2011- HealthGIS Conference E - Proceedings

Technical Session-Realtime & Early Warning Systems Innovation of Health Care Service Via Mobile Phones Technology 188 Teerawong Laosuwan, Poramate Chunpang 192 197 Mobile Technology Integrated With GIS for Better Management of Health Services 201 Vinod Kr Sharma, V. Bhanumurthy, G. Srinivasa Rao 204 208 Improving Health Care in Remote Villages using Space Technology – A Technology Demonstration 213 K.S Srinivasan , J.R. Sharma 216 Current Scenario and Recommendations of Public Health GIS Users in India 221 Vasna Joshua, A Elangovan, V Selvaraj, S Mehendale, T P Ahluwalia 221 222 Strengthening the Efficiency of Orphan and Vulnerable Children (Ovc) Program Design and 222 Implementation Through GIS Application in Ebonyi State, Nigeria 223 Adegoke Olufemi, Agwu Ibiam, Uduma Eme, Balonwu Lucia, Ojo Williams Evaluation of Public Health Asset for Better Management - A GIS Based Approach Kuldeep Pareta, Kapil Chaudhery, Ramesh C. Dhiman, Manoj Pant An Architecture For WEB Based Real Time Monitoring of Infants At Hospital Nurseries Using RFID And Sensor Network Sanit Arunpold, Hamid Mehmood , Nitin Tripathi Status Of Health System In East Singhbhum District Of Jharkhand State, India: Community Perspective Reflected Through GIS Maps. Deepak Kumar Dey, Madhulika Jonathan using Web-GIS Solution for Hidden Population Survey Vasan Choengsa-Ard, Nitin Tripathi Hybrid Positioning Systems for Healthcare Hamid Mehmood, Nitin K. Tripathi Google Trends for Formulating GIS Mapping of Disease Outbreaks in India Indrajit Bhattacharya GIS: A Tool Empowering Epidemiological Health Research Lalit J. Raute, Mangesh S. Pednekar, Prakash Gupta Enhanced Emergency Health Communication Through Discover Ms David Bandi Dayakar Nittala, Sudha Yerramilli, Albert Williams, Felix Okojie Managing Health Geospatially 187

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STATUS OF HEALTH SYSTEM IN EAST SINGHBHUM DISTRICT OF JHARKHAND STATE, INDIA: COMMUNITY PERSPECTIVE REFLECTED THROUGH GIS MAPS Deepak Kumar Dey, Madhulika Jonathan Planning, Monitoring and Evaluation Officer, Health Specialist, Unicef State Office for Jharkhand, Email: [email protected], [email protected] ABSTRACT This paper is the outcome of data generated through an unrelenting exercise undertaken by UNICEF State Office of Jharkhand in the year 2010 with committed and persevered assistance from select NGO partners. In course of exercise, the decentralized assessment process not only was undertaken in a participatory manner, opening scope for people to express their views and intent to make contributions in the state-initiated development process; but also was undertaken right within the contexts of rural people duly appreciating the challenges that people face. Over 30 critical health related indicators were proved with community members, validated though village level meeting across all study villages of the district, and presented through GIS maps. Using of GIS for graphical presentation was very useful to highlight the pattern of problems. The GIS based presentation was widely appreciated by the district administration to identify pockets and enable them to make evidence based decisions. KEY WORDS: Service delivery, health services, health facilities, measurable indicators, framework adopted, decentralized approach, and community aspirations. 1. METHODOLOGY Decentralised & in- 1. Status of 4. An articulation of poor's The assessment undertaken in form of (a) administration context participatory facilities perspective of well being of structured questionnaire, (b) undertaking small and focused group discussion in 1066 villages on East assessment 2. Key problems & ill-being Singhbhum district, and (c) deliberations with sector experts and administrative authorities brought about 3. People's treasure of information about people’s choices, aspirations frustrations and urge to participate in development processes around them for them. To conclude, the data 5. Evolving priority 6. Evolving key planning thus generated were plotted on GIS maps and made public for larger sharing and inputs. & opportunity grid considerations The detailed health assessment under the umbrella of 7. onwards - - Key plan reccomendations and Decentralized District Planning in East Singhbhum sector-stretegies district of Jharkhand State of India, primarily brings about extensive village level data on three aspects of care. Only 19 and 18 villages were found to have a development planning: A status of key health