Rocco Panciera- UNICEF Session 3 – How geospatial data and technologies could support the current microplanning process Rocco Panciera- UNICEF

The current Situation cEPI has identified the following information gaps in the current microplanning process Improve knowledge of geographic characteristics of RHC and SubRHC  to support more efficient microplanning Availability of accurate, verifiable information on distances (and travel times) between health facilities and EPI communities  to improve costing of microplanning Improve information on barriers to immunization delivery associated with geographic accessibility and seasonal accessibility issues (e.g. difficult terrain, flood- prone areas)  to improve quality of microplans Strengthen tools for visualization and mapping of EPI performance and resources  to equip township EPI team with the tools to identify gaps and inefficiencies to improve the EPI microplanning for better outcomes Microplans Health area maps

How can geospatial data and technologies support the current microplanning process in Myanmar? Let’s start by understanding the geographic dimension of the immunization program

The Geography of the Immunization Program The delivery of immunization services involves the interaction (e.g. exchange of services, data, resources etc.) between a number of elements The geographic objects relevant to the distribution & delivery of immunization services Each of these elements is associated with a physical location on the surface of Earth Each element with a physical location on the earth can be represented as a “geographic object” having a “geographic location”

The Geography of the Immunization Program The interactions between geographic objects of the immunization program are very often dependent on their geographic location. For Example: the distance between a community/settlement and the nearest health facility will have a significant impact on the utilization of services by the population of the population and the delivery of services

The Geography of the Immunization Program One must also consider other geographic elements that allow for the physical connection between the geographic objects of the immunization program. These are mainly The geographic objects relevant to the distribution & delivery of immunization services Administrative divisions Reporting divisions Transportation infrastructure (e.g. roads) Landscape features (terrain relief, rivers, water bodies , landcover etc.) In addition to that, one must also consider other elements that allow for the physical geographic linkage between the objects forming the immunization program, namely (see also diagram in Figure 2): • Administrative divisions or service delivery areas (e.g. national and sub national boundaries, health districts, facilities catchment areas, etc.). Although largely a human convention, they have a significant role on how immunization programs are planned, monitored and analyzed, and therefore provide geographic context to spatial analysis and visualization. • Transportation infrastructure (e.g. roads): along which vaccines are delivered to health facilities, population travel to reach facilities or vaccination teams travel to deliver vaccination sessions etc. • Landscape features (terrain, river, lakes, land cover etc.) which constitute the environment that he population and the vaccine carrier will have to cross to reach a point of care as well as the source of potential physical barriers to movement.

The Geography of the Immunization Program One must also consider other geographic elements that allow for the physical connection between the geographic objects of the immunization program. These elements collectively determine the channels and barriers through which population and services interact In addition to that, one must also consider other elements that allow for the physical geographic linkage between the objects forming the immunization program, namely (see also diagram in Figure 2): • Administrative divisions or service delivery areas (e.g. national and sub national boundaries, health districts, facilities catchment areas, etc.). Although largely a human convention, they have a significant role on how immunization programs are planned, monitored and analyzed, and therefore provide geographic context to spatial analysis and visualization. • Transportation infrastructure (e.g. roads): along which vaccines are delivered to health facilities, population travel to reach facilities or vaccination teams travel to deliver vaccination sessions etc. • Landscape features (terrain, river, lakes, land cover etc.) which constitute the environment that he population and the vaccine carrier will have to cross to reach a point of care as well as the source of potential physical barriers to movement.

The Geography of the Immunization Program The objects and elements of the immunization program can be represented as geospatial data in a GIS using 4 main types of geographic objects 3. Mobile-type objects Community health Workers (CHW) Midwives Target population (e.g., children, pregnant mothers) Means of vaccines transportation (Motorbikes, boat, etc.) 1. Point-type objects Health facilities Vaccination delivery sites Vaccines storage and cold chain facilities EPI communities (Settlement, city, towns, villages, hamlets, camp, wards) Namely the four groups of geographic features include: 1. Objects with a fixed location whose geography can be simplified by a point (e.g., health facility, community/settlement, vaccines storage facility, etc.). The geography of these objects is obtained through their geographic coordinates. 2. Objects with a fixed location but whose geography has to be represented either by: . Polygons due to their much larger extent (Examples: administrative divisions, health facilities catchment areas, etc.) Lines due to their mainly longitudinal extension (e.g., road, river, etc.). 3. Objects which are mobile (i.e., don’t have a fixed location such as children, pregnant mothers, vaccination teams, vehicles, etc.). Such objects can be geographically represented as being attached o a fixed object (e.g. individuals in a community/settlement), or as a point whose geographic coordinates (latitude and longitude) change in time. 4. Continuous: some elements of our environment are not defined objects per say and not associated with one specific location, but are rather distributed spatially. These are better represented using a continuous surface (e.g. terrain, land surface attributes, population distribution) 2. Polygon & line-type objects Administrative divisions Reporting divisions Roads, railways Rivers Water bodies 4. Continuous-type objects Terrain Land cover

The Geography of the Immunization Program The immunization program also collects statistical information (e.g., number of vaccine doses delivered at a health facility, number of children < 1 year old in an EPI community, etc..) Statistical information can be attached to specific geographic objects through the use of a unique Identifier. Unique ID EPI community POPULATION DATA Health Facility Master List Unique ID

Geospatial Technologies Geospatial technologies form the set of technologies that facilitate the integration of geography into immunization programs. These technologies refer to equipment used in measurement, analysis and visualization of earth's features, including the natural environment, human infrastructure and the elements of the immunization program: Satellite Positioning System Remote Sensing GIS Acquiring the geographic location of geographic objects by recording their latitude and longitude coordinates. Obtaining information about the earth’s surface feature from satellites, aircraft or drones An integrated collection of computer software and data used to view and manage information about geographic places, analyze spatial relationships, and model spatial processes

How can geospatial data and technologies support the current microplanning process in Myanmar?

