Karnataka Health System Development & Reform Project Karnataka Health Geographical Information System Dr. B.G. PRAKASH KUMAR Deputy Director (SICF/HMIS) KHSDRP, Bangalore D.L. Devaraj, M.Tech.-Geoinformatics Sr. Programmer, HMIS Wing KHSDRP, Bangalore
GIS - Karnataka Area of Karnataka 1,91,791 sq.km. Population of the State 5,28,50,562 Urban Population 1,79,58,620 Rural Population 3,48,91,941 Male 2,68,56,343 Female -2,58,77,615 % of Urban Population 33.98% % of Rural Population 66.02% Sex Ratio Urban 940/1000 Rural 976/1000 Literacy Urban 81.05% to 74.20% Rural 47.69% to 59.68% No. of Districts - 29 No. of Taluks - 176 No. of Revenue villages 29,406 No. of Habitant villages - 27575 No. of Non-habitant villages - 1908
Health Facilities in Karnataka No. of District Hospitals 27 No. of Taluk level hospitals 121 No. of Sub-divisional hospitals - 27 No. of CHCs 325 No. of PHCs 2195 No. of Sub-centres 8143 No. of urban PHCs 17 No. of Maternity Annex 304 Central Govt. Hospital and Dispensaries 26 Local Body s Govt. Dispensaries 53 Rural Family Welfare Centres 269 Urban Family Welfare Centres 87 Urban Health Centres 124
Need for GIS Preventive health care involves health care professionals reaching out to communities and providing health education and prophylactic measure. The issues involved are access (where all a professional can reach from the facility) load or coverage ( how many citizens can be covered with the available resources) use rate ( how much of the resources get used up and why) These issues are easily analysed using a map based planning system rather than a statistical table based system. It is faster, easier to find villages that can be reached in half an hour from a particular PHC on a map
Need for GIS The curative aspect involves locating health care facilities appropriately so that the patient does not have to travel too far (access) and equipping the facilities with adequate resources (personnel, equipment, supplies and infrastructure) GIS mapping can be used to locate availability of facilities with all the adequate resources and to know the distribution of health facilities Static and semi-static data can be added in layers
Need for GIS To understand the localization of good or bad performance of the system and the causes for it. A GIS based planning and monitoring solution enhances the ability of health care managers to understand, and use the insight obtained from a locational perspective to plan and implement a programme that achieves the goal of better health care with better resource productivity.
Spatial Data Source of Data Base Map of village boundary NIC, Karnataka Data through GPS for locating the Villages, Road Layers and Village Boundaries Karnataka State Remote Sensing Application Centre Non-spatial Data Data collection from DH, TLH, CHC, PHC, Subcentre, other health facilities Infrastructure, personnel, supplies, diseases, census data and other health related data
Phase 1 Background (HMIS/GIS) Creation of Health Jurisdiction database for the entire State Phase 2 Integration of Health Jurisdiction upto PHC level to web enabled DHIS2 Software Analysis of indicators in DHIS2 Software
Objective - Health GIS Application Effective utilisation of health infrastructure To improve efficiency in the allocation and use of health resources To improve the quality health services To implement Arc GIS Application which is an interactive spatial analysis tool by which we can perform redistricting, relocating health jurisdiction
Methodology GIS database creation One district was taken as a pilot district and extended to other districts. Duration 5 months Information collected through template from the health facilities DH, TLH, CHC, PHC, Sub-centres Data updation through modified templates or additional templates during January month of every year
Map Layers Base Map Administrative Boundaries State Boundary District Boundaries Taluk Boundaries Village Boundaries Road network layer BBMP Boundaries Health Jurisdiction Boundaries CHC Boundaries (Reporting) Primary Health Centre Boundaries Sub-centre Boundaries Tuberculosis Unit Boundaries