facilities, Primary health center (PHC) or a Sub-health center key health problems that the communities face and (SHC), within the village; which is merely 2% of the associated aspiration articulated in terms of people’s total villages in the district. No state of India is needs towards improving health status in the district. supposed to have a PHC or an SHC at every village. The assessment undertaken through popular and However, considering difficult and remote terrains of participatory methods adjoins perspectives and East Singhbhum, communities of 39% villages able to apprehensions of the people, not exactly in structured access a PHC at another village at a distance of 10 mms numeric form, albeit. is a difficult proposition to accept when these are meant primarily for pregnant & lactating women and children! 2. MAJOR FINDINGS Inhabitants of 30% villages in the district travel more 2.1 Status Of Existing Health Facilities than 10 kms to visit an SHC. Residents of approx. 50% Gross inaccessibility to primary and referral health and 75% villages travel for more than 5 kms to visit an services is less but to suggest anything else. Stunning, SHC and PHC respectively. but the fact is that significant proportion of villages of East Singhbhum does not have ready access to health 216 Managing Health Geospatially

All relevant facilities are reported to be seriously of Rogi Kalyan Samiti/ Primary Health Centre wanting, considering growing awareness of the Management Committee for better management and villagers, overwhelming sense of deprivation reported improvement of PHC services with involvement of PRI during the participatory assessment. Utter disparity have also been made as a part of the Indian Public reported when it comes to delivery of the most basic Health Standards. The monitoring process and quality services, compared to urban amenities in the assurance mechanism is also included. district.Immunization within village could not be 3. PROBLEMS PERTAINING TO PROVISION reported in some 27% villages; communities of 65 villages travel to another village at distance of more OF HEALTH SERVICES than 1 kms to get immunization-related services. There are 4% villages where almost all facilities exist Availability of trained dais (midwives) was reported with acute problems and villagers drew urgent attention only for 12% villages! Villagers of more than 22% to these. These 4% villages are beyond the figures villages travel go for more than a distance of 5 kms to depicted at the chart. Some parameters like carrying out avail services of a trained dai. inspection of AWC operations is something villagers find is most problematic causing quality implementation In all these cases of assessment and reporting, one only of the schemes. Inferring a sense of villagers referring to takes note of non-availability of the tangible facilities. need for monitoring, the UNICEF study brings out an However, going by the standard of facilities that implicit urge of the people to participate in tracking of Government of India guidelines suggest might not have timely and quality access to the schemes benefits – the been observed; could be slickly found. A detail account deepest concern expressed on national flagship of standard facilities expected to be maintained at a programs. Villagers in case of approx. 40% villages’ PHC or an SHC, and its quality, has been suggested in highlighted problem related to non-availability of the following shaded box. AWCs. The villager’s assessment of lack of monitoring and supervision gets also indicated with the fact that in Standards set up for basic facilities in rural health 11% villages despite having an AWC, the functionaries centers and relevant quality standards: Guidelines are found to be continuously absent. issued by the Government of India Figure 1: Percentage of villages having problems related Service delivery to Health services  All “Assured Services” as envisaged in the PHC Figure 2: Percentage of villages having problems related should be available, which includes routine, to human resource performance monitoring preventive, promotive, curative and emergency care in addition to all the national health programs. Intelligent observations made by villagers cited as  Appropriate guidelines for each National Program problems: 12% villages suffer despite having AWC for management of routine and emergency cases are presence of functionaries’ less than proportionate being provided to the PHC. number of children. At least in 10% villages, the  All the support