Dr Harshit Sinha has done his doctorate in medical geography from M.S.University of Baroda. He has been in health sector for almost over a decade and has worked in different national and international assisted heath projects.
Dr. Harshit Sinha
Project Director, Vardaan foundation, India Email: [email protected]
About Harshit Sinha
Dr Harshit Sinha has done his doctorate in medical geography from M.S.University of Baroda. He has been in health sector for almost over a decade and has worked in different national and international assisted heath projects. During the tenure, he had planned; co-ordinate evaluated and implemented the health programmes in both urban and rural settings. Presently he is heading an NGO (Vardaan Foundation) and a consultancy firm (Vardaan Consultants). He had special interest in using GIS and RS technology for Health sector and very recently through his organization have started a health forum for promoting GIS and RS technology in health sector. Very recently he has been selected by World Health Forum team to identify gaps in health research in Geneva for World Health Organization.
- Readers of www.GISdevelopment.net would like to know how GIS and Remote Sensing is being used in Public Health Service
There is a strong relation of GIS and Remote sensing in Public Health. Given that health and ill health contain a spatial dimension and being a medical geographers, I emphasized that the science geography in the past history has always played a significant role in studying disease distribution and diffusion for imparting better health services. As you know that Public health is a state responsibility which gives emphasis to explore the subject matter of health to a broader spectrum. GIS and Remote Sensing are essential tools in this respect. The former helps to link wide ranges of data set (including georeference data) and support the policy makers for condition (What is…?); location (Where is it…?); trend (What has changed since…?); Pattern (What spatial pattern exist ..?) and for doing modeling (What if…?). While the latter gives the broad and dynamic picture of a affected/infected region (from any disease or …) with ground realities, linked with all types of allied science (Sanitation, Drinking water, Seweage line etc) to deal with health problems caused by environmental and lifestyle factors. Combing both the technologies together in public health gives much emphasis to strengthen disease surveillance and help in assessing health services by reaching the unreached population in a given area.
- What are the present areas of activities in GIS and RS for Health Service? Which area has benefited most in the health services
Application of GIS and RS in Health services are numerous and it all depend upon the necessity for different types of health programmes. The common benefits for the application of GIS and RS in health care services is to know the geographical variations in the provision for health care and the distribution of disease, measuring the effectiveness and coverage of the health programmes and last but not the least is from assessment and analysis to action. There are instances where both of these technologies have been used with many geographical approaches related to disease ecology, disease distribution, disease diffusion, allocation model, locating the optimum and central place for the desired health institution. For me it will be very difficult to explain you in detail within the short time frame. But I can tell you the use of GIS and RS for health sector in India is adhoc and at very primitive stage. They are mostly cornered for research purpose only rather than for program monitoring as observed in the western countries. And those who are using, doesn’t know the optimum and correct usage of these technology in the health sector.
- What are the problems faced in using GIS and Remote Sensing for health services?
The question is somewhat similar like our country has enormous natural and human resources, but always surrounded with numerous problems for its optimum and proportionate usage. India in RS technology is quite ahead and its business is day by day blooming. Application of these technologies in health sector was limited because, health was never integrated with the other prime sectors and remained as allied discipline. Secondly the status of public health in our country is very poor and moreover the medical specialists view “technology” in terms of curing the disease rather than understanding the pattern of prevalence and spatial distribution. Thirdly lack of availability of georeferenced database at regional and local level. And even if at all, is available – than the pitiable part is that it is not accessible. Creating such database is costly and time consuming and if any untrained person dare to build it, he is lost forever and never reaches to the end of the task.
Taking lead from this, I want to highlight another strong aspect of under utilization of these technologies in health sectors – is the unavailability of trained professionals. Usually non-medical professional, with a background of software engineering or satellite technology trains the medical persons. They do learn the usage of the software and satellite technology but major problem arises when one has to correlate the health data with this sophisticated technology. Our academic institutions teach more benefits of applying GIS and RS technology in other sector. This is because one doesn’t know the exact and scientific methodology to link the health data with the spatial data using computer cartographic technique and statistical science. And last but not the least is the individual efforts in learning the technology. In our public sector set up, one is not willing to take extra pain because he is so much preoccupied with the daily routine work. If handful people take interest in doing so, they are victimized or demoralized in one or the other way and majority will always propagates the benefits of current manual system because non of them are willing to put extra efforts in learning the new technology within the same benefits provided by the authority.
- What are the future prospects of “GIS and RS in Health” as a specialized discipline of study?
