Investing the marginal dollar for                                        MNH: Geographic accessibility                    ...
Context - Investing the marginal dollar               for MNH• Operationalizing the UN Secretary General’s  Joint Action P...
Context - The Tanahashi framework                                                                                         ...
Approach – Geography and GIS                                                                                              ...
Approach – Geography and GISBuffers                              Network                                 Surface          ...
Tool – AccesMod (History)2002: Start of the activity within the context of the of a cost-effectiveness      analysis2003: ...
Tool – AccesMod (Download)Freely accessible for ArcView 3.2 and ArcGIS 9.3.1: • Through the WHO web site (currently update...
Maximum                                                                                                 travel time       ...
WHO MNH project – Analysis Country covered: Burkina Faso, Cambodia, Laos, Malawi and Rwanda                  (+ Philippine...
WHO MNH project – Example of             implementation in CambodiaInput data - GIS Location EmOC                      Adm...
WHO MNH project – Example of                 implementation in CambodiaInput data - StatisticsAt the national level   - To...
WHO MNH project – Example of              implementation in Cambodia Input parameters – travelling scenario               ...
WHO MNH project – Example of             implementation in CambodiaInput parameters – Maximum travel time                 ...
WHO MNH project – Example of             implementation in CambodiaInput parameters – Demand             BEmOC: 100 % of a...
WHO MNH project – Example of             implementation in CambodiaResults of the first analysis (BEmOC andCEmOC)       In...
WHO MNH project – Example of             implementation in CambodiaResults of the second analysis (BEmOC and CEmOC)       ...
WHO MNH project – Example of             implementation in CambodiaThird analysis (2 hours travel time only): Step 1 – Use...
WHO MNH project – Example of             implementation in CambodiaThird analysis (2 hours travel time only): Step 2 – Pol...
WHO MNH project – Example of             implementation in CambodiaThird analysis (2 hours travel time only): Step 2 – Pol...
WHO MNH project – Example of               implementation in CambodiaFourth analysis (2 hours travel time only): Step 1 – ...
WHO MNH project – Example of             implementation in CambodiaFourth analysis (2 hours travel time only): Complement ...
WHO MNH project – Added value to         policy discussionInform current policy discussions at country and global   level ...
Strengths and Weaknesses of the                     approachStrengths:• Good level of flexibility• Goes beyond the usual a...
Expectations from the mash-up• Learn about other approaches using GIS to  measure physical accessibility and geographic  c...
Thank You !                   Karin Stenberg : stenbergk@who.int                     Maliqui Blerta: maliqib@who.int      ...
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Investing the marginal dollar for Maternal and Newborn Health: Geographic accessibility analysis in five countries (Burkina Faso, Cambodia, Laos, Malawi, Rwanda)

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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 Maternal and Newborn Health: Geographic accessibility analysis in five countries (Burkina Faso, Cambodia, Laos, Malawi, Rwanda)