services to fulfill the above assistant functionaries (Sahayika) are not available. objectives will be strengthened at the PHC level. Minimum requirement for delivery of the above- mentioned services : The following requirements are being projected based on the basis of 40 patients per doctor per day, the expected number of beneficiaries for maternal and child health care and family planning and about 60% utilization of the available indoor/ observation beds (6 beds). It would be a dynamic process in the sense that if the utilization goes up, the standards would be further upgraded. As regards, manpower, one more Medical Officer (may be from AYUSH or a lady doctor) and two more staff nurses are added to the existing total staff strength of 15 in the PHC to make it 24x7 services delivery centre. Facilities The document includes a suggested layout of PHC indicating the space for the building and other infrastructure facilities. A list of equipment, furniture and drugs needed for providing the assured services at the PHC has been incorporated in the document. A Charter of Patients’ Rights for appropriate information to the beneficiaries, grievance redressal and constitution Managing Health Geospatially 217

Most importantly, the villagers in 47% villages find the between government providers and clients should be ANMs’ not visiting the houses as a serious problem. developed. Representation of the poor on village health This adds with 10% those villages where the AWC committees is one way. While Panchayati Raj has yet to functionaries are found to be absent for more than a develop in Jharkhand, supervision and responsibility for month (ref. adjacent chart). public service delivery by local elected bodies should be a long term strategy for increasing accountability. Once Understandably, in 77% villages having PHC there is no the medium-term strategic objectives of priority and provision of mobile van meant to provide ready referral basic health services are met, it would be easier to and transportation services. But not being able to make tackle the challenges of secondary and tertiary curative provision for very basic necessities such as free health care, especially hospitalized and specialized medicines meant for lactating and pregnant mothers and services. The state of the latter is extremely precarious preparedness for basic pre- & post natal care and with limited coverage of the rural poor by both public delivery. Provision/ availability of nutrition supplements and private institutional health facilities. In particular, and regular immunization etc. are a proven affair of the high incidence of health shocks, including casual conduct in large number of villages – villagers emergency and catastrophic diseases, is a major barrier clearly making out these as serious problems. to upward mobility of the rural poor. The public health system needs a threshold level of basic health But there are issues pertaining to diversion of incentive infrastructure, human resources, management capacity, payments to villagers _ lactating and pregnant women _ skill, and the experience to effectively administer they attributing these too as significant problems. activities across districts and blocks in both rural and Villager’s intent to participate in a supervisory urban areas, with greater or lesser accessibility. Only mechanism with government when it comes to delivery then will it become easier to design effective delivery of basic services and entitlements, seem justified and mechanisms for the hospital-based and specialized need of the situation. It is important here to take note of curative services. Public-private partnership will enlarge the recommendations and views expressed by the World further in that context, with greater attention to Bank reports below: innovative health insurance products. Greater attention Factors influencing progress in priority health needs to be paid to the inter-sectoral impact on health (Excerpts from World Bank report on Jharkhand : status as well. Addressing the challenges of inclusive development – Status of priority health services is poor also in terms of 2007: Page 88) inadequate infrastructure facilities and basic amenities therein. Nearly in two third of the PHCs suffer poor Developing and strengthening organizations and arrangement of housing the functions of the center. In systems: The GoJ has just begun the processof forming most of the centers there is gross lack of basic amenities new institutions, such as the healthdirectorate, such as