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3.4 Health: Surveillance of Infant Mortality
With the address base, the centerlines, and all of the socio-economic information available, the Municipal Secretary of Health is using geoprocessing and desktop mapping to fight infant mortality in the city [6].

The Health Department of the city of Belo Horizonte, with PRODABEL's support, has implemented a system for infant mortality surveillance in high-risk areas. The system, based on GIS techniques, processes social and demographic data generated by many institutions, using geography as a common frame of reference. The importance of the system is to provide help in the decision-making process, favoring the discussion and evaluation of specific public policies. The goal is to reduce infant mortality ratios. Belo Horizonte, which has a population of more than two million, has about 345,000 (17.2%) people living in high-risk neighborhoods, which corresponds to only 3% of the city's total area. In a typical month, about 450 infants die, many from avoidable causes; and of those deaths, more than half live in poor neighborhoods.

With the Infant Mortality Surveillance Program, the children that run the highest risk in the first year of life, due to low birth weight, children born to adolescent or illiterate mothers, or newborns in favela (slum) regions receive individualized care from health centers. Geoprocessing is used to produce this distribution, through geographic localization of a newborn's residence, therefore assigning the follow-up responsibility to the more geographically adequate health care unit. Counting only on the simple presence and orientation provided by health care professionals, the program is expected to reduce many avoidable deaths (pneumonia, diarrhea, malnutrition) among children less than one year of age. Since the beginning of the program, the infant mortality rate has been reduced by 35%.

4. What Can India Learn From The PRODABEL Experience?
Many developing country government organizations have been attempting since the late eighties and early nineties to implement GIS technology to support their socio-economic development processes. In 1991, [7] noted that despite the rhetoric which exists around the potential of GIS, there is very little evidence to show that this potential has really been converted into applications of substance that have made a difference to their socio-economic development processes. And recently, Sahay and Walsham [4] based on an extensive empirical study of GIS use reinforced Taylor's inference within the context of India and Malaysia. They reported while a lot of hardware and software has been acquired by various organizations, there is little in terms of "real" use wherein the outputs of the GIS have been integrated to support their organizational decision making processes.

Seen within this broader (and rather dismal) context of GIS experiences in developing countries, the PRODABEL experience in Belo Horizonte is indeed a very refreshing and positive contrast. There is positive evidence that GIS technology is being used quite meaningfully by a number of different departments involved in the municipal administration of Belo Horizonte, including health, education and transportation. It becomes becomes important for us to reflect on the reasons why we think the PRODABEL experience has been positive, and draw some broader lessons for similar GIS projects in developing countries. Sahay and Walsham [4] have pointed out a number of important issues which impede the effective implementation of GIS technology in developing countries. We will look at some of those issues to see how they have been addressed in the PRODABEL case. Specifically, we will focus on issues of: institutional arrangements; sustainability; data management and manpower related issues.

Many GIS projects fail in developing countries come as a package of international aid, with agencies like UNIDO, UNESCO, USAID and CIDA being very active in this regard. Often what is found in such internationally funded projects is that typically these projects are 2-3 years long, and when the aid money dries up the GIS projects also die away. As a result, what we often find is a number of pilot projects, and other kinds of experimentations but little in terms of full blown use. Another issue related to international aid projects is that they are typically accompanied by consultants from the donor country. So, while they are present in the recipient nation, there is some activity, but with their departure, the activity also dies out because there have been very limited attempts to develop local sustenance mechanisms. Specifically, there are limitations in terms of manpower, technical support and hardware and software resources. Also, often in these technology transfer projects, the international consultants have limited understanding of the local context, and they try to implant Western processes which have little to no applicability in the developing country context [5].

It is interesting to see how PRODABEL have tried to address these institutional bottlenecks which are a regular occurrence in many GIS projects in developing countries. Firstly, they have not relied on international technology transfer and instead have attempted to build in-house expertise over a long period of time (starting in 1989). Secondly, PRODABEL has set up an organization which is dedicated completely to the development of geoprocessing expertise to support municipal administration in Belo Horizonte. Being organizationally within the structure of the municipal administration, they are in a better position to understand user needs as compared to international consultants. Also, since they are physically co-located with the other departments, they are always on hand to respond to the queries of the users thus providing the much needed technical support which also helps to instill a sense of self-confidence to the users to engage with this new and complex technology.

Another interesting feature of the PRODABEL experience is the systematic and integrated manner in which they have gone about to build a database for the needs of the city. In many GIS projects in developing countries we find that the problem of data is not given the necessary importance, and we find that different departments go about trying in their own individual and compartmentalized way to develop their databases. In contrast, at PRODABEL, the first task of the GIS exercise was seen as creating a comprehensive database. After creating an initial framework for the integrated database, they have gone about systematically and incrementally adding on to the database reflecting the needs of the different departments. This integrated approach has had a number of positive implications. Firstly, it reduces data redundancy and thus keeps costs in control. Secondly, the responsibility of maintaining the database is mostly with PRODABEL which is competent to deal with the various technical issues. Thirdly, an integrated approach allows new applications to be built on easily with the same dataset, thus satisfying the needs of various end user departments.

A very significant feature of the PRODABEL effort was the team of geoprocessing professionals that were picked from several departments of the company, in such a way that specialists from the various technological areas involved could adequately assess and develop a technology that was essentially unknown at that point. The team included: systems analysts who were specialized in databases, data modeling, and data administration; applications development specialists with an understanding of different domain areas; experts in computer graphics and digital image processing; urban cadastre and cartography specialists; and operating systems and computer networks experts. That initial team was, at a later time, joined by an applications programmer, another applications development analyst, an operating systems and network support analyst, a geographer, and eight digitizing technicians (who were formerly cadastre technicians or draftsmen).

Over the years, the team has achieved the status of national reference in urban GIS, due to the pioneering character of the project, and the delivered and perceived results. This team has also a very strong research orientation, and more than 70 articles have been published by the various team members in national and international conference proceedings, and various Brazilian GIS magazines. A large number of lectures and presentations at seminars and conferences has been given, and numerous technical visits from all parts of the country have been hosted at PRODABEL. After the first five years of centralized applications development, the initial team was dismantled, with some members leaving the company to pursue positions in the private sector, and some others were transferred to various end-user departments thus helping to initiate GIS projects there. These movements were part of PRODABEL's corporate policy to decentralize municipal administration information technology resources. Currently, the remainder of the core team is responsible for the maintenance of the existing digital cartographic data, building applications development related to the urban digital basemap and database maintenance procedures. This basemap contains general-use geographic entities, such as street centerlines, addresses, and neighborhoods. Decentralized GIS application development teams are currently being structured, through a technology dissemination and professional requalification program.

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