GIS Methods:
Applications to HIV and
Family Planning
Livia Montana
UNC-Chapel Hill, Carolina Population Center
Measurement, 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?
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