drinking water and sanitation/ toilet. Jharkhand Health Society, and the department for health Considering the priority of health sector is adjacent to and family welfare. Organizational structures and women and children, the functionaries too being staffing should reflect the required roles and functions women, basic amenities are a must to attract quality in under a system of public financing and rural service functioning of the centers and also in delivery of its provision. Human resources, planning and budgeting, services. financial management, quality assurance, monitoring, procurement and, finally, regulation and accreditation Figure 3: Status of Infrastructure and basic amenities would all need strengthening. Also, the centers not being adequately equipped, fails to Making greater use of demand-side approaches: In inculcate a basic orientation of amenities and hygiene addition to behavior change communication to on the communities receiving the services (ref. chart). overcome demand-side barriers, demand side approaches, such as demand-side financing (DSF) should be used. DSF is defined as a means of transferring purchasing power to specified groups for the purchase of defined good and services. Purchasing power can be in the form of vouchers, stipends, grants or loans, and scholarships. Certain health services, such as maternal care, STI treatments are particularly suitable for DSF support. Additionally, strategies that give voice to and strengthen participation of excluded groups in health care planning and management would promote use of services by the poor. Promoting local oversight of public health services: Mechanisms to strengthen the chain of accountability 218 Managing Health Geospatially

Often the villagers infer, from the perspective of Figure 4: Community aspirations emerged based on inequitable access to entitlements and provisions, a case assessment of facilities and problem of willful denial and relate such to the basic issue of social marginalization. The same World Bank report While analyzing problems nearly half of the responders underlines the fact, as the current study team too tends complained about ANMs not visiting households. When to believe that the social disparity between the serving 7% responders despite their academic and competence functionaries and the receiving communities make a lot constraints aspire to monitor performance of the of difference. functionaries, the reasons behind such becomes quite apparent. The villagers’ intent expressed to supervise Factors influencing progress in priority health performance of the health sector performances are (Excerpts from World Bank report on Jharkhand : mainly aimed to poor quality of construction and Addressing the challenges of inclusive development – maintenance of infrastructure, attendance of 2007: Page 85 & 87) functionaries and inadequate quality of basic health care services. It is significant here to note that the villagers Social disparity in health and nutritional indicators have not been made aware of the provisions of is equally striking. The nutritional status of children institution development at the local level and scopes fromScheduled Caste and Scheduled Tribe (SC/ ST) provided to elicit people’s participation. groupswas found to be much worse as compared to sociallyadvantaged, groups (ref. chart 5.6). Sixty-one It may be noted, since the awareness levels of the percent of children from ST groups were underweight, villagers are low, the health sector functions assumed to compared with 38% from non-SC/ ST/ backward be technically complex, villagers do not have much groups. observation on human resource requirements or facilitative/ catalytic functions which could be Addressing the demand-side constraints is crucial discharged either by the locals (a host of informal health for the success of health policy in Jharkhand. These service providers) or by non-state agents/ CSOs. include costs (related to transportation, opportunity However, observation suggests that when it comes to costsof lost work when seeking health care, unofficial relevance of traditional health service providers, a fees etc.), lack of knowledge and awareness of health significant proportion of rural demography depends on needs and availability, and socio-cultural beliefs and tribal healers, quacks and traditional mid-wives. practices. As noted earlier, there are wide disparities in health status and service coverage across districts and 5. GIS FOR EVIDENCE BASED DECISION population groups in the state. The