Session 1.3: Examples from the Region MODULE 1: MEDICAL GEOGRAPHY Session 1.3: Examples from the Region

Geography in Public Health The use of geography in public health helps solve issues in different public health programs such as: Planning Communicable diseases Emergency management Immunization This session presents some overview examples of this in the Asia and the Pacific Region. Geography in Public Health As mentioned in the previous session, geography is an important dimension of public health and can be used to help solve public health issues. Some of the public health programs where geography can be used are: Planning Communicable diseases Emergency management Immunization This session presents some overview examples of the use cases in the Asia and the Pacific Region. The examples are taken from different publications on the topics presented. The links for the publications are icluded in each slide.

Geography in Public Health: Planning How can geography be used in public health planning? Mapping health resources Identifying resources coverage Identifying potential gaps to inform resource allocation Geography in Public Health: Planning How can geography be used in public health planning? Mapping health resources Identifying resources coverage Identifying potential gaps to inform resource allocation

WHO National eHealth Strategy Toolkit The WHO National eHealth Strategy Toolkit is an expert, practical guide that provides governments, their ministries, and stakeholders with a solid foundation and method for the development and implementation of a national eHealth vision, action plan and monitoring framework. Although not an example of case study of geography in public health per se, it advocates and emphasizes the importance of geography in public health planning and e-health strategy. WHO National eHealth Strategy Toolkit (Refer to slide) https://apps.who.int/iris/handle/10665/75211

WHO National eHealth Strategy Toolkit 18 mention of the terms geographic or geographical WHO National eHealth Strategy Toolkit In this toolkit, the term geographic or geographical is mentioned 18 times.

EmOC Planning Geographic accessibility analysis of emergency obstetric care (EmOC) services in Cambodia This project, lead by WHO, assesses the accessibility coverage and geographic coverage of emergency obstetric services in Cambodia inform policy discussions on how to optimize or target the spending of the marginal dollar for maternal health at country level. The analyses were conducted using geospatial technology particularly AccessMod. AccessMod is a WHO tool that is a free and open-source standalone software for spatial analysis and modeling. EmOC Planning (Refer to slide) The analyses done for this project were made possible through the availability of the needed geospatial data. http://www.healthgeolab.net/KNOW_REP/WHO-HIS-HGF-GIS-2016.2-eng.pdf

Planning for a pandemic Health care planning for pandemic influenza in Lao PDR GIS was one of the tools used in health care planning for pandemic influenza. By exporting simulation results into GIS software, maps geographical analysis of the distribution of resources. The maps on the right show the estimated numbers of hospital beds and medications in response to three scenarios of pandemic influenza (mild, moderate, and severe) in Lao PDR. Planning for a pandemic (Refer to slide) By using the different maps produced for this project, the Ministry of Health of Lao PDR can plan appropriately for each of the three scenarios of pandemic influenza. Stein et al. BMC Public Health 12: 870 (2012) doi:10.1186/1471-2458-12-870

Geography in Public Health: Communicable Disease How can geography be used in solving communicable diseases problems? Risk mapping – identifying potentially high risk locations Identify the population at risk of being infected by the vector Identifying environmental and spatial risk factors Simulate population movement and therefore potential areas of re-infection Support surveillance , locate, control and monitor identified cases - Laos Support foci investigation Manage localized outbreaks Geography in Public Health: Communicable Disease How can geography be used in solving communicable diseases problems? Risk mapping – identifying potentially high risk locations Identify the population at risk of being infected by the vector Identifying environmental and spatial risk factors Simulate population movement and therefore potential areas of re-infection Support surveillance , locate, control and monitor identified cases - Laos Support foci investigation Manage localized outbreaks

Dengue Surveillance Review: Geographical Information Systems for Dengue Surveillance GIS is being used in dengue surveillance systems in different countries such as Philippines and Thailand. GIS is used in mapping the distribution of dengue in a geographic area which allows instant visual identification of areas at risk and enables faster mobilization of resources. “Maps for visualization of dengue surveillance data are particularly useful for public health professionals advocating for increased resources, such as vector control or laboratory facilities for serological confirmation of disease, because policy makers respond more positively to maps rather than raw numbers or graphs.” Dengue Surveillance (Refer to slide) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3335676/pdf/tropmed-86-753.pdf

Risk Mapping of HIV/AIDS Update on the Epidemic in Vietnam: Mapping the Risks and Drivers of HIV/AIDS Maps were used to show prevalence of HIV/AIDS cases per province , show the correlation of HIV cases with Tuberculosis cases (as TB is one of causes of death among HIV infected people), and the relationship between the increase of infection and number of clinics in certain areas. Risk Mapping of HIV/AIDS (Refer to slide) http://sites.tufts.edu/gis/files/2013/11/Wanlund_Anne.pdf

Malaria and Dengue Risk Mapping Malaria and Dengue Risk Mapping and Response Planning in the Greater Mekong Subregion This technical assistance project under the Asian Development Bank had 4 major outputs, all of which have geographic dimension: Output 1: Provision of GIS software through the collaboration with Esri and promotion of the concept of common geo-registry and sharing of public health master lists towards the geo-enablement of health information systems. Output 2: Geospatial data and technologies were used to develop malaria and dengue incidence and basic risk maps in Cambodia, Myanmar, and Thailand. Analyses over space and time were conducted to determine trends in disease patterns and examine the determinants and drivers of these patterns in all 3 countries. Malaria and Dengue Risk Mapping (Refer to slide) https://www.adb.org/sites/default/files/project-documents/47197/47197-001-tcr-en.pdf

