Investing the marginal dollar for Maternal and Newborn Health: Geographic accessibility analysis in...

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


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.


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

…


Approach – Geography and GISApproach – Geography and GIS

Geography

GIS


SpiderBuffers Network Surface

Approach – Geography and GISApproach – Geography and GIS


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!


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

http://www.who.int/kms/initiatives/accessmod/en/index.html

http://www.who.int/kms/initiatives/accessmod/en/index.html

http://www.arcgis.com/home/index.html


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)


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:


Input data - GIS

WHO MNH project – Example of implementation in Cambodia


Location EmOC Admin boundaries

Hydro network Road network

DHS clusters DEM Births distribution

Landcover


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



Input data - Statistics


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



Input parameters – travelling scenario

Low density vegetation: 3 km/h

Sec nat roads: 80 km/hProv roads: 60 km/hUrban roads: 50 km/h


BEmOC

CEmOC

1 hour

2 hours



Input parameters – Maximum travel time

1st Analysi

sOther

Analysis




Input parameters – Demand

BEmOC: 100 % of all births

CEmOC: 15 % of all births

Working at reaching Universal Coverage




Results of the first analysis (BEmOC andCEmOC)




Results of the second analysis (BEmOC and CEmOC)




Third analysis (2 hours travel time only): Step 1 – Use of AccessMod

Universal coverage within the catchment area




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




Comparison between national norms and reality

Discussion onthe national norms

Third analysis (2 hours travel time only):Step 2 – Policy discussion




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




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


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.


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


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


Thank You !Thank You !Karin Stenberg : [email protected]

Maliqui Blerta: [email protected] Ebener: [email protected]

mailto:[email protected]



Date post:	12-Jan-2015
Category:	Health & Medicine
Upload:	icsintegrare
View:	658 times
Download:	2 times

Investing the marginal dollar for Maternal and Newborn Health: Geographic accessibility analysis in...

Health & Medicine