Transcript of "Geographical information systems in health research and services delivery in the philippines"
Geospatial Health 2, 2007, pp. 147-155Geographical information systems in health research andservices delivery in the PhilippinesLydia R. Leonardo1, Bobby A. Crisostomo2, Juan Antonio A. Solon1, Pilarita T. Rivera1,Alvin B. Marcelo3, Jonathan M. Villasper31 Department of Parasitology, College of Public Health University of the Philippines, Manila, thePhilippines; 2National Mapping and Resource Information Authority, Manila, the Philippines; 3NationalTelehealth Center, University of the Philippines, Manila, the Philippines; 4Department of Geography,College of Social Sciences and Philosophy, University of the Philippines, Diliman, the Philippines4Abstract. Accessible public data emanating from remote sensing from earth-observing satellites, as well as geographi-cal information systems in general, are playing an increasing role in the public health sector in the Philippines. Thispaper reviews currently available systems in the country in this area, emphasizing the utility in complementing fieldstudies with the development of disease models. The goal is to map out important biological threats by characterizingthe niches infectious agents, and their vectors or intermediate hosts, occupy temporally and spatially.Keywords: The Philippines, geographical information system, remote sensing, epidemiology, mapping, public health,health service, health delivery.Introduction satellites, advanced image-analyses and statistical methods, the relationships between agro-climatic Geographical information systems (GIS) and data, disease prevalence and vector distributionremote sensing (RS) are the latest technologies could neither easily be shown, nor comprehensive-added to man’s growing arsenal in the fight against ly understood and studied. The situation now isage-old and emerging diseases. Originally devel- quite different.oped for military reconnaissance, these technolo- Never before has the epidemiological backgroundgies have rapidly found use in areas as diverse as of diseases with environmental determinants beenmeteorology, oceanography, forestry, urban devel- so clearly exposed, not only making it possible toopment and ecology. Geospatial applications have identify their exact prevalence distribution but alsoalso been appropriated by the medical field where pinpointing areas where the conditions are support-they are not only used for general information ive for certain endemic hazards, parasitic infectionsmanagement for the health services but have also in particular. Clearly, such information is of greatbeen developed into powerful tools revolutionizing importance as it facilitates geographic localizationthe way epidemiological research is carried out. and time projection when the risk for disease out- Before being supported by sensor data from breaks would be at critical levels. The data emanat- ing from current RS/GIS activities, regularly fur-Corresponding author: nished by epidemiologists and scientists specializingLydia R. Leonardo in the study of ecosystems, complement ongoingDepartment of Parasitology field studies and facilitate the generation of nearCollege of Public Health University of the Philippines real-time map reports.Manila, the PhilippinesTel. +632 532 5929 Fax +632 521 1394 This paper presents how GIS has been utilized inE-mail: email@example.com health research in the Philippines and how it is
148 L.R. Leonardo et al. - Geospatial Health 2, 2007, pp. 147-155explored as a tool to improve the health services increased use of GIS started just about this decadedelivery system. focusing on land use and environmental assessment. Since then, the use of these new technologies in meteorology, positioning and navigation, communi-General GIS activities in the Philippines cations and scientific research has grown substantial- ly in extent and magnitude finally pervading so many As in many countries in the West where RS is cur- areas of the government that it necessitated the cre-rently used, the introduction of this technology in ation of an inter-agency body, i.e. the Science andthe Philippines in the mid-1970s was primarily for Technology Coordinating Council – Committee forthe purpose of generating baseline resource infor- Space Technology Application (STCC-COSTA),mation as well as for monitoring and inventory which has the mandate to serve as the national bodyassessment of forest, mineral and coastal-zone coordinating and overseeing all activities related toresources. An early successful RS application was space technology (Fajardo et al., 2001).the inventory of all forested areas in the Philippines Four government agencies are credited with hav-conducted by the Department of Environment and ing played key roles in the unprecedented growth ofNatural Resources using the General Electric Image RS and GIS in the Philippines in the 1990s. These100 system to process US LandSat MSS scenes are the National Mapping and Resourcetaken between 1972 and 1976 (Solis, 1992). Information Authority (NAMRIA), the Philippine