The future of GIS and RS in Health is enormous, but not as a specialized discipline. One has to break the barrier of the term “specialized”, because today I feel that with the availability of hardware and software technology at affordable rates, it is possible for various authorities to gain insights into the consequences of decisions relating to public health care system. The gap between the incoming (health) data and decision-making process for different health programmes has given momentum to the use of GIS and RS in public health programmes. This is because GIS and RS technology helps to link, store, manage and integrate large amount of spatially referred data , that can be readily retrieved and displayed through maps for the process of planning, monitoring and evaluation of health programmes. The utmost requirement to popularize such technologies in public health is possible through political will – the way Rajiv Gandhi took initiative to popularized the computers in our country during the mid eighties. No doubt there are many serious issues emerging out with the introduction of such technologies in public health. Because individual health is a sensitive and personal property?
- Do you feel customized software on GIS and RS for health services would be better option?
Sorry, Right question asked in a wrong way !. There is no need for customizing software on GIS and RS for health services. To my knowledge there are about 40 public health software freely available and easily accessible on the different web site through Internet. Most of these softwares are developed either on ‘C’, Microsoft Excel or Microsoft Access or any other software for projecting the diseases, describing the pattern of the disease in an area, knowing the risk factors involved in particular type of disease etc. My point is that see how public health specialist have used the same software for different application of health programme. Similarly the GIS software available in the market has similar type of provision to develop and used for different health programms. It all depends upon individual caliber to optimize the usage of GIS and Remote Sensing technology for different health programme. Take an example, I have used GIS and Remote sensing technology to detect endemic areas for Leprosy during my thesis work (refer my book Leprosy in India, Rawat Publisher, New Delhi) and if you look the back issues of your magazine (June 2000, Vol. IV issue 6), a friend of mine have used the similar technology for detecting the malaria prone zone. Thus there is no need to have customized software on GIS and RS for health services. The only thing in demand today is to see how one can customized the current available GIS software alongwith the Remote Sensing technology for particular health programme. (Once again I want to stress on individual caliber for the optimum usage of the technologies).
- What do your think are the economic benefits ratio of the investment made in the GIS and RS for Health services?
It all depends upon your applications in health programme. No matter for GIS software it is one time investment with long term benefits in many ways. The usage of Remote sensing technology depends upon as to what type of exercise one has planned to know the status of particular health problem. Today the RS data are available at affordable cost (accept the restricted zone as demarcated by GOI). These data helps us to know the dynamic nature of the disease simultaneously over time and space in doing trend analysis, time series analysis and above and all projecting the future status of the disease. As the time passes and with the improvement of technology, the rate of hardware and software related to GIS and RS will decrease. During last two decade, the computer revolution in our country is the prime example in this regards.
- Should the present medical administrative setup be aware of the potential of GIS and RS and further use them through a centralized agency for monitoring disease outbreaks in their region? OR a nodal agency should be monitoring the state of the affairs and informing the medical people as and when needed.?
Replying to your first part of the question is YES, they should be made aware and as far as my knowledge is concerned pace of progress is on but slows. Those who knew the benefits linked with conditional quarries in these technologies are on their way. I mean to say that one must make them aware about the optimum utilization of the technologies or otherwise, it will be just like a computer used for typing letters.
Commenting on the second part, I will say that this problem is just like a center and state relationship in our day to day home affairs of our country. The Center does not know the ground realities of the State and the State do not know the center’s requirement. To some extent, both are true in there respective position. There are instances, where central based system has totally failed and that is why bottom up approach was initiated with the introduction of reproductive and child health programme in our country in 1997. I forsee a similar type of situation that will arise when we linked GIS with health information system of our country. Since in rural areas, the unit of collection for different types of health information will be a village and in urban area it will be a ward, then question arises, who will made responsible to enter the sensitive health data, how it will be validated and who will do it. Which types of health information should be passed to the center? …. etc. There are nemours question, which could be resolved with the better understanding between center and state health administrative bodies and above and all the most sensitive issues will be which type of data be made publicly through internet technology? As I have earlier mentioned that the application of GIS and RS technologies is at primitive stage, for me it will be too early to comment on this.
- Could the outcome of such a setup mentioned in Q7 be linked to the emergency response system?
Once the protocol and terms of reference for the usage for GIS and RS technology with health information system is finalized between center and state government, there is 100% possibility to link to the emergency response system with it. Or otherwise once again somewhere in the end of this decade ‘plague’ like disease will re-emerge in country without any disease surveillancesystem.
- Could we see a “GIS Based Model”, where in the climate of given place, change in weather, economic status of the residents and the utility services etc. predict the disease outbreak?
The high-end user of GIS and RS technologies knows the correct methodology for doing so, provided that your database is regularly updated. The technology has provision for doing the time series analysis for any disease over given space and time linked with different types of data set as mentioned earlier. GIS Based model are more accurate and scientific, but one should not forget that model are abstract concept and keeps on changing with respect to time.