Health GIS Tools and Applications Informing Decisions in Yemen Environmental Health Risk Mapping The PHRplus Project is collecting and integrating data from many government sources, and creating applications that show how the health GIS can make use of these government statistics in new, innovative ways. For example, the Ministry of Planning (MoP) provided PHRplus with district-level data for the governorate of Shabwa, detailing the percentage of population with access to safe drinking water, as well as information on the percentage of population using various sanitation types (sewer system, closed pit, open pit, pipe to wadi, dry latrine, or nature). This information, combined with demographic data provided by the Central Statistical Organization (CSO), was used to calculate a water and sanitation health risk index (HRI) for each district in Shabwa (see Exhibit 4). In this manner, the HRI was based equally on two contributing factors, drinking water quality and the sanitation system available weighted according to type (i.e., sewer systems posed the least risk and no sanitation system posed the highest risk). The HRI analysis results are easily visualized on the GIS’s map interface. The HRI alone for each district is informative, however, using the GIS to weight the potential risk by the population distributed throughout each district adds increased value to the analysis. The three districts in Shabwa with the highest HRI (At’talih, Jirdan, and Markhah Al Alya) were not the same three districts with the highest populations at risk (Ataq, Jirdan, and Markhah Assufla). Integrating different sources of data into a population-weighted risk index gives health care professionals vital new information that helps them prioritize their intervention efforts by targeting the largest population area at high risk for waterborne and communicable diseases.  Exhibit 4. Water and Sanitation Health Risk Index in Shabwa Conclusion Use of GIS in Yemen by the MoPHP and other decision-making organizations in the past has involved mostly preparation of maps to show the locations of specific features. However, the underlying data has not been reliable and inconsistent across the Yemen GIS user community. The PHRplus Project cleaned and enhanced GIS base map data layers to form the underpinnings for developing health-based decision tools and applications. The PHRplus Project has been maximizing the use of accurate health data and spatial information to improve the health system in Yemen. The tools and applications described in this paper highlight the important role spatial considerations can play when analyzed in combination with a comprehensive health facility database, demographic and population data, health information systems, and summary statistics. The four tools and applications specifically demonstrate sophisticated use of a health GIS to enhance facility utilization, improve distribution of preventive and curative care, and provide evidence-based rationale for targeted assistance and service delivery. Easy-to-use health GIS tools are being designed to assist governorate- and district-level officials with local health care decisions in support of the Yemen health sector strategy to promote health system decentralization.
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