In 1974, multi-disciplinary researchers from the Atmospheric Geophysical and AstronomicalUniversity of the Philippines (UP) developed the first Services Administration (PAGASA), the Soilsprototype computerized GIS model in the country Research Development Center (SRDC) - Bureau ofdealing with a computerized land assessment and Soils and Water Management (BSWM) and the UPplanning system. This model was eventually intro- Training Center for Applied Geodesy andduced into several government agencies in 1979. The Photogrammetry (UPTCAGP) (Papa, 2003).Table 1. Current availability of GIS capabilities at different levels in the Philippines.Local government units Municipalities Cities Provinces Total(LGUs) No. % No. % No. % No. %With GIS capability 215 14 71 61 42 53 328 19Without any GIS 1285 86 46 39 37 47 1368 81Total no. of LGUs 1500 100 117 100 79 100 1696 100Table 2. Diversity of GIS capabilities at the different levels of local government units (LGUs) in the Philippines.Level of GIS Municipalities Cities Provinces Totalcapability No. % No. % No. % No. %Acquaintance 1285 86 46 39 37 47 1368 81Gestational 175 12 35 30 20 25 230 14Developmental 35 2 23 20 18 23 76 4Operational 5 0 13 11 4 5 22 1Total no. of LGUs 1500 100 117 100 79 100 1696 100
L.R. Leonardo et al. - Geospatial Health 2, 2007, pp. 147-155 149 The results of a nationwide survey of GIS capabil- Tropical Medicine (RITM), the UP Manila and theities of local government units (LGUs) conducted in Philippine Council for Health Research andthe years 2001 - 2003 by NAMRIA showed that the Development (PCHRD). The mandates of thesemajority of these political and geographical entities institutions are as follows:had only reached the very early stage of GIS devel- (i) the DOH is the principal health agency in theopment, e.g. acquaintance and the gestation stages Philippines and is responsible for ensuring(Tables 1 and 2). Efforts to improve GIS capability access to basic public health services to allwere then intensified as the new technology’s invalu- Philippinos through the provision of qualityable contribution to decision-making was realized health care and regulation of providers ofand its advantages in facilitating various develop- health goods and services <http://www.ment activities became evident. The Department of doh.gov.ph/profile.htm>;Health (DOH) initiated several GIS projects based (ii) the RITM is a research facility under the DOHon the promise of this technology in health planning which was formally established in 1981 with theand disease surveillance (Inventory, 2004). signing of Executive Order No. 674. It is respon- sible for planning and implementing research programmes for infectious and/or tropical dis-GIS capabilities at key government health-related eases <http://www.ritm.gov.ph/abt.htm>;institutions (iii) the UP Manila is one of the seven autonomous universities under the UP system and is an Faced with the dearth of written documentation education center for health sciences andof GIS-based health projects, its use in health research <http://www.upm.edu.ph/aboutupm/research and how it has been explored as a tool to aboutupm-overview.htm>. It has two healthimprove the delivery of health services, a computer units which are centers of excellence: (a) thesearch was carried out using a general-purpose National Institutes of Health - Philippines (NIH-search engine <www.google.com> and the more Philippines) which is a recognized authority onnarrow search engine for medical research papers health research and development in the countryand communications <www.pubmed.com> together and is a key source of critical health informationwith visits to special websites known to the team of for national development in the Philippines andauthors such as <www.doh.gov.ph>, <www.gisde- Southeast Asia <http://www.iamp-online.org/velopment.com> and <www.geocomm.com>. In interacademy-networ-to-monitor-emerging-addition, DOH officials, involved in the said infections>; and (b) the Philippine Generalprojects, were interviewed and an informal listing Hospital which is the premier tertiary hospitalproduced by technical personnel assigned to com- continuing to uphold its mission of providingpile lists of GIS projects in the DOH was consulted. health care, training, research and qualityFurther, proceedings of a conference on GIS use and health service, particularly to the underprivi-potential, sponsored by the UP Health Informatics leged. It is a center of excellence and leadershipUnit, headed by one of the authors of this paper, with a strong impact on health policiesprovided information on the capabilities of some <http://www.pgh.gov.ph/v2/?fid=aboutus>.provinces or LGUs with reference to this technolo- The PCHRD is one of five sector councils of thegy. Finally, a review of annual reports of NAMRIA Department of Science and Technology (DOST), arevealed the overall state of GIS utilization in the forward-looking, partnership-based national bodycountry. responsible for coordinating and monitoring all Besides the DOH, the major institutions for health activities in the field of research and developmentin the Philippines include the Research Institute for with reference to health at the national level