Malaria and Dengue Risk Mapping Malaria and Dengue Risk Mapping and Response Planning in the Greater Mekong Subregion Output 3: The key findings of the analyses done were used for policy recommendations while the maps and analyses produced were already being used by the countries to inform strengthening of malaria elimination and dengue control programs. Output 4: Supported the strengthening of the malaria program's technical capacity to manage and use geospatial data and technologies in the three countries. Malaria and Dengue Risk Mapping (Refer to slide) https://www.adb.org/sites/default/files/project-documents/47197/47197-001-tcr-en.pdf

Geography in Public Health: Emergency Management How can geography be used in emergency management? Mapping of emergency or disaster-prone area Mapping of affected population and health resources Identifying alternative resources Identifying potential gaps to inform future resource allocation Geography in Public Health: Emergency Management How can geography be used in emergency management? Mapping of emergency or disaster-prone area Mapping of affected population and health resources Identifying alternative resources Identifying potential gaps to inform future resource allocation

Health data collection for emergencies and disasters Health Data Collection Before, During and After Emergencies and Disasters—The Result of the Kobe Expert Meeting In October 2018 at the Asia Pacific Conference for Disaster Medicine (APCDM) 2018, “Health Data collection before, during and after emergencies and disasters” is one of the five proposed major Health Emergency and Disaster Risk Management (H-EDRM) research areas. One of the key recommendations was to include geographical information in the collected data. Health data collection for emergencies and disasters (Refer to slide) Although not an example of case study of geography in public health per se, it advocates and emphasizes the importance of geography in public health emergency management. https://www.mdpi.com/1660-4601/16/5/893/htm

Earthquake emergency management Case study of Chauk earthquake As part of the pilot project of integrating geography and time in the Health Information System of Myanmar, a case study was done for the 24th August 2016 Chauk earthquake event. By using the Peak Ground Acceleration distribution map for the earthquake and the geographic coordinates of the health facilities from the master list, it was possible to identify which health facilities had the highest probability of experiencing damages at the time of the event. The spatial distribution of pregnant women for the same year also allows the identification of how many of them are located in the same PGA zone. Earthquake emergency management (Refer to slide) This is discussed in more detail in the story map for Myanmar in Session 2.3. https://www.mdpi.com/1660-4601/16/5/893/htm

Geography in Public Health: Immunization How can geography be used in immunization? Mapping of emergency or disaster-prone area Identify places (risk areas) requiring interventions/vaccinations Asses the service delivery network and identify barriers to access/utilization Identify gaps and/or inequities in immunization coverage Setup vaccination strategy for optimal vaccine performance Monitor spatial performance of the vaccination program Assess spatial impact of vaccination on health outcomes Identify spatially related predictors of the performance of vaccination on health outcomes Geography in Public Health: Immunization How can geography be used in immunization? Mapping of emergency or disaster-prone area Identify places (risk areas) requiring interventions/vaccinations Asses the service delivery network and identify barriers to access/utilization Identify gaps and/or inequities in immunization coverage Setup vaccination strategy for optimal vaccine performance Monitor spatial performance of the vaccination program Assess spatial impact of vaccination on health outcomes Identify spatially related predictors of the performance of vaccination on health outcomes

Improving Immunization in Pakistan Use of geospatial technology to improve immunization in Pakistan The Expanded Program on Immunisation (EPI) of Pakistan enlisted the help of the Punjab Information Technology Board (PITB) to solve the problem of low geographic coverage and low performance of field vaccinators. E-Vaccs is an immunization information system with an accompanying smartphone application for vaccinators. Field vaccinators have to check in at 3 different locations and provide geo-tagged and time-stamped information. Improving Immunization in Pakistan (Refer to slide) Because the attendance of field vaccinators could now be monitored properly, the attendance improved drastically from a mere 36% to a staggering 94%. https://www.dawn.com/news/1311870/how-pakistan-turned-around-its-vaccination-programme-using-technology

Improving Immunization in Pakistan Use of geospatial technology to improve immunization in Pakistan To address the low geographical coverage of rural areas, PITB came up with a dashboard with color-coded maps which are used to see the broader overview of immunization performance in each district. Using these maps to ensure that vaccinators cover areas with low immunization performance, geographical coverage ended up increasing from 25% in 2014 to 88% in 2016. Improving Immunization in Pakistan (Refer to slide) https://www.dawn.com/news/1311870/how-pakistan-turned-around-its-vaccination-programme-using-technology

Immunization Planning in Myanmar Use of geospatial data and technology for Immunization Planning in Myanmar The Myanmar Central Expanded Programme of Immunization (cEPI) is using WHO's Reaching Every Community Strategy to vaccinate every child in the country. In this strategy, the development of a microplan based on the population information in the catchment areas of the health workers is an important tool to ensure effective coverage and equity. Immunization Planning in Myanmar (Refer to slide) Several trainings were conducted to strengthen the technical capacity of the Myanmar EPI program when it comes to geospatial data and technologies. http://www.nationalplanningcycles.org/sites/default/files/planning_cycle_repository/myanmar/myanmar_cmyp_2017-2021.pdf https://uncareer.net/vacancy/national-consultant-support-cepi-geospatial-data-management-178549

Immunization Planning in Myanmar Use of geospatial data and technology for Immunization Planning in Myanmar The use of proper geospatial data management practices helps in: identifying inequities in vaccination coverage and health outcomes addressing existing gaps in service delivery by optimally deploying available resources with minimum waste effectively monitoring progresses toward national and global development targets Immunization Planning in Myanmar (Refer to slide) http://www.nationalplanningcycles.org/sites/default/files/planning_cycle_repository/myanmar/myanmar_cmyp_2017-2021.pdf https://uncareer.net/vacancy/national-consultant-support-cepi-geospatial-data-management-178549

Other examples What other examples of the use of geography in public health do you know? In what other public health programs is geography used? Discuss with each other how else can public health benefit from the integration of geography. Other examples (Refer to slide)