At the sub national level - Population by age groups and sex - CBR (or fertility rate if CBR not available) - Percentage of births delivered in a health facility (all level) - Percentage of births delivered by C-section
At the cluster level (Household survey): - Total number of non-assisted home deliveries
At the health facility level: - For BEmoC (including CEmOC): Number of: nurses, midwifes and doctors - For CEmOC: Number of functional operatory theaters, OB/GYN, medical
worker qualified to perform CS, medical worker qualified to perform anesthesiology
WHO MNH project – Example of implementation in Cambodia
WHO MNH project – Example of implementation in Cambodia
Input data - Statistics
Investing the marginal dollar for MNH: Geographic Accessibility Analysis in five countriesSouthampton, March 11th, 201312 |
Built areas, bare soils: 5 km/h
Low density vegetation: 4 km/h
Dense vegetation: 2 km/hWalking
Taking a vehicle
Prim nat roads: 80 km/h
Rural roads: 40 km/h
Based on WHO report and localknowledge
WHO MNH project – Example of implementation in Cambodia
WHO MNH project – Example of implementation in Cambodia
Input parameters – travelling scenario
Low density vegetation: 3 km/h
Sec nat roads: 80 km/hProv roads: 60 km/hUrban roads: 50 km/h
Investing the marginal dollar for MNH: Geographic Accessibility Analysis in five countriesSouthampton, March 11th, 201313 |
BEmOC
CEmOC
1 hour
2 hours
WHO MNH project – Example of implementation in Cambodia
WHO MNH project – Example of implementation in Cambodia
Input parameters – Maximum travel time
1st Analysi
sOther
Analysis
Investing the marginal dollar for MNH: Geographic Accessibility Analysis in five countriesSouthampton, March 11th, 201314 |
WHO MNH project – Example of implementation in Cambodia
WHO MNH project – Example of implementation in Cambodia
Input parameters – Demand
BEmOC: 100 % of all births
CEmOC: 15 % of all births
Working at reaching Universal Coverage
Investing the marginal dollar for MNH: Geographic Accessibility Analysis in five countriesSouthampton, March 11th, 201315 |
WHO MNH project – Example of implementation in Cambodia
WHO MNH project – Example of implementation in Cambodia
Results of the first analysis (BEmOC andCEmOC)
Investing the marginal dollar for MNH: Geographic Accessibility Analysis in five countriesSouthampton, March 11th, 201316 |
WHO MNH project – Example of implementation in Cambodia
WHO MNH project – Example of implementation in Cambodia
Results of the second analysis (BEmOC and CEmOC)
Investing the marginal dollar for MNH: Geographic Accessibility Analysis in five countriesSouthampton, March 11th, 201317 |
WHO MNH project – Example of implementation in Cambodia
WHO MNH project – Example of implementation in Cambodia
Third analysis (2 hours travel time only): Step 1 – Use of AccessMod
Universal coverage within the catchment area
Investing the marginal dollar for MNH: Geographic Accessibility Analysis in five countriesSouthampton, March 11th, 201318 |
WHO MNH project – Example of implementation in Cambodia
WHO MNH project – Example of implementation in Cambodia
Third analysis (2 hours travel time only):
• BEmOC: • Number of nurses, midwifes, doctors per X
number of births per year
• CEmOC:• Number of OB/GYN, nurses, midwifes, medical
workers qualified to perform C-Sections, medical workers qualified to perform anesthesiology as well number of operatory theaters per X number of births per year
National norms
Step 2 – Policy discussion
Investing the marginal dollar for MNH: Geographic Accessibility Analysis in five countriesSouthampton, March 11th, 201319 |
WHO MNH project – Example of implementation in Cambodia
WHO MNH project – Example of implementation in Cambodia
Comparison between national norms and reality
Discussion onthe national norms
Third analysis (2 hours travel time only):Step 2 – Policy discussion
Investing the marginal dollar for MNH: Geographic Accessibility Analysis in five countriesSouthampton, March 11th, 201320 |
WHO MNH project – Example of implementation in Cambodia
WHO MNH project – Example of implementation in Cambodia
Fourth analysis (2 hours travel time only): Step 1 – Redistribution of capacities
+7
Gap within 2 hours travel time = 0
+9
+6 (new staff)
Universal coverage within 2 hours
Investing the marginal dollar for MNH: Geographic Accessibility Analysis in five countriesSouthampton, March 11th, 201321 |
WHO MNH project – Example of implementation in Cambodia
WHO MNH project – Example of implementation in Cambodia
Fourth analysis (2 hours travel time only): Complement of capacities
New facilities to cover the births outside of 2 hours of travel time
Building, staff, equipment,..
+
=Total cost to reach universal coverage
Investing the marginal dollar for MNH: Geographic Accessibility Analysis in five countriesSouthampton, March 11th, 201322 |
WHO MNH project – Added value to policy discussion
WHO MNH project – Added value to policy discussion
Inform current policy discussions at country and global level by providing:
• Recommendations on health system output indicators and benchmarks on EmOC;
• Evidence on current health system barriers to care from the supply perspective and their implications for expanding universal access to MNH services;
• Guidance on the relative financial resource requirements for different scenarios aiming at expanding access to, and use of, quality skilled care at birth taking place in health facilities.
Investing the marginal dollar for MNH: Geographic Accessibility Analysis in five countriesSouthampton, March 11th, 201323 |
Strengths and Weaknesses of the approach
Strengths and Weaknesses of the approach
Weaknesses:• Data intensive exercise (data availability, quality, accuracy,..)• Dependent on Esri’s technology (Arcview 3.2 or ArcGIS 9.3.1 +
Spatial analyst extension)
Strengths:• Good level of flexibility• Goes beyond the usual accessibility analysis by including the
capacity (HR and equipment) component to measure geographic coverage
• Results are easy to understand and facilitate policy discussion
• Allows using MNH as a driver to improve the integration of the geographic dimension in the HIS
Investing the marginal dollar for MNH: Geographic Accessibility Analysis in five countriesSouthampton, March 11th, 201324 |
Expectations from the mash-upExpectations from the mash-up
• Learn about other approaches using GIS to measure physical accessibility and geographic coverage
• Have a chance to discuss few issues including:• Methods to spatially distribute births at the
sub national level• EmOC International/national norms (staff and
equipment )• Find way to improve the current approach
Investing the marginal dollar for MNH: Geographic Accessibility Analysis in five countriesSouthampton, March 11th, 201325 |
Thank You !Thank You !Karin Stenberg : [email protected]
Maliqui Blerta: [email protected] Ebener: [email protected]