150 L.R. Leonardo et al. - Geospatial Health 2, 2007, pp. 147-155<http://www.pchrd.dost.gov.ph/newpchrd/index. these indicators were analyzed and identified.php?option=com_content&task=view&id=34&Ite These include the catchment population, themid=33>. number of health workers, the facility age, the All these key institutions, with the exception of length of clinic hours, available equipment,the PCHRD, which acts only as a coordinating and drugs/medicines and supplies, accessibility ofmonitoring body, have either established a GIS lab- the health facility, etc. The model was designedoratory or undertaken a GIS health project. to also be able to use spatial data analysis with regard to location/allocation in order to identi- fy the demands of the catchment population,Applications which would show which health facilities require assistance. The pilot areas chosen for With support from the Asian Development Bank this component were Capiz, a province in the(ADB), the Maternal GIS Project was initiated under Visayas region, and Mt. Province in Luzon; andthe Women’s Health and Safe Motherhood (iii) the Maternal Health GIS Laboratory at theProgramme in December 1999. It was conducted in National Epidemiology Center (NEC) at thecollaboration with NAMRIA developing the follow- Philippine Department of Health.ing three components: The investigation of a system for the analysis of(i) the National Health Atlas, the aim of which the utilization of support to different health facilities was to develop an integrated GIS database of was carried out as a pilot study. This was also done health facilities, i.e. a tool to display the loca- in Capiz where the Maternal Health Modeling study tions of 2,410 rural health units (RHUs) and took place. Another pilot study, aimed to set up an 690 public hospitals in the country and facili- Infectious Disease Data Management System, was tate the retrieval of information for any upcom- conducted in three municipalities in Cavite in Metro ing queries in this field. The location of the Manila covering two diseases, namely rabies and RHUs and hospitals was recorded through a pulmonary tuberculosis. Apart from the major pro- ground survey using hand-held global position- jects described above, which were supported by ing system (GPS) devices. However, all forms, both national and foreign donors, the various pro- distributed to these health facilities to gather grammes at the DOH have made efforts to incorpo- data for the database, were not returned and rate GIS-based methodologies in their operation and the database “only” contains information from service, both for small and more far-reaching activi- 1,878 RHUs and 446 hospitals. Although the ties. The National Epidemiology Center, which is survey was not completed the National Health responsible for regular surveillance and disease Atlas is still useful. It can be accessed at the monitoring, is gradually shifting to more powerful DOH website <http://www.doh.gov.ph/ databas- visualization and analysis tools in performing its es.htm>; obligations. Various sections in the DOH in charge(ii) the Maternal Health Modeling is a GIS-based of control and prevention of different diseases in the application system and a model to gauge the country are also slowly turning to GIS as way to effect of project inputs (materials, supplies and determine the magnitude and extent of disease prob- services) provided by the different health facili- lems. For example, the RITM used GIS in a five- ties on maternal health. The following indica- year project funded by the NIH in the United States tors were used by the model: pre-natal atten- entitled “Schistosomiasis transmission and ecology dance, post-natal attendance, maternal and in the Philippines”. infant mortality rate, and birth weight. Factors Interfacing agriculture and health, the Food and or variables that have significant influence on Agriculture Organization (FAO) launched an inter-
L.R. Leonardo et al. - Geospatial Health 2, 2007, pp. 147-155 151national initiative with reference to food, i.e. the control programmes. The maps will no doubt findFood Insecurity and Vulnerability Information good use in strategic planning for malaria control atMapping System (FIVIMS). The Philippine compo- the local level, in budget planning and prioritizationnent is managed by the National Nutrition Council, of local resources, in developing malaria informa-a policy-making body composed of key government tion and advisory packages for local residents andagencies and private sector representatives. The foreign travelers, malaria risk assessment at thegroup identified 12 variables and, using regression national level and in recommendation of policy andand cluster analysis, categorized the provinces of the programmatic measures to enable the malaria con-Philippines into five vulnerability clusters ranging trol programme in responding and managing malar-from not vulnerable to highly vulnerable. In order