GIS Methods: Applications to HIV and

Family Planning

Livia MontanaUNC-Chapel Hill, Carolina Population CenterMeasurement, Learning & Evaluation Project

Identifying Populations at Greatest Risk of Infection - Geographic Hotspots and Key Populations

Geneva, July 25-26, 2013

Data Availability

• Health facility data – Census– Surveys– Surveillance– Routine information systems

• Outreach and community based services• Population surveys

Mapping Results: Monitoring and Measuring Progress Towards Targets and Goals

• How can GIS methods be used to link and triangulate these data sources?– Identify populations at risk– Update temporal and spatial scales of maps of

populations at risk– Understand differences in estimates across varying

temporal and spatial sources• How can GIS methods help inform planning and

programs to better serve those in need?– Can we link quality and availability of services to

population-level outcomes?

Montana, Mishra, Hong 2008.

Comparing HIV Prevalence from Sentinel Surveillance Sites and DHS Data

Using GIS to Inform Programs: Family Planning (FP)

• Urban Reproductive Health Initiative (BMGF)• Integrate FP services• Improve quality• Increase access• Reach the urban

poor

• 5-year prospective evaluations in each country

Measurement, Learning & Evaluation Project:Evaluation Design

• Large Longitudinal Samples– To measure causal impact of the program

• Small Cross Sectional Surveys– To measure change in key indicators between

baseline and endline

• Facility Surveys– All facilities mentioned in the individual survey– Random sample of additional facilities – Census of high volume facilities– Public and private facilities– Longitudinal

Linking Family Planning Users to Health Facilities: Supply & Demand

• Where did you go for services?– Distance calculations from primary sampling unit

(PSU) to facility

• Preferred providers– The most popular provider in the PSU

• What is the quality of services in your geographic area?– Buffers around PSUs– Census of facilities measured at baseline and

midterm– Quality measures from facility surveys

Innovations in Evaluation• Urban women can chose from many facilities to

get their family planning counseling and contraceptive methods

• Urban women may not even consider sources close to their residence

• Choice of facility is intricately linked to the choice of contraception

• Program evaluation methods that simply link individuals to nearby facilities may include a completely incorrect choice set

Unanswered Questions

• Geographic access to services in urban areas– Does distance matter in urban settings?

• How does quality of services influence choice and uptake?– Do women choose higher-quality facilities?– Do family planning users or new adopters choose

higher-quality facilities?

Challenges and Future Directions

• Availability of health facility locations– Census, and survey data

• Ability to link reported facility names to the master list of facilities

• How to map the extent of community-based activities (community health care workers, outreach etc)

…challenges and future directions

• Continued development of methodologies that combine geographic information to generate small-area estimates

• Validation of small-area estimates of HIV prevalence, and populations at risk

• Need for rigorous evaluation methodologies combining GIS and other methods to assess causal relationships and program impacts