M.D. (Provincial Public Health Office, Pattani Province)
Ph.D. (Department of Geography, Kasetsart University)
Email : [email protected]
Ph.D. Candidate (Asian Institute of Technology)
The Pattani Provincial Public Health Office (PPHO) received financial support from the United Nations Population Fund AID (UNPFA) to launch a pilot project on application of Geographic Information System (GIS) for analyzing and planning of Reproductive Health (RH) services in 2001. The project had both short-and long-term objectives. The short-term objective was to introduce a GIS technology in RH application in analyzing and seeking clusters of houses of pregnant women who use TBAs services for delivery. The long-term objective was to apply the GIS technology and the experience gained during the implementation of the system prototype development phase for developing the health plans in RH and other health concerns such as STD/HIV/AIDS protection, family planning, adolescent reproductive health, health education and epidemiology for common and rare disease control. More importantly, the project aimed to build up the capacity of the Information Technology and related GIS technologies to health personnel of Pattani PPHO so that they can further develop and apply the GIS knowledge in other public health areas after completion of the pilot project. It was expected that the model used in the pilot project would be applied in the extension of the project to cover public health services in Pattani over a broader area.
For launching the pilot project, four villages of Napradu Sub-district in Khok Pho District, Pattani Province, southern region of Thailand, were selected as the study area. These included Ban Thung Han, Ban Talad Na Pradu, Ban Huai Pai and Ban Napradu villages as shown in Image 1.
Image 1: Napradu Sub-district, the Study Area
The objective of this pilot project was to develop the system prototype of the Geographic Information System (GIS) for analyzing and planning of the public health services in Pattani Province. For the initial system prototype development, it aimed to reduce Infant Mortality Rate (IMR) and Maternal Mortality Ratio (MMR) by using GIS as a tool for analyzing and seeking clusters of houses of pregnant women. The GIS analysis would be used for a health plan development to encourage pregnant women to deliver at the government hospitals instead of using Traditional Birth Attendants (TBA) services. After completion of the pilot project, it aimed to extend the GIS for strengthening RH and other public health services in the other areas e.g. Adolescent RH, Reinforcement Male Involvement in RH, Mother and Child Health Care, Sexual Education, Epidimeology, Vaccination, and Information, Education and Advocacy, etc. Further more, the pilot project also aimed to build up GIS database and link it with existing public health database or known by the Public Health Ministry as HCPro, and analyze GIS data and tabular data of HCPro together.
In achieving the objectives of the project, methodologies applied for the study were as followed:
- Identify the scope of work and study area, discuss about needs and expectations of Pattani PPHO in GIS applications in the field of public health services.
- Investigate and acquire secondary data especially maps, aerial photographs of the selected area and other related spatial data. Topographic maps at the scale of 1:50,000 were used to locate the area and to delineate boundary for purchasing aerial photographs. Aerial photographs at the scale of 1:15,000 were purchased from the Royal Thai Survey Department.
- Investigate Pattani PPHO computer facilities, and HcPro database. It was found that the PPHO was well-equipped with computer facilities and the HcPro database could be linked directly to GIS database.
- Field visits to various Tambon health centres suggested by the Pattani PPHO in order to select study area for the pilot project. It was finally decided to select four villages in Napradu Sub-district as the study area for the pilot project.
- Investigate and acquire GIS software and GPS to be used in the pilot project.
- Provide training and on-the-job training to the health officers in concepts of mapping, aerial photos and GIS, and the use of GPS in geographic survey. A group of health officers who received GIS training were expected to serve as a GIS expert team of Pattani Province.
- Interpret aerial photos. Aerial photos of Napradu at the scale of 1:15,000 and 1:4,000 were interpreted. Information extracted from aerial photo interpretation included land use, household location, road network, significant places and water body.
- Conduct a ground truth survey using GPS for checking, verification and updating data. This was to check the correctness of aerial photo interpretation and to update data. Aerial photos were geocoded using GPS technology and manual differential GPS (DGPS).
