§  Maternal  and  newborn  mortality  remain  high  with  significant  geographic  inequi8es.  

• Loca8on  of  services  is  key  determinant  to  care-­‐seeking  

§  Geographic  Informa8on  Systems  (GIS)    allow  a  more  in-­‐depth  analysis  of:  

• Current  situa8on:  causes  and  factors  behind  adverse  maternal  and  newborn  outcomes  

• Planning  for  improved  resource  alloca8on:  where  to  locate  health  services  for  maximum  coverage,  especially  for  hard  to  reach  popula8ons  

§  Combining  health  and  geographic  data  can  is  crucial  for  post-­‐2015  agenda,  and  contributes  to  universal  health  coverage  

• Lessons  learned  –  malaria,  HIV,  and  MNH  

Why  Data  Visualiza.on?  

Background  

•  Projects  working  on  MNH  Mapping    –  Inves8ng  the  marginal  dollar  for  MNH:  Assessing  geographic  

access  to  skilled  maternity  care  (EmOC)  

•  EmONC  indicator  mee8ng  -­‐  December  2012  –  Poten8al  for  GIS  mapping  for  EmONC    

•  Mapping  MNH  Mash-­‐up  –  March  2013  –  Literature  review,  state-­‐of-­‐the-­‐art,  collabora8on  

•  State  of  the  World’s  Midwifery  –  June  2014  •  Mapping  Technical  Consulta8on  –  January  2015  

–  Recommenda8ons,  informal  network    

•  State  of  the  art  publica8on  –  2015  –  “The  geography  of  maternal  and  newborn  health:  the  state  of  the  

art”     2

Tanahashi  Framework  

Source: Tanahashi (1978): Health service coverage and its evaluation. Bulletin of World Health Organization; 56: 295-303.

Target  Popula.on:    Expected  Pregnancies/Births  

More  informa.on  at:  www.worldpop.org.uk  

Accessibility  Coverage  

Location EmoC Admin boundaries Road network River network

Altitude Landcover Birth distribution

How  Can  Data  Be  Used?  

•  Raise  awareness  on  the  importance  of  geography  when  looking  at  accessibility  to  MNH  and  outcomes  –  Universal  Health  Coverage  –  sub-­‐na8onal,  equity  

•  Facilitates  discussions  with  MOH  stakeholders  –  where  to  build/upgrade  facili8es  to  increase  access,  where  to  locate  health  workers    

•  Understand  where  deaths  and  other  poor  outcomes  are  happening  –  and  where  to  target  services  

•  Inform  the  policy  making  process  by  allowing  to  test  assump8ons  before  implemen8ng  them.  

•  More  detail  on  assump8ons  and  analyses:  hcp://www.ncbi.nlm.nih.gov/pmc/ar8cles/PMC4453214/pdf/12942_2015_Ar8cle_12.pdf  

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Next  Steps  

•  Network  of  public  health  prac88oners,  geographers,  researchers,  program  managers,  academics,  and  others    

•  Documenta8on  of  how  maps  have  been  used  for  decision-­‐making  across  countries  

•  Standard  geo-­‐coded  list  of  health  facili8es  in  all  countries  –  open  access  

•  Ensure  format  and  sofware  for  maps/visuals  tailored  to  end  user  

•  Capacity  building  to  create  and  interpret  maps/visuals  for  decision-­‐making  

•  Open  source,  accessible,  GIS  sofware  

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THANK YOU

EXTRA SLIDES

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Availability Coverage: Mozambique 2007

Access to Care: Philippines

Province level Municipality level

Aggrega8ng  informa8on  might  mask    pockets  of  heterogeneity  at  a  lower  level  

Percentage  of  births  where  the  household  is  located  within  2  hours  of  a  maternity  facility  (BEmONC,  CEmONC)  

Scaling  up  CEmONC  facili.es   Upgrading  the  Polomok  Municipality  Hospital  from  BEmONC  to  CEmONC  would  allow  for  8  of  these  11  BEmONC  to  find  themselves  within  2  hours  of  reach  of  a  CEmONC  facility.  

Philippines

This  kind  of  analysis  could  also  be  used  to  improve    BEmONC  accessibility  coverage  especially  in  Sarangani  Province  

Health Outcomes: Mozambique, 2007

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Number  of  unacended  home  births  (DHS  2010),  on  top  of  catchment  areas  using  accessibility  and  geographic  coverage  analysis  

Access to Care: Burkina Faso

Maternal and Newborn Mortality

•  289,000 women die each year as a result of pregnancy and childbirth

•  Xx newborns die each year in first month of life •  Globally accepted targets for reduction of maternal

and newborn mortality by 2030 - Sustainable Development Goal 3 –  By 2030, reduce the global maternal mortality ratio to less

than 70 per 100,000 live births –  By 2030, reduce neonatal mortality to at least 12 per 1,000

live births and under-5 mortality to at least 25 per 1,000 live births

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