to ia during disasters and other emergencies (Blolandmake this large body of data more accessible to pol- and Williams, 2001). A comparative analysis of theicy planners it has been produced in the form of topographic factors and their relationship withmaps. In this way, the project, accessible at the prevalence of malaria in various areas with different<http://www.asiafivims.net/phil/phi_web2/PH2%20 environmental and climatic conditions was also per-1-1.html> website, has provided the decision mak- formed.ers at the national level with the advantage of sum- Among the LGUs, some provinces in the Visayasmarizing priorities. Although it is not inconceivable region and the Pangasinan province in Luzon havethat “highly vulnerable” villages exist in provinces started turning to GIS as a means of improving theirthat are not classified as such, there are no data to services in general. The provincial government ofidentify vulnerable areas in the lower political units Capiz depends much on GIS in the area of health(municipalities or cities). provision and it has one of the strongest transmit- The first successful attempt of using RS and GIS ters in the country. The data are collected by thein health research was a study, carried out by UP Bisita sa Pamilya programme, stored in the MSManila, applying these technologies in determining Access database <www.microsoft.com> and soft-the environmental determinants of the two vector- ware programming is done with Borland C++ andborne diseases, i.e. malaria and schistosomiasis displayed using ArcView 3.1. Health officials access(Leonardo et al., 2005). The programmes developed the GIS-based tools to contact candidates for surgi-in the project were turned over to the pilot munici- cal missions such as, for example, Operation Smilepalities in Davao del Norte in Mindanao for updat- (a surgical mission for cleft lip and cleft palateing of prevalence maps and other data collected dur- patients). Patients with congenital face deformitiesing the duration of the study. A seminar held to used to be recruited for operation in an ad hoc man-facilitate the dissemination of the information col- ner but GIS permits a fairer and more straightfor-lected served as an eye-opener for what GIS can do ward selection from the database. Other examplesby attracting many municipal health officers and of local use of GIS include the tracking of dengueother information technology personnel. In fact, the cases and selection of candidates for the indigentsuccess of this study encouraged another faculty in programme of the Philippine Health InsuranceUP Manila where Dr. Pilarita Rivera proposed to Corporation.extend the coverage to the national level concen- Cebu city in the province of the same name has atrating on the most important of diseases, e.g. GIS center which supports other city governmentmalaria. The project entitled “Application of GIS in departments in the management of their projectsmalaria surveillance in disaster-prone provinces in and in the improvement of their services. In Luzon,the Philippines” will produce malaria GIS maps the Pangasinan provincial government started thewhich will be regularly updated and used in the use of GIS to map out, in ten pilot municipalities,evaluation of the effectiveness of the local malaria the service delivery points (SDP) which include
152 L.R. Leonardo et al. - Geospatial Health 2, 2007, pp. 147-155RHUs, hospitals, private clinics and pharmacies, sible for the development of standards in the cre-and reproductive health indicators. The objective is ation and use of all major geographic informationto develop a system leading to a referral process that holdings for socio-economic activities such as popu-will direct users of the family planning programme lation, income, mortality, and health facilitiesto the appropriate SDP not only depending on their (Milrad, 1990).needs of commodities and requirements in this area Most, if not all, of these GIS projects make use ofbut also on their capacity to pay. The activity is at personal computers, mostly pentium-based.present housed in the Provincial Population Office. Peripherals include digitizers, plotters and scanners.It employs non-customized ArcView 3.3 with the The GIS software products used are Arc/Info andnetwork analyst extension for production of the ArcView.maps which depict the road networks and barangay(village) boundaries based on land use maps of thevarious municipalities and data provided by the Efforts to standardize the documentation of GISLand Management Bureau and NAMRIA. An data in the health areaexpanded follow-up project has been subsequentlydeveloped that is expected to be funded by USAID. All GIS applications customized for the maternal The Philippine Institute for Development Studies GIS project employ a standard coding scheme which(PIDS) launched a GIS-based website of socio-eco- was developed to uniquely identify all the RHUsnomic indicators <www.pids.gov.ph> at the region- and hospitals encoded in the areas covered by theal and provincial levels. However, only two health system. The coding