Map Layers Health Infrastructure Locations Sub Centre Location Points PHC Location Points CHC Location Points Taluk Hospitals Location Points Sub-divisional Hospitals Location Points District Hospitals Location Points ART Centres Location Points ICTC Location Points Blood Bank Location Points Mobile Health Clinics Location Points Citizen Help Desk Location Points
Map Layers Sub-centre Boundaries
PHC Boundaries Map Layers
Map Layers Community Health Centre Boundaries
Map Layers Taluk Level and District Hospitals
Non-spatial Data District Hospital (DH) Data Sheet Name of the District Hospital Sanctioned beds Arogya Raksha Samithi formed Availability of Ambulance Water Supply Owned/Other source No. of Staff Quarters No. of Operation Theatres No. of Labour Theatres No. of Beds in Male Wards No. of Beds in Female Wards No. of Beds in Paediatric Ward No. of Beds in Special Ward
District Hospital (DH) Data Sheet (Contd.) Non-spatial Data Laboratory Lab for routine checkup Pathology Lab Microbiology Lab Biochemistry Lab Post-mortem Room Cold Storage facility to preserve body Solar lighting Solar Water Heater Blood Bank facility Trauma Care Centre Integrated Counselling and Testing Centre (ICTC) X-ray facility ECG facility Ultrasonography facility Generator Waste Management Land fill Deep burial Recycling Autoclaving/microwaving Discharge into drains after disinfection Incineration Worm composting Casualty Services Non-clinical Services Generator
District Hospital (DH) Data Sheet (Contd.) Non-spatial Data Staff Pattern of DH Physician General Surgeon Paediatrician Gynaecologist Anaesthetist Opthalmologist Orthopaedic Surgeon S W V S W V S W V S W V S W V S W V S W V ENT Surgeon Radiologist Pathologist Skin Specialist General Duty Medical Officer Dentist S W V S W V S W V S W V S W V S W V Other Specialities Staff Nurse Pharmacist Lab Technician X-ray technician Refractionist S W V S W V S W V S W V S W V S W V
Non-spatial Data Taluk Level Hospital (TLH)/ Sub-divisional Hospital (SDLH) Data Sheet Name of the TLH/SDLH Sanctioned beds Arogya Raksha Samithi formed Availability of Ambulance Water Supply Owned/Other source No. of Staff Quarters No. of Operation Theatre No. of labour rooms Wards Beds in Male ward Beds in female ward Beds in Special ward Beds in paediatric ward
Non-spatial Data Taluk Level Hospital (TLH)/ Sub-divisional Hospital (SDLH) Data Sheet (Contd.) Laboratory for routine checkup DMC Post-mortem Room Cold Storage facility to preserve body Solar lighting Solar Water Heater Blood Storage facility Trauma Care Centre Integrated Counselling and Testing Centre (ICTC) X-ray facility ECG facility Ultrasonography facility Waste Management Land fill Deep burial Recycling Autoclaving/microwaving Discharge into drains after disinfection Incineration Casualty Services Non-clinical Services Generator
Non-spatial Data Taluk Level Hospital (TLH)/ Sub-divisional Hospital (SDLH) Data Sheet (Contd.) Staff Pattern of TLH / SDLH Physician General Surgeon Paediatrician Gynaecologist Anaesthetist Opthalmologist S W V S W V S W V S W V Orthopaedic Surgeon S W V S W V S W V ENT Surgeon Radiologist Pathologist Skin Specialist General Duty Medical Officer Dentist S W V S W V S W V S W V S W V S W V Other Specialities Staff Nurse Pharmacist Lab Technician X-ray technician Refractionist S W V S W V S W V S W V S W V S W V
Non-spatial Data COMMUNITY HEALTH CENTRE / CHC (FRU) DATA SHEET Name of the CHC/CHC (FRU) Sanctioned beds Distance from the taluk headquarters Name of Sub-centres No. of Gram Panchayats Arogya Raksha Samithi formed Availability of Ambulance Water Supply Owned/Other source No. of Staff Quarters Operation Theatre Labour Room Beds in Male ward Beds in Female ward