exclusion of To analyze the data, comprehensive database and particular groups such as STs is particularly striking. software to project analysis was developed by the The health department has no systematic strategy for district administration. The front page looks like below: improving performance of lagging districts and population groups, such as SCs and STs. Some recognition is given to a special approach in tribal areas; however, this is not backed up by the concept of resources being allocated on the basis of need. There is a need for greater use of incentives for providers to serve target populations, as well as greater use of demand-side approaches, such as provision of vouchers for overcoming social exclusion. 4. ASPIRATIONS OF THE VILLAGERS An assessment of the basic facilities and problems either emanating from those or otherwise; clearly underline and connect with the villagers’ aspirations. There is a gross infrastructure deficit in several ways in large number of villages. Besides non-availability of PHCs/ SHCs and AWCs, villagers complained almost synonymously against the half-constructed and incomplete infrastructure and a lot of those unattended by functionaries. A significant 14% responders expressed desire to have proper basic facilities such as drinking water and toilet. Considering that the basic facilities are primarily meant to provide relief to women, pregnant or lactating, and early-age children; the aspiration is sounded on very basic needs of civic amenities. Managing Health Geospatially 219

Sample slides of GIS Maps of health access from the Problem identification indicator 2:Villages where site: www.dcpjharkhand.co.in is give below to highlight mobile van for health check-ups is reaching. Green the importance to locate patterns in villages is given color indicates “no problems exist” whereas red color below: indicates problems exists. Facility indicator 1: Access to Immunization - Green colorindicates“Have access”; Red colorindicate “Problems exist (no access)” which is presented in district map, covering all villages. Facility indicator 2: Drinking water facility in 6. CONCLUSIONS Anganwadi Centers (Green color: Have access, Red The assessment reflected new dimensions to identify color: Problems exist (no access). various facility gaps, collective problems perceived by community members on both soft issues like manpower, Problem identification indicator 1: Villages where and services and infrastructure gaps. Based on this, A.N.M was absent for more than one month (Green community level aspiration emerged. color: No Problem; Red color: Problems exist), Using GIS for pictorial presentation revealed positive presented in a District map covering all villages. experience to all stakeholder(s) involved to highlight the patternson access to health facilities and services. The GIS based presentation was widely appreciated by the district administration to identify pockets and enable them to make evidence based decisions. This year again, the assessment will be carried out in East Singhbhum district of Jharkhand to track changes through GIS maps and enable our team to analyze the status of health system from the perception of community members. ACKNOWLEDGEMENTS I would like to express my gratitude to all those who gave me the possibility to complete this paper. I want to thank the District Planning and Monitoring Unit established under District Administration, East Singhbhum district of Jharkhand State for developing the software and analyzed the facts from community lens. I have furthermore to thank Dy. Commissioner, East Singhbhum district for regular inputs to undertake decentralized district planning exercise in the district and encouraged us to go ahead. Especially, I would like to give my special thanks to my colleagues, and NGO partners to support in undertaking the assignment. 220 Managing Health Geospatially