scheme was given the nameindicators, infant mortality rate and prevalence of HF_CODE which is short for “Health Facilitymalnutrition, were featured in this undertaking. Code”. The same scheme was adopted for the devel- The Inter-agency Task Force on Geographic opment of the Philippine database in HealthInformation (IATFGI) was created on 15 April 1993 Mapper, which is a surveillance and mapping systemby virtue of the National Statistical Coordination for infectious diseases developed by the WorldBoard (NSCB) Memorandum Order No. 01-93. The Health Organization (WHO) and the UnitedIATFGI is primarily in charge of promotion and Nations International Children’s Emergency Fundcoordination of the efficient development, manage- (UNICEF) <http://www.who.int/health_mapping/ment and utilization of geographic information in tools/healthmapper/en/index.html>. Its structure isthe Philippines. NAMRIA acts as the chair and composed of three levels: the Philippine standardNSCB as the co-chair of IATFGI. The only IATFGI geographic code (PSGC) component, the facilitymember-agency engaged in health services is DOH type and a facility number, as shown in Table 3.which acts as the Chair of the IATFGI’s technical The first level is the 6-digit PSGC code developedworking group (TWG) on socio-economics and has by the National Statistics Coordination Boardbecome very active in the IATFGI’s standardisation (NSCB) which is a systematic classification of geo-activities. The TWG on Socio-Economics is respon- graphic areas in the Philippines. This classification isTable 3. Example of how the geographical location and type of facility for health-delivery are used to construct a standardcode for use in health databases in the Philippines. PSGC component Type Facility no. Administrative unit/geographical location 061903 R 0001 Dumalag RHU 061904 H 0001 Dumaro Medicare Community Hospital
L.R. Leonardo et al. - Geospatial Health 2, 2007, pp. 147-155 153based on the three well-established levels of geo- data itself there is not only the need of determininggraphical-political subdivisions of the country such the availability and accuracy of specific datasets, butas the region, the province, and the also the problem of obtaining specific, timely data inmunicipality/city. The PSGC is being adopted as a a desired map scale and projection and gettingstandard code by the IATFGI and used by NAMRIA access to the right storage medium. In addition, thein most of its GIS development projects. The second end-user must know all about data conversion,level of the HF_CODE identifies the type of health translation of files, have experience with largefacility where ‘H’ stands for hospital and ‘R’ for datasets and be security-minded. Finally, it wouldRHU. The facility number, finally, is a four-digit not be possible to work in this field without goodsequential number that defines the health facility cooperation with those who produce the data andwithin that municipality. As an illustration, an RHU the unfailing support of management and vendorswith a facility number ‘0003’ means that it is the (Yavas et al., 1985).third RHU (in sequence) within that municipality. The experience proves that the start-up of a GISThe default value is ‘0001’ (Papa and Crisostomo, project is much less of a problem than to sustain the2003). activities encouraged. The task of moving on with minimal financial support, or none at all, becomes daunting after the final project reports have beenIssues and prospects for the future turned in and the huge responsibility of carrying on without further support sinks in. The personnel The challenges that come with introducing a rad- working within the framework of a GIS projectically new technology that changes existing proce- mostly have background knowledge in the area ofdures completely are always great. The start-up information technology (or in adjacent fields such ascost of establishing the new GIS technology in geodetic engineering and geography) or have under-terms of hardware and software, manpower train- gone special training in GIS through a course takening and maintenance is tremendously high and locally or abroad. When the projects terminate, themost pioneers in a situation like this must therefore staff is either absorbed by departments with similarhave access to special funds which in practice projects, return to their original appointments ormeans that they will have to rely on foreign donors leave altogether to seek other employments. Post-such as the World Bank, USAID, WHO, etc. The project stagnation is a potentially serious problemhuge cash flow needed for the acquisition of hard- that must be tackled without delay as there general-ware and software could be overwhelming to an ly is a lack of ideas on how and where to use theagency new to the field. equipment caused by low or missing incentive cou- Due to security reasons and the requirement of pled with poor encouragement to use the technolo-continuing maintenance, most of this expensive GIS gy for new projects. Added to this is the impressionequipment and software are kept in offices