Non-spatial Data COMMUNITY HEALTH CENTRE DATA SHEET(Contd.) Laboratory DMC Post-mortem Room Solar lighting Solar Water Heater Waste Management Land fill Deep burial Recyclining Autoclaving/microwaving Discharge into drains after disinfection Incineration Blood Storage facility Trauma Care Centre Integrated Counseling and Testing Centre (ICTC) X-ray facility ECG facility Ultrasonography facility Generator Non-clinical Services Staff Pattern of CHC/CHC (FRU) Physician General Surgeon Gynaecologist Anaesthetist General Duty Medical Officer Dentist Other specialists S W V S W V S W V S W V S W V S W V S W V Staff Nurse Pharmacist Lab Technician X-ray Technician Refractionist S W V S W V S W V S W V S W V
Non-spatial Data Name of the Taluk: PRIMARY HEALTH CENTRE DATA SHEET Name of the PHC - Type of PHC GOIP/MNP/24X7 PHC/Others Sanctioned beds Distance from the taluk headquarters Distance from the nearest FRU Name of Sub-centres No. of Gram Panchayats Arogya Raksha Samithi formed Availability of vehicle PHC building Owned/rented
Non-spatial Data PRIMARY HEALTH CENTRE DATA SHEET(Contd.) Water Supply Owned/Other source Compound Wall No. of Staff Quarters Operation Theatre Labour Room Ward Laboratory Post-mortem Room DMC (Lab) Solar lighting Solar Water Heater Waste Management Land fill Deep burial Recycling Discharge into drains after disinfection Integrated Counseling and Testing Centre (ICTC) Staff Pattern Medical Officer Staff Nurse Pharmacist Lab Technician Total S W V S W V S W V S W V S W V
Non-spatial Data Name of the PHC: SUB-CENTRE DATA SHEET Taluk Name: Name of the Sub-centre No. of villages Population of the Sub-centre Distance from the PHC Location of the Sub-centre Within the village / far away from the village Sub-centre building Govt./rented/donated/no building Junior Health Assistant (Female) Working / Not working Functioning of clinical portion No. of Anganwadis No. of Schools LPH HPH HS College No. of Hostels -
SUB-CENTRE DATA SHEET(Contd.) Non-spatial Data Water supply Owned / other sources No. of VHSCs No. expected to be formed No. constituted and functional No. of ASHAs/ Link workers working No. of trained dais working No. of untrained dais operating - No. of water bodies open wells tanks lakes rivers borewells Availability of essential equipment to deliver MCH services
SPATIAL ANALYSIS
Map depicting Low Birth Weight Name of the District Indicator Live birth with less than 1.8 kgs BAGALKOTE 137 BANGALORE RURAL 138 BANGALORE URBAN 155 BBMP 171 BELGAUM 850 BELLARY 425 BIDAR 978 BIJAPUR 675 CHAMARAJA NAGAR 119 CHIKKABALLAPUR 88 CHIKMAGALUR 40 CHITRADURGA 175 COORG 141 DAVANGERE 229 DHARWAD 120 GADAG 598 GULBARGA 864 HASSAN 981 HAVERI 280 KARWAR 259 KOLAR 713 KOPPAL 304 MANDYA 314 MANGALORE 160 MYSORE 913 RAICHUR 928 RAMANAGARAM 19 SHIMOGA 86 TUMKUR 686 UDUPI 113
Map depicting Low Birth Weight Name of the District Indicator Live births with less than 2500 gms. BAGALKOTE 1480 BANGALORE RURAL 460 BANGALORE URBAN 76 BBMP 846 BELGAUM 6911 BELLARY 1500 BIDAR 2305 BIJAPUR 3647 CHAMARAJA NAGAR 848 CHIKKABALLAPUR 1224 CHIKMAGALUR 330 CHITRADURGA 617 COORG 492 DAVANGERE 2205 DHARWAD 337 GADAG 1329 GULBARGA 5814 HASSAN 1547 HAVERI 1206 KARWAR 1442 KOLAR 3293 KOPPAL 834 MANDYA 753 MANGALORE 792 MYSORE 3013 RAICHUR 1914 RAMANAGARAM 158 SHIMOGA 1126 TUMKUR 3609 UDUPI 471
Areas of Concern The area shown in Green are the PHCs reporting more than the district average for incidence of TB The road network is shown to facilitate planning of outreach activities
Resource Use The four hospitals shown had a Bed Occupancy Rate between 80-100 during 2008 Bed Occupancy range is shown in the map
Progress at a glance GIS has been developed and hosted used for planning. Under GIS Mapping, three layers have been incorporated Area marking for PHCs, Sub-centres, taluks and districts for the purpose of programme management. Static and Semi-static data is attached as a second layer and is successfully implemented for all the districts. GIS Mapping is completed for all the 29 districts in the State and the Static and Semi-static data for all the 29 districts is completed and validation is also completed. GIS is made web enabled. Blood Bank facilities, ART Centres, 24X7 PHCs, etc.