  1. 1. Investing the marginal dollar for MNH: Geographic accessibility analysis in five countries Steeve Ebener Gaia GeoSystems Investing the marginal dollar Southampton, for MNH: Geographic Accessibility Analysis in five countries| Southampton, March 11th, 2013 th March 11 , 2013
  2. 2. 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 countries | Southampton, March 11th, 2013
  3. 3. Context - The Tanahashi framework Target population who do not Effectiveness Coverage contact services Contact Coverage … Geographic aspect Acceptability CoverageProcess of service Accessibility Coverageprovision Availability Coverage TARGET POPULATION Investing the marginal dollar for MNH: Geographic Accessibility Analysis in five countries | Southampton, March 11th, 2013
  4. 4. Approach – Geography and GIS Geography GIS Investing the marginal dollar for MNH: Geographic Accessibility Analysis in five countries| Southampton, March 11th, 2013
  5. 5. Approach – Geography and GISBuffers Network Surface Spider Investing the marginal dollar for MNH: Geographic Accessibility Analysis in five countries| Southampton, March 11th, 2013
  6. 6. Tool – AccesMod (History)2002: Start of the activity within the context of the of a cost-effectiveness analysis2003: 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 2.12008: Release of version 3.0 (anisotropic version for Arcview 3.2)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 countries | Southampton, March 11th, 2013
  7. 7. 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/ind ex.html • ArcGIS online: http://www.arcgis.com/home/index.html (search for AccessMod)Currently working at identifying sources of funding togenerate a version that would run under ArcGIS 10 Investing the marginal dollar for MNH: Geographic Accessibility Analysis in five countries | Southampton, March 11th, 2013
  8. 8. Maximum travel time To From Processing Order New health facility information Investing the marginal dollar for MNH: Geographic Accessibility Analysis in five countries| Southampton, March 11th, 2013
  9. 9. WHO MNH project – Analysis Country covered: Burkina Faso, Cambodia, Laos, Malawi and Rwanda (+ Philippines)Type of infrastructures: BEmOC and CEmOCAnalytical steps:1. Physical accessibility to EmOC: Proportion of births taking place within a given travel time to the nearest BEmOC or CEmOC2. 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 countries4. 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 Investing the marginal dollar for MNH: Geographic Accessibility Analysis in five countries | Southampton, March 11th, 2013
  10. 10. WHO MNH project – Example of implementation in CambodiaInput data - GIS 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 countries | Southampton, March 11th, 2013
  11. 11. WHO MNH project – Example of implementation in CambodiaInput data - StatisticsAt the national level - Total and urban/rural Crude Birth Rate (CBR); - Maximum expected travel speed on the different road typesAt 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-sectionAt the cluster level (Household survey): - Total number of non-assisted home deliveriesAt 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 Investing the marginal dollar for MNH: Geographic Accessibility Analysis in five countries | Southampton, March 11th, 2013
  12. 12. WHO MNH project – Example of implementation in Cambodia Input parameters – travelling scenario Built areas, bare soils: 5 km/h Low density vegetation: 4 km/h Walking Low density vegetation: 3 km/h Dense vegetation: 2 km/hPrim nat roads: 80 km/hSec nat roads: 80 km/hProv roads: 60 km/hUrban roads: 50 km/hRural roads: 40 km/h Taking a vehicle Based on WHO report and local knowledge Investing the marginal dollar for MNH: Geographic Accessibility Analysis in five countries | Southampton, March 11th, 2013
  13. 13. WHO MNH project – Example of implementation in CambodiaInput parameters – Maximum travel time 1 hour BEmOC CEmOC 1st Analysis Other 2 hours Analysis Investing the marginal dollar for MNH: Geographic Accessibility Analysis in five countries | Southampton, March 11th, 2013
  14. 14. WHO MNH project – Example of implementation in CambodiaInput 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 countries | Southampton, March 11th, 2013
  15. 15. WHO MNH project – Example of implementation in CambodiaResults of the first analysis (BEmOC andCEmOC) Investing the marginal dollar for MNH: Geographic Accessibility Analysis in five countries | Southampton, March 11th, 2013
  16. 16. WHO MNH project – Example of implementation in CambodiaResults of the second analysis (BEmOC and CEmOC) Investing the marginal dollar for MNH: Geographic Accessibility Analysis in five countries | Southampton, March 11th, 2013
  17. 17. WHO MNH project – Example of implementation in CambodiaThird 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 countries | Southampton, March 11th, 2013
  18. 18. WHO MNH project – Example of implementation in CambodiaThird analysis (2 hours travel time only): Step 2 – Policy discussion National norms • 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 Investing the marginal dollar for MNH: Geographic Accessibility Analysis in five countries | Southampton, March 11th, 2013
  19. 19. WHO MNH project – Example of implementation in CambodiaThird analysis (2 hours travel time only): Step 2 – Policy discussion Comparison between national norms and reality Discussion on the national norms Investing the marginal dollar for MNH: Geographic Accessibility Analysis in five countries | Southampton, March 11th, 2013
  20. 20. WHO MNH project – Example of implementation in CambodiaFourth analysis (2 hours travel time only): Step 1 – Redistribution of capacities Gap within 2 hours travel time = 0 +7 Universal coverage+9 within 2 hours +6 (new staff) Investing the marginal dollar for MNH: Geographic Accessibility Analysis in five countries | Southampton, March 11th, 2013
  21. 21. WHO MNH project – Example of implementation in CambodiaFourth 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 countries | Southampton, March 11th, 2013
  22. 22. WHO MNH project – Added value to policy discussionInform 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 countries | Southampton, March 11th, 2013
  23. 23. Strengths and Weaknesses of the approachStrengths:• 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 HISWeaknesses:• Data intensive exercise (data availability, quality, accuracy,..)• Dependent on Esri’s technology (Arcview 3.2 or ArcGIS 9.3.1 + Spatial analyst extension) Investing the marginal dollar for MNH: Geographic Accessibility Analysis in five countries | Southampton, March 11th, 2013
  24. 24. Expectations 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 countries | Southampton, March 11th, 2013
  25. 25. Thank You ! Karin Stenberg : stenbergk@who.int Maliqui Blerta: maliqib@who.int Steeve Ebener: steeve.ebener@gaia-geosystems.org Investing the marginal dollar for MNH: Geographic Accessibility Analysis in five countries| Southampton, March 11th, 2013

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