of high- of GIS as a novelty or a fad which every office mustranking officials where access necessarily becomes have and which might be replaced by something elselimited. This situation discourages trained personnel in a few years time. Hence, the risk is great that thefrom practicing what they have been trained to do equipment ends up in a showroom untouched orresulting in underused equipment and underdevel- under-used in offices which have no real need for it.oped GIS facilities. In spite of the considerable problems that the Staff is faced with many problems in implement- information revolution brings with it, there is noing GIS technology such as funding and updating of doubt that the role of GIS in health research andthe GIS databases, integrating data with other infor- services delivery in the Philippines is well-mation systems and maintenance. Regarding the entrenched. The efforts of the government in coor-
154 L.R. Leonardo et al. - Geospatial Health 2, 2007, pp. 147-155dinating and supporting GIS initiatives in the var- Conclusionsious sectors are a source of encouragement. Thedirection of activities and the objective of the The cost for a country to equip itself and makingDOH in using GIS for evidence-based planning, itself ready to join the global mainstream of GISmonitoring, evaluation, and policy-making activi- users is very high. However, the potential profits areties assure stakeholders of the sustainability of the equally high and for a country whose main resourcesystems employed (National Objectives for is its people, GIS may be crucial in the questHealth, 1999). Attempts to make GIS technology towards improved health and welfare.available to the public with efforts such as offer The decision to set up a centralized separate GISfree downloading of the powerful GRASS soft- department or designate fulltime and permanentware package not only turn on the green light for GIS personnel is not far-fetched. However, sustain-late starters but facilitate the work for those who ability is the key and will depend critically on thehave already made a head start. In addition, sev- technical know-how as well as upgrading of skills,eral websites offer public access data at different either through formal degree programmes orscales from the global level down to regional and through short courses; even training to use specificprovincial levels. software packages. This certainly reduces the Significant sites offering free data are the Digital expenses for hiring foreign consultants, somethingChart of the World at <www.maproom.psu.edu/dcw/>, that could not be avoided in the early days of start-the University of Maryland (UM)’s highly empow- ing up GIS activities from scratch.ered “Global Land Cover Facility (GLCF)” at GIS applications in the area of public health have<http://glcf.umiacs.umd.edu/index.shtml>, and the brought in a new wave of optimism in this sectorNational Aeronautics and Space Administration’s regarding the way health-oriented research and deliv-“World Wind” at the <http://www.worldwind. ery of services will develop. Convinced of the powerarc.nasa.gov/index.html> website. The GLCF and facility which this tool can provide for informa-archive offers raw satellite images of almost any tion management, both administration and rank andplace on the earth that can be downloaded for free. file of the Philippine DOH have expressed willingnessThe images are donations to, and holdings of, the to overhaul the existing system and move to formatsUM that have been released for public consumption. compatible with this technology. Outside the govern-The Philippines is well covered by their LandSat ment, in the academe, the private sector and amongholdings. On the other hand, World Wind provides non-governmental organizations, GIS is slowlya technology for viewing the earth’s terrain in visu- becoming an essential tool in many of their activities,ally rich 3D and for virtually visiting any place in both in research and in the delivery of services.the world. LandSat imagery and Shuttle RadarTopography Mission (SRTM) elevation data areused to be able to fly across the world including the ReferencesPhilippines in any direction. World Wind makesavailable also the Moderate Resolution Imaging Bloland PB, Williams HA, 2001. Malaria control during massSpectroradiometer (MODIS) data covering the population movements and natural disasters. Washington, DC, National Academies Press.Philippines for viewing and downloading. The Fajardo IS, Carandang E, Crisostomo BA, 2000. Country report“Google Earth” which is available at the Google on space satellite projects and policy in the Philippines.website <http://earth.google.com/index.html> has Inventory of the Status of GIS Capabilities of Local Government Units, 2004. Information management depart-features very similar to those of World Wind. ment, national mapping & resource information authorityHowever, some of its data cannot be downloaded (NAMRIA).for free but for a fee. Leonardo LR, Rivera PT, Crisostomo BA, Sarol JN, Bantayan
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