Developing Capacity for Post-Conflict Interventions: GIS-based approach for Delivering Equitable Health Services in Darfur, Sudan Dr. Abdel Rahman Khider H. (Ph. D. Geography) Patients Helping Fund – Sudan Cell phone +249 912616888, Fax +249 83 439910 P. O. Box 45 Elsagana, Khartoum – Sudan abdel_khider@hotmail.com http://www.phfsudan.org ABSTRACT: This paper emphasis the power of Geographical Information Systems (GIS) in support to health services programs related to post-conflict situations, with perceptions to application in Darfur and similar war-torn areas of Sudan. The Darfur humanitarian crises affect about 3.4 million inhabitants (n towns, displaced or refugee [1]) and occur on largely desert terrains of the size of France, making delivery of health services a challenging task. The challenge can greatly be reduced by creating a customized robust query module of a Health Information System that relates health and disease epidemiology to cadastral parcels via spatial overlay on ArcView 3.1 / ArcExplorer 3.0 platforms and Windows environment; the associated attribute data is created on MS-Access. The principal input from the greater Darfur region (i.e., statistical, image, maps and GPS information) comprises health/epidemiology spatial database, as well as demographic, topographic and environmental data pertaining to public health. Using adequate functionality and weights of the GIS package, the user may view, manipulate, query, report, analyze or model any health phenomena (e.g., disease or hazard pattern) as well as identifying facts or studying health aspects of vulnerable groups (Children, women or elderly) in relation to the violence and non-violence incidents in the region. 1. INTRODUCTION Sudan geography and ecology are important structural factors shaping the health, nutrition, and population (HNP) situation, the improvement of which will be key part of Sudan’s development strategy in the coming years [2]. As Darfur crises end, people displaced by conflict will return home, or establish themselves in new communities. In any circumstances, these communities will be faced with scarce economic opportunities, limited resources and less aid to meet their need. One of the major concerns after achieving peace is how to rebuild health sectors and offer equitable health care in the region. Calling upon initiatives such as capacity building, resource mobilization and partnerships building would facilitate successful recovery from the crisis. In the area of capacity building in particular, this paper justifiably proposes setting-up a ‘GIS’ information system for the Darfur region and extensively demonstrates the type of support the GIS techniques can offer to the health recovery process. The system can be a pilot with a vision to be adopted elsewhere in Sudan after refining and adjustments. Darfur region (Fig. 1) lies at the western part of Sudan along the borders with Libya, Chad, and Central African Republic. The region is including three states (namely North Darfur, South Darfur and West Darfur) hosting 4,746,456 inhabitants within 510 sq. km. Figure 1 shows the location of the region and capital towns of each of the three states. The Darfur humanitarian crises affect about 3.4 million inhabitants (in towns, displaced or refugee [1]) and have resulted in a serious civil strife and greater human sufferings. Some basic introductory information regarding the situation of health, with particular emphasis to the study region, is given in the flowing sections.  Fig. 1. Location of Darfur Region, Sudan 1.1. The Health Care System of Sudan The health care system of Sudan is formed of three-level networks: Federal Ministry of Health level; State level (health centers and hospitals); and Locality level (lower-level primary health care). The organizational structure includes networks of: (1) Primary Health Care (PHC) units, dressing stations and dispensaries; (2) health centers; and (3) first-referral level or secondary hospitals in bigger towns. The Key Public Health Programs include Immunization (The Expanded Program on Immunization (EPI), Malaria Control Program, Tuberculosis, HIV/AIDS, and Maternal Health. After the outbreak of the crises in Darfur, delivering equitable health service in the Darfur region is becoming a greater challenge and a heavy burden on the country’s limited resources. This is particularly evidenced in the case of malaria being endemic to much of Sudan and epidemic in other areas [3], causing a major burden among both adults and children. For instance, a total of 227,550 clinical and lab confirmed malaria cases and 211 deaths (CFR 0.09%) have been reported in Greater Darfur between 1st January and 30th December 2005, while 168,584 malaria cases including 319 deaths (CFR 0.19%) were reported between 22nd May and 31st December 2004 [4]. 1.2. What GIS Can Offer for Post-Conflict Situations in Darfur There will be high need for an informed management of crisis recovery in order to rebuild and recover the capacity of the public health system and physical infrastructure in the Darfur states. The usefulness, robustness and advantages of GIS as data integration and analytical tools can be summarized as follows ([5], [6]):
- Early assessments of recovery needs and designing integrated recovery frameworks. - Planning and assistance in area-based development and local governance programs. - Developing comprehensive reintegration programs for former IDPs, returning refugees and ex-combatants. - Supporting economic recovery both at the local and national level. - Supporting in-country capacity building, resource mobilization and partnerships. 2. OBJECTIVES OF THE GIS SYSTEM: The prime objective of any health information system must lead to maximizing the use of accurate health data and spatial information to improve the health system in Darfur, with particular focus on achieving the following targets:
As clearly shown in Fig. 2, the proposed (GIS) health information system for the study region of Darfur will have two major units: a data warehouse and GIS software platforms to handle the databases of the warehouse. The data warehouse is an essential block in the GIS system, and used here to refer to a generic term for a system for storing, retrieving and managing large amounts of any type of data, which often includes sophisticated compression and hashing techniques for fast searches, as well as advanced filtering [7]. The data warehouse normally includes spatial data loaded into a Relational Database Management System (RDMS) and non-spatial (attribute) databases fed into the GIS system. Attribute and spatial data are then linked. MS Access can serve as a hub for attribute data creation.  Fig. 2. The Geographic Information System (GIS) Components, Darfur For the case of Darfur, a major data warehouse can be localized in the Federal Ministry of Health (FMOH) while each of the states’ ministries of health will have a minor data warehouse. A central server is used to access all these databases from both state ministries of health in Darfur and external data providers like the ones shown in Fig. 2. The software platforms include graphical user interfaces (GUI) desktop tool-sets (consisting of check boxes, drop-down lists, input fields, maps, etc.) that are used for viewing and analysis by the GIS system users and decision makers (health authorities). 