- Conduct related socio-economic survey. Village health volunteers conducted a social survey using questionnaires in every household in four villages. Details of questionnaire contained general household and respondents’ information, pregnancy and ANC, and roles and involvement of husbands in taking care of their wives during pregnancy, after delivery, and in sharing housework. During field survey, village health volunteers also collected data on housing conditions of respondents by observations.
- Digitize and edit data [build-up GIS database] using GIS software. Arc/Info and ArcView were used for data input. Several layers were created for GIS database such as land use map, road map, and location of houses.
- Link HcPro non-spatial to the spatial database. The main purpose of the Pattani PPHO was to link HcPro to the GIS database for analyses. Some common fields for linking non-spatial to spatial database were created. Output of household locations of four villages were shown in image 2.
- Analyse GIS data and socio-economic data. Information on pregnant women were extracted from HcPro, then linked to GIS database to seek and visualize their house locations. GIS technology was used to seek distances from these houses to locations of TBAs and health centres.
- Discuss other aspects of health plans with PPHO officers in order to prepare a health decision-making support system (DSS) using HcPro with GIS database.
- Conduct system testing.
Image 2: Household Locations in Selected Villages, Na Pradu Sub-district
For analyzing TBA services for delivery, criteria to seek clusters of houses of pregnant women who used TBAs’ services were set up as described below:
- Locations of Napradu Health Centre;
- Locations of TBAs’ houses;
- Locations of houses of pregnant women who tend to use TBAs’ services;
- Data from HcPro recording pregnant women who delivered by using TBAs’ services;
- Distance of pregnant women’s houses to TBAs’ houses;
- Distance of pregnant women’s houses to health centres; and
- Occupations, ages, educational levels and religion of pregnant women who uses TBAs’ services.
For GIS analysis, several applications were used as followed:
- Buffer TBAs’ houses using 500 metres interval;
- Buffer the health centre using 500 metres interval;
- Overlay pregnant women’s houses over buffered map of TBAs’ houses and buffered map of the health centre. The output map indicated the relationship between locations of pregnant women, distance from their houses to TBAs’ houses and the health centre as shown in Image 3.
- Select data of pregnant women who used TBAs’ services recorded by HcPro to see their religion, occupations, ages and educational levels. This is to understand personal and social backgrounds of those who prefer to use TBAs’ services.
- Visualize tabular data indicating Haemorrhagic Fever (HF) using GIS. This was to present a better picture of diseases and sickness of Pattani province by showing situation of Haemorrhagic Fever (HF) during 1997 to 2001. Image 4 shows the tabular figures linked and displayed by GIS.
Image 3: Locations of TBAs and Pregnant Women, and Tentative Service Area of TBAs in Na Pradu Sub-district
Image 4: Haemorrhagic Fever in Pattani Province During 1997-2001
In launching the pilot project, the GIS database were created. These spatial data were derived from aerial photograph interpretation and verified by ground truth survey. The spatial data were linked with the available health database called HcPro which was the household based data stored in dBASE file format. A social survey was also conducted in almost every households in the selected villages using questionnaires to collect primary data on pregnancy and ANC, involvement of husbands during pregnancy period, family planning and using TBAs’ services.
From the study, it was found that most pregnant women in all villages practiced modern way of family planning. Oral contraceptive was the most popular method used. Most pregnant women delivered in government hospitals or sub-district health centres.
From the analysis, it showed that distances from TBAs and health centre had some influence on pregnant women. It was found that those who lived near the Khok Pho community hospital would go to the hospital when delivered. Using TBAs’ services was found more in Muslim village and majority of them used their services in delivery. Almost all of them found TBAs’ services satisfactory.
It also showed that Islamic pregnant women who used the TBA’s services received lower education and were attached to agricultural sector. From the pilot study, it was recommended that the Pattani PPHO should consider about raising awareness on RH to these Muslim women and mobilizing them to use government services.