How can Geospatial Data and Technologies support the Microplanning Process in Myanmar? The different geospatial technologies come together to support the microplanning process: Satellite Positioning System: used to acquire location of geographic objects core to the immunization program EPI communities Health facilities Characterize location of health services with respect to target population

How can Geospatial Data and Technologies support the Microplanning Process in Myanmar? The different geospatial technologies come together to support the microplanning process: Satellite imagery: used to acquire information on the connecting environment Hydrographic network (rivers, water bodies Characterize geographic accessibility and barriers between health services and target population Terrain relief Seasonal hazards (e.g. historic flood areas) Land cover

How can Geospatial Data and Technologies support the Microplanning Process in Myanmar? The different geospatial technologies come together to support the microplanning process: GIS: used to manage, analyze, model and visualize the geospatial data Perform spatial analysis (e.g. calculate distances between EPI communities and Health facilities) Produce thematic maps for decision-making and evaluation

How can Geospatial Data and Technologies support the microplanning process in Myanmar? Gap: knowledge of geographic characteristics of RHC and SubRHC to support more efficient planning of health facilities catchment areas Proposed support: Use of accurate GIS maps of SubRHC and RHC areas including geographic layout of health facilities, EPI communities and connecting environment Hand-drawn maps GIS maps

How can Geospatial Data and Technologies support the microplanning process in Myanmar? Gap: Availability of accurate, verifiable information on distances (and travel times) between health facilities and EPI communities  to improve costed microplanning of ( currently limited to “CRASH” session types) Proposed support: Use of AccessMod software for mapping physical accessibility and estimating distances and travel times between health services and EPI communities Takes into account terrain morphology and landscape attributes Uses multimodal transport process (e.g. walk, bicycle, motorized vehicles), Accounts for travel in both directions (to and from health facility)

How can Geospatial Data and Technologies support the microplanning process in Myanmar? Gap: information on barriers to immunization delivery associated with geographic accessibility and seasonal accessibility issues (e.g. difficult terrain, flood-prone areas)  to improve quality of microplans Proposed support: Use of geospatial information on terrain elevation and flood prone areas to characterize areas with difficult accessibility or seasonal accessibility issues

How can Geospatial Data and Technologies support the Microplanning Process in Myanmar? Gap: tools for visualization and mapping of EPI performance and resources  to equip township EPI team with the tools to identify gaps and inefficiencies to improve the EPI microplanning for better outcomes Proposed support: Translation of microplanning data to thematic maps with indicators of RHC’s performance and microplans resources Microplanning resources RHC’s performance? Better planning

Thematic mapping in support of the microplanning process in Myanmar Two types of maps will be used to achieve the desired objectives Map Type 1: Base microplanning maps Purpose: to support the microplanning process at RHC and SRHC level Map Type 2: Monitoring & Evaluation maps Purpose: to support M&E of microplanning at township level for the 6-months and annual reviews

Understanding the Process of Map Production and use Base microplanning maps Central State/Region Township RHC/SRCH Central State/Region Township RHC/SRCH S/R geospatial data manager supports updating of master lists In collaboration with township focal person Central level geospatial data manager maintain, complete and regularly update master lists and core geospatial layers + create travel time/distance matrices -->Before Dec Updated data communicated to S/R S/R geospatial data manager undertakes annual update of base microplanning map Base microplanning maps are distributed to townships Dec 3. RHC/SRHC personnel use base microplanning maps for decision-making and supervision of microplanning S/R geospatial data manager answers verification requests using geospatial data & base microplanning maps Jan TMO and EPI focal verify and approve microplans using previous 1 year M&E report (including M&E maps) Feb Request of GIS support Microplans (forms & completed base microplanning map) S/R EPI officer verify and approve microplans using previous 2 years M&E report (including M&E maps) Central officer EPI officer verify and approve microplans using previous 2 years M&E report (including M&E maps) Mar

Understanding the Process of Map Production and use M&E maps Central State/Region Township RHC/SRCH Monthly report (January – June) Monthly report (January – December) SubRHC/RHC personnel collects population headcounts and immunization data from proceeding 12 months and project target population Central level EPI officers maintain, complete and regularly update master lists and core geospatial layers June S/R geospatial data manager produces 6- months M & E Evaluation maps Current year’s microplans (forms & completed base microplanning map) Updated master lists is communicated to S/R TMO and EPI focal use 6 months evaluation maps to support mid-term EPI evaluation of microplanning Dec S/R geospatial data manager produces 12- months M & E Evaluation maps TMO and EPI focal verify and approve microplans using previous 1 year M&E report (including M&E maps) Feb Back to microplanning maps Evaluation maps are distributed to townships

Short term effort vs. long term benefit The introduction of Geospatial Data and technologies requires an initial efforts Initial effort to set up additional data vs. maintaining existing paper-based method might seem a lot BUT consider the long term benefits After the initial set up, updating the geospatial data, statistical data and connection between the two will require minimum effort The connection of EPI program data to the ground reference (health facilities master lists) will make data management easier, more efficient and collaborative across health programs Better planning and monitoring of vaccination activities resulting in increased coverage and more efficient management of immunization resources Geo-enabling the immunization program will align with the geo- enabling of the National Health Plan.