MEASURE DHS Nathan Heard
support contractor to the U.S.
Department of State's
Humanitarian Information Unit
In 2003, the US President's Emergency Plan for AIDS Relief (PEPFAR) was launched to combat global HIV/AIDS – the largest commitment by any nation to combat a single disease in history. On July 30, 2008, the United States expanded its commitment authorising up to $ 48 billion over a period of five years to combat global HIV/AIDS, tuberculosis and malaria. Through 2013, PEPFAR plans to work in partnership with host nations to support treatment for at least three million people, prevention of 12 million new infections; and care for 12 million people, including five million orphans and vulnerable children. To meet these goals and build sustainable local capacity, PEPFAR will support training of at least 140,000 new health care workers in HIV/AIDS prevention, treatment and care. PEPFAR is implemented by seven US government agencies. The public health sector is increasingly turning to the use of GIS to improve HIV/AIDS programme monitoring, evaluation and planning. HIV/AIDS epidemic is characterised by enormous geographic variation, with striking sub-national, national and continental differences in the distribution of HIV prevalence and densities of those who are infected. Since sub-Saharan Africa remains the most heavily affected region, PEPFAR focuses most of its efforts in this part of the world, with services provided not only in facilities, but often at the community level (Figure 1).
Mapping and spatial analysis help decision makers and programme managers visualise relationships that might be hidden or otherwise hard to understand in tables or charts. Among the many challenges GIS can help address are measuring geographic coverage of HIV/AIDS services; locating orphans, vulnerable children and critical populations; coordinating activities across multiple sectors and actors; and evaluating programme implementation.
In an effort to encourage data-driven decision making across sectors and programmatic areas, beginning in 2005, PEPFAR started placing special emphasis on strengthening GIS capabilities on the African continent through the support of development of key spatial data layers, geospatial tools, and capacity building. PEPFAR programmes continue to work with African ministries of health, national AIDS coordinating agencies, NMAs and others to increase the use of geographic data and develop decision support tools that incorporate mapping. To provide a sample of PEPFAR’s GIS work, a few select examples implemented through USAID are highlighted below.
Improving data infrastructure – OVC mapping
Substantial effort in the capture, formatting and organisation of data is usually required prior to mapping. As a result, the process of map generation can help identify critical data gaps and provide a framework within which data from different sources may be integrated to answer programmatically important questions. For example, to improve health services to orphans and vulnerable children (OVC) affected by HIV/AIDS, the Office of the US Global AIDS Coordinator (S/GAC) and USAID enlisted MEASURE Evaluation to assess the data available for mapping OVC activities and to produce maps that would assist in decision-making processes. Twelve countries participated in the effort, 10 of which were in Africa:
Botswana, Côte d’Ivoire, Ethiopia, Mozambique, Namibia, Nigeria, Rwanda, Tanzania, Uganda, and Zambia. The OVC mapping activity was executed in two phases: data evaluation and mapping. In the data assessment phase, MEASURE Evaluation analysed the availability and quality of data for OVC mapping purposes. For every country that provided mappable data, maps were produced. In those cases where the data could not be mapped, an evaluation document was produced that provided guidance on why the data could not be mapped and where possible, offered suggestions on how to improve the data. MEASURE Evaluation then
worked with key decision makers in selected countries to improve data collection system and explore ways that the data could be used to create maps showing OVC populations as well as health facilities and aid services that could help these populations (Figure 2). A key finding of this activity was the value of geographic data to facilitate new linkages between OVC data with other datasets such as those found on https://www.hivspatialdata.net/. These linkages provide valuable context to the OVC issue and broaden the evidence base used for decision making.
Because GIS technology is too costly for many to implement, MEASURE Evaluation developed the E2G thematic mapping tool to enable countries to map data using the free mapping programme Google Earth. This tool allows users with administrative-level data (e.g., percent OVC by district) stored in Excel to produce maps of the data in Google Earth. The Google Earth display can be printed, saved as a JPEG file for publications, or stored in a Web-accessible space. 13 African countries that can currently be mapped with the tool. The E2G thematic mapping tool is free to all users and is available on the MEASURE Evaluation Web site.
Training and capacity building in Kenya
Quality data is the keystone for effective evidence-based decision making. Geographic data can not only improve the decision-making process, it can help strengthen overall data quality by bringing to light inconsistencies in data that might otherwise have been overlooked. An example from Kenya is instructive in this regard. In June 2008, at the request of USAID, the MEASURE DHS project organised a GIS training workshop for provincial monitoring and evaluation staff of the PEPFAR- supported AIDS, Population, and Health Integrated Assistance (APHIA II) project in Kenya. APHIA II collaborates with the Government of Kenya and local implementing partners to expand the availability of quality, sustainable, HIV/AIDS and tuberculosis prevention, treatment, care and support. The workshop aimed to train APHIA II staff to use GIS software and link geographic coordinates to the Kenya PEPFAR monitoring system (KePMS). Participants learned how to query databases, conduct basic proximity analysis and export maps for reports and presentations. During the training, provincial teams produced maps using their project data and presented their findings to project leaders, gaining valuable experience in making data accessible to key stakeholders. Following the training, teams returned to their provinces and worked on integrating GIS into their monitoring and evaluation work, leading to improvements in data quality.
In the long term, success is contingent upon strengthened partnerships and coordination across sectors and among national stakeholders engaged in mitigating the impact of HIV/AIDS. Geography can provide a useful framework for integrating activities, organising data and answering questions important to HIV/AIDS programme implementation. Support of national SDIs and capacity to use geospatial technology within the health sector will ultimately benefit a wide array of public health programmes in addition to HIV/AIDS.