2.1. System Development Approach The development of the above GIS system will follow the normal course of applications development procedures as depicted in Fig 3. The basic information requirements for the design of the system depends on extensive analysis where the desired system must meet certain criteria, based on its relevancy, accuracy, usability, affordability, adaptability and accessibility as well as its timeliness [8].  Fig. 3. The System Development Approach Flowchart In the design and development phases, the GIS will be created as prototype (i.e., a model or pattern of the product; [8]), with all necessary documents and information already built-in. This will be inclusive of creating user interface, master, simple processing functions and all necessary tools (with Automated Mapping/Facilities Management (AM/FM) functions integrated into the design). The prototyping will subsequently be refined and evaluated, and changes where necessary are made. Following the testing, the system will finally be put to implementation and proper documentations and training materials will be produced (Fig. 3). 2.2. System Design Approach The GIS system can be designed as two major applications toolsets (Fig. 4): a GIS health planning and management tools (simple application), and Health Surveillance tools (with significant analytical functionality) [9].  Fig. 4. The System Design Applications Flowchart The health planning and management application may be designed for a health care delivery system which can support targeting health care resources and interventions. The toolsets can, therefore, allow professionals to investigate or conduct GPS-enabled Health Facility Survey; targeting service delivery improvement or improvement of a facility accessibility and utilization; or planning a service or program intervention. On the other hand, the health surveillance application will offer a comprehensive set of analytical tools to support conducting a number of health surveillances. Among these are tracking infectious diseases, assessing health risk of a certain factors, planning of control strategies, as well as planning and delivering interventions where need is greater. The above mentioned applications can be developed as plug-in collections to be attached to ESRI’s ArcView 3.1 workstations, integrating the power of geographic information systems (GIS), imaging software, global positioning system (GPS), and in-field sampling. Table 1 [a-c] includes a collection of toolsets identified within specific frameworks: [a] shows characteristics for a Viewing Interface; [b] Health Facility Targeting and Health Care Coverage and Accessibility interface; and [c] Health Surveillance Interactive Mapping and Health Risk Modeling interface. As might be required, a stand-alone software can be created using Visual Basic 6.0 and MapObjects 2.2 software (an ActiveX control). The ActiveX objects offers many sophisticated capabilities that help insertion of dynamic maps into many applications), and can be plugged into standard Windows development environments [10]. Table 1 (a-c) Main Plug-in GIS interfaces to be attached as ArcView extensions (or a sand-alone)  Table 1 (continue)   ArcExplorer (a GIS data explorer built with MapObjects technology) can be used in conjunction with the ArcView 3.1. ArcExplorer is designed with enhanced viewing functionalities for viewing geographic data, displaying image formats; address matching (locate street addresses or intersections on a map); distance measuring; identifying and query geographic and attribute data; displaying data using classifications, symbols, and labeling; pan and zoom through multiple map layers; view and download data published on Web sites which use ESRI IMS technology [11]. 4. KEY FUNCTIONALITIES AND ANALYTICAL APPROACH Useful illustrations of how the GIS approach can be effectively applied as a supportive tool in the health research and investigations are demonstrated in Table 2. Table 2 Some Major GIS Analytical Approach for Service improvement and Planning Interventions in Darfur  Table 2 Continue  5. Discussion The proposed Health Geographical Information System would provide the health professionals in Darfur region with appropriate capabilities to perform important types of spatial analysis towards achieving the target of health recovery. Such a system can conspicuously support the Early Warning and Alert Response Surveillance (EWARS) in the Greater Darfur region currently maintained by the World Health Organization (WHO) [12]. Epidemiologists working in the region in a GIS analytical environment can effectively find areas of high incidence disease outbreaks (geographical distribution/variation) and label them as worthy of further investigation (statistically significant), or set on examining the spatial relationship between disease incidence and information that is geo-referenced (environmental variables). The ideas and information gained by the GIS practice will certainly allow focusing of the sparse resources for prevention or containment of the disease on state or locality levels. With regard to the fluid situation in the region, nonetheless, an important impediment to the implementation of a GIS health information system would be the continuous need of significant amount of additional data collection, which is practically difficult given the lack of capacity and insufficient resource by the local health authorities. This is virtually true, since data gathering, encoding and maintenance is the most expensive part of a GIS [13]. Finally, implementing a GIS system may highlight the need for a specialized body to deal with the tasks of setting the standards and guidelines for the system to ensure smooth data collection, exchange, review and analysis. Partners from the international community, UN agencies and international NGO’s can play a trmendous role in the operation of this system. 6. CONCLUSION To improve the health care system in Greater Darfur in the post-conflict situation, this paper proposes setting up a Health GIS to help equip the epidemiologists, managers and policy makers with powerful decision-support tools for management of the public health care system and effective disease surveillance and service improvement. The previous, current and future health data (along with demographic and environmental databases) for Darfur individual states can be integrated into a relational database with a GIS interface to facilitate efficient use of the data. The customizable GIS tools can improve the capacity of Public Health officials and decision-makers to visualize, understand, and make decisions more easily that using hard copy maps and charts. 7. ACKNOWLEDGEMENT The author wishes to thank Dr. M. El Hassan A. Rahman, General Manager of the ‘Patients Helping Fund – Sudan’ for his constructive support to make this work a success. 8. REFERENCES
|
Makeshift camps of internally displaced persons (IDP’s) in the Darfur region, Sudan