GIS@development June 2000; Health GIS in India

With most of the international development funding and focus oriented towards health care systems, it is the best time and opportunity to develop a comprehensive and structured health GIS for the entire country

Medical geography is relatively a new concept in India. Though GIS is being used to deliver a pizza on time, its immense applicability in delivering health care services is yet to be explored fully. The sheer size of our country, varied life styles, climatic zones and environmental conditions (all of which have a direct impact on health and ill-health) make it all the more important for India to have a health GIS. With most of the international development funding and focus oriented towards improving health care systems, this is, if not too late, the best opportunity and time to develop a comprehensive and structured health GIS for the entire country. In this article the authors make an attempt to share his views and experiences in developing a health GIS for Leprosy and TB mapping in the states of Madhya Pradesh, Orissa and Tamil Nadu.

DANLEP in GIS
The Danida-assisted National Leprosy Eradication Programme (DANLEP) is one of the foremost organisations to deploy GIS in the health sector. A dynamic Drug Delivery Point (DDP) system delivers Multi Drug Therapy (MDT) treatment to the leprosy patients in their own villages at regular intervals. GIS in DANLEP started with the primary objective of mapping the drug delivery points vis-a-vis patient location for the entire state of Madhya Pradesh.

With a view to catering to the needs of other health sector programmes, all other health facilities were also subsequently mapped. Unlike other sector programmes, the health sector programmes are largely dependent on the existing widely distributed government health system. It is beyond doubt that this government health system needs a technical management support to cater to the rural poor in improving the health service delivery. The Health GIS developed by DANLEP is being extensively used by other health sector programmes, viz., TB control, HIV/AIDS, Maintaining Cold Chain equipment for Pulse Polio, among others.

Unlike other GIS users, Health GIS users (medical practitioners to a large extent) are relatively new to the concept of computer mapping. Though the field staff (at PHC level) have their own hand drawn, not to scale mapping system - its applicability as a management support tool is limited due to its inability to integrate datasets and prepare combined maps for districts or states. Availability of digital maps has increased manifold. Today, maps down to the village level, are available. These digital maps can be used as the base for the preparation of Health GIS. However, the administrative divisions of health being different, these digital maps need to be modified for incorporating health boundaries. A PHC boundary is generally the most feasible administrative boundary for a national-level health GIS.

Some Successful Health GIS programmes in India
Apart from DANLEP, many development agencies and government institutions are exploring Health GIS in India. Malaria Research Centre, New Delhi (www.malaria-tn.org), Vector control research center, Pondichherry, UNICEF, WHO for leprosy, TB, malaria and Pulse Polio programmes (www.whosea.org), DANPCB (Danida-assisted Blindness Control Programme), HIV/AIDS programmes in TN, Orissa and MP, to name a few.

Future of Health GIS in India
Many health programmes are now showing a great deal of interest in GIS applications, which definitely is a healthy sign. However, the role played by vendors in this regard is something to be concerned about. Aggressive marketing strategies by them leads to prospective health GIS users being flooded with advanced modules of GIS software, which they might not require at all. Also, the user is likely to get confused as to what software is actually required in the organisation for its scope of work . It has been observed that in some cases the entire equipment is lying idle for want of trained and skilled manpower. To create a successful GIS community, vendors would have to play a positive and a truly healthy role by providing objective -oriented and appropriate technical know-how to prospective users.

Some key issues related to Health GIS in India

Data sharing: Health being a humanitarian subject, all other projects who have developed digital maps should share their data sets for health mapping purposes. DANLEP has already set up a commendable example in this respect by sharing its data with other development projects. Health being an interdisciplinary subject, needs inputs from socio economic, environment and landuse aspects. Such data generation is beyond the scope of any health sector programme and needs only to be provided by the respective departments.

National Health GIS: It is high time we have a national Health GIS system in place. GIS as a planning and management tool can substantially help in reducing the monitoring and implementation costs of health sector programmes.

Training: Health administrators should be imparted necessary training in GIS use.

Planning: DANLEP's experience suggests that GIS can be very helpful in designing campaigns, IEC activities, integration studies and awareness programmes. It is observed that leprosy and TB endemicity is prevalent in tribal areas. Studies in relation to poverty level, tribal settlements and accessibility have helped in optimising location and reallocation of service delivery centres.

Identification of Hotspots: DANLEP has undertaken studies to identify health hotspots by studying disease profiles across Orissa for multiple diseases. DANLEP suggests that more studies should be conducted throughout the country to identify health hotspots in order to evolve a comprehensive health management programme.

Internet and Health GIS
Health-gis@who.ch is a very useful email group for health GIS users. Mapinfo-L and Arcview-L also provide useful information regarding health GIS from time to time.

Conclusion
Health GIS is here to stay. DANLEP has established a successful health GIS in not only its main office but also in all its three operating states. These three nodes are providing excellent support to the local government health department. The authors feel that these success stories should be replicated in all those states which are yet to use GIS for health. With the advent of Internet mapping, information and data dissemination have become a lot more easy-facilitating a "National Helath GIS" not a distant reality