Lessons Learnt Due to instability of tenure training to be an continuous ongoing process especially on the job to sustain activities in the field. Close monitoring and supervision to be undertaken by district level officials for inculcating continued improvement and sustenance in performance.
CHALLENGES Collection of data and information periodic, dynamic and event data collection Reporting delays and data gaps frequent change of reporting format, training on formats Data quality / validity Data quality check and validation at various levels Compatibility with survey data System issues Contd.,
CHALLENGES System issues Data definition issues on information to be captured Quality checks and using data validation Identifying and notifying nodal officers for HMIS at various levels IT enabling districts, taluka and facilities Training at various levels Monitoring and evaluation at various levels Increasing information awareness
Redistricting Benefit Rationalize the Health services availability by reforming the Health Jurisdiction District officers can Redistrict the PHC boundaries by reallocating the sub-centres Redistrict the sub-centre boundaries by reallocating the villages
Plan Ahead Adding both public health facilities and private health facilities to compare the availability of health facilities in each district for infrastructure strengthening plan Mapping & Analysis Adding various layers like availability of pharmacies, Human Resource management, etc. Disease profile and epidemic out-break Mapping & Analysis Mapping & Analysis of drop-out children Immunization Vital Statistics of IMR, MMR Mapping & Analysis Integration of all programmes
Plan Ahead Data discipline Timely data collection, constant verification, scheduled for data validation and monitoring at various level Capacity building / training Development of module for training, calendar for training various staff at various level Expansion of monitoring activities
Specific Software Features ArcInfo is most completed desktop GIS. It includes all the functionality of Arc Editor and Arc View and adds advanced spatial analysis, extensive data manipulation, and high-end cartography tools. Organizations use the power of Arc Info every day to create, edit, and analyze their data in order to make better decisions, faster. Arc Info is the de facto standard for GIS. With Arc Info, one can Perform advanced GIS data analysis and modeling Take advantage of tools designed for overlay analysis, proximity analysis, surface analysis, and raster processing and conversion Publish and convert data in many formats Create and manage personal geodatabases, multiuser geodatabases, and feature datasets Use high-end cartography tools to generate professional-quality, publication-ready maps Design customized symbols and place sophisticated annotation and labels on your maps
Redistricting - Split Benefit The User can split a overpopulated Health Jurisdiction to form a new Health Jurisdiction (PHC / SC) District officers can split PHC/Sub-centre boundary to create a new PHC/Sub-centre. New PHC/Sub-Centre location will be created
Usage of Split facility in GIS The splitting was done using the tool provided using tools and a proposal was created. The new populations are Sudi 36403 Nidagundi 28863
Relocating Benefits To rationalize the Health Services Infrastructure to serve allocated population, presently there are anamolies between the prescribed population level and actual population served by a Health Centre. Position of a Sub-Centre or a PHC can be changed to facilitate better access for citizens
Redistricting - Modify Benefit User can move a particular village from one health jurisdiction to another health jurisdiction to reform the service availability District officers can move Sub-Centre/Village to a different PHC/Sub-centre Attribute data will be updated