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Author Index A Elangovan 201 Chomchid Imvitthaya 139 A. A. Hanafi-Bojd A. Daryanavard 116 Choosak Nithikathkul 26, 27, 91, 111, 117, A. K. Dixit Abaka Brice Hervé Mobio 116 120 Abbas Najjari 106 Chudech Losiri 139 Abdul Qader Rahemi 117 Chun-Yi Hsiao Abdullah G. Al-Zahrani 80 Abdullah M. Al-Rabeah 71 Chutima Pai-Ngam 116 Adegoke Olufemi 142 DAE Anita Zaidi Adittya 28 Adonis Kontos 92 David Bandi Dayakar Nittala 223 Adonis Krou Damien Kouame 92 David J. Hughes Agwu Ibiam 204 David Taverner 61 Albert Williams 153 De Abreu J. F. 5 Alexandra Ziemann Alice B. Conant 5 Deepak Kumar Dey 92 Alistair Briscombe 117 Diwakarbaral 216 Amit K. Awasthi 204 Duangduan Krailas 153 Ampas Wisetmora 223 Eric M'moi Valère Djagoua 90, 116, 120 Anil Kumar 176 Eva Pilot 117 Anita Bhargava 176 Archana Ghode 5 Farhadinejad Taher 152 Arisara Charoenpanyanet 12 Felix Okojie 223 Aruna M. Patel Aruna Srivastava 8 Ferreira R.C. 92 A.T. Jeyaseelan 91 G. Srinivasa Rao 192 Ayub Khan 119 Garima Sharma Azharul Islam Khan 100 Gaurav Sharma 8 Aziz S. 185 George Kurien M. 8 Azizan A. S. 163 Ghanshyam Sethy 121 B. K. Tyagi 186 Giovanna Raso 168, 170 B.N. Nagpal 119 H. Vatandoost 117 Bageshree Vinodray Parmar 119 Hamid Mehmood 116 Balonwu Lucia 28 Hao Ran Lee 213, 221 Bhogendra Mishra 37, 129 Bhoj Raj Ghimire 2 Harvey Rubin 5 Bindu Bhat 179 Hemant S. Desai 186 Biranchi Jena 179 Heng Sopheab 49 Boosya Bunnag 17 Boris Kauhl 17 I.P. Sunish 222 Bryan K Kapella 119 Indrajit Bhattacharya 56, 197 C. Rajina 152 C.Ravichandran 25 J.R. Sharma 12 C.Ravichandran 204 Jafari Mohamadreza 183 Chattapat Chounprasith 153 James C Kile 186 Chen Gong 153 Janak Joshi 163 Chen X. 183 Janakrai Reshamwala 172 176 Janecek P. 30 Managing Health Geospatially 111 Jaruporn Tosng 135 176 Jaruwat Sreekaew 197 186 12 K. Hari Kishan Raju 12, 208 17 K.S Srinivasan 116 168 Kalpesh .I. Khatri 5 170 Kapil Chaudhery 94 116 Kattaliya Oiangpan 118 Kent Smetters 163 Kerrie Mengersen 224

Khakzad Amad 152 Nur Farhana J. 179 Khamphilung S. 124 O.P.Kansal 168 Khandoker Tamirul Islam O.P.Kansal 170 Khosrotehrani Khosro 2 Ojo Williams 204 Kouadio Affian 152 Oleksandr Neduzhko Kouakou Eliezer N'goran 117 Oleksandr Postnov 43 Kuldeep Pareta 117 P K Garg 43 Kuryan George 12, 208 P. Suganthi 154 Lakshminarayanan Paban Kumar Ghimire 17 Samavedham 52 Pallavi Luthra 25 Lalit J. Raute 37, 129 Pankaj Kumar 89 Liao Yilan Parvin Shamszadeh 106 Lim Y. A. L. 222 Phaisarn Jeefoo 71 Loganathan Ponnambalam 53, 118 Phorntip Phromsuwan 156 Louis Royal Pichainarong N. 116 Lutfe Ara 179 Pipat Reungsang 124 Mark Pietroni 37, 129 Pongrama Ramasoota 26, 117, 120 M. Govindaraju 26, 117 Poramate Chunpang 120 M.K. Das Prabhat Jha 188 Madhulika Jonathan 2 Prakash Gupta 80 Mahaweerawat U. 2 Prashant Pathak 222 Mahesh 17 Priyanka Jariwala 75, 159 Mahmood Azimi 119 R D Garg 33 Mamta Dattani 216 R. R. Pardeshi 154 Mangesh S. Pednekar 124 Rakesh P.S. 176 Manjeet Singh Chalga 186 Ramana Rao 52 Manoj Joseph 142 Ramesh C Dhiman 176 Manoj Pant 121 Rani Singh 12, 208 Margaret Loughnan 222 Rashi Dadhich 56 Mark Rohit Francis 106 Rashmi Kandwal 33 Martins 66 Rekha Saxena 154 Martya Rahmaniati 12, 208 Rofaida Mohammed Elhassan 119 Masahiko Nagai 184 Abdelrahman Elzubair 185 Mengieng Ung 52 Roongrasamee Boondao Mohammad A. Al Mazroa 92 Rujee Rodcha 85 Mohammad Zare 153 Rujira Thanasung 172 Momin Kazi 153 S Mehendale 183 Murtaza Ali 49 S. Rama Subramoniam 201 Murthy Usn 92 Sahil Chopra Murthy Yvs 71 Sampath Kumar P. 56 Musyamas Danngeao 28 Samrit Srithamrongsawat 33 Nakarin Chaikaew 28 Sanit Arunpold 119 Nammon Taneepan 119 Sathirakorn Pongpanich 61 Ngui R. 119 Saulat Fatima 213 Nicole Rosenkötter 116 Seema Jalan 61 Nigel Tapper 147 Seema Jalan 75, 159 Nina Slavina 116 Sergiy Pozdnyakov 56 Nitin K Tripathi 179 Shelza Shekhawat 66 176 43 Managing Health Geospatially 184 66 43 52, 184, 213, 221 225

Shikha Dixit 90 Vorapoj Promasatayaprot 30, 61 Shilu Tonghit 94 Wan Yusoff W. S. 179 Shivam Gupta Wanchai Phatihutahorn 91 Shoae Ziyaodin 8 Wanpen Chaichumpa 27 Sholehah I. 152 Wech-O-Sotsakda C. 124 Shrutika Salvi 179 Wenbiao Hu 94 Siriwan Hassarangsee 176 Wijitra Buttama 21 Soksan Moeun Worayuth Nak Ai Somchai Nichpanit 52 Wu Jilei 90, 111, 116,120 Somdee T. 49 Wutjanun Munttitanon 53 Song Xinming 26, 117 Yangyuen S. Songklang S. 124 Yogendra Mishra 21, 26 Souris M. 118 Yuwaporn Sakolvaree 124 Sovannary Tuot 124 Z. Charrahy 153 Srinivasa Rao M 163 Zheng Xiaoying 27 Suchra Naish 49 116 Sudha Yerramilli 119 Sukanya Wongsaroj 94 53, 118 Suluck Namchote 223 Sumattana Glangkarn 91 Supachai Nakapan 90, 116 Supaporn Indum 30 Supath Triyawong 184 Supattra Makkaew 116 T P Ahluwalia 26 Tachayanee Bootjinda 116 Tatyana Gerasimenko 201 Teerawong Laosuwan 90 Thitima Wongsaroj 43 188 Thomas Krafft 26, 27, 90, 91, 111, Thongkrajai P. 116, 117, 120 Thu Phan 176 Tipdecho T. 124 Uduma Eme 184 V Selvaraj 163 V. Bhanumurthy 204 V. K. Dua 201 V. Saravanabavan 192 Vasan Choengsa-Ard 119 Vasna Joshua 152 Venkata Raghava Mohan 221 Vijay Kumar Baraik 201 Vikas K. Desai 52 Vinod Kr Sharma 119 Vinohar Balraj 186 Viroj Kitikoon 192 Vladimir Buntilov 52 27, 90 27, 91 226 Managing Health Geospatially