GIS Based Health Management Information Systems in the Revised National Tuberculosis Control Programme (RNTCP) and Disease Surveillance
Health is one of the major aspects of socio-economic development of India. In this country, healthcare data is routinely collected at health facilities. Forms are completed to record attendances, diagnoses, prescriptions and referrals. This data is passed to different levels where they are collated and summarised. These data need to be integrated and analysed so that it can act as a useful decision support tool in formulating health schemes in a more realistic and need based manner.
Background and Aim of the Project
Geographic Information Systems (GIS), which is a computer-aided database management and mapping technology that organises and stores large amounts of multi-purpose information, has the ability to integrate, manipulate and analyse the spatial and its corresponding non-spatial data at very high speed, which is unmatchable by any of the manual methods. A Health Management Information System (HMIS) can integrate GIS with health sector. It is a system designed to collect and report information on programme that allows the user to plan, evaluate and monitor the operations and the performance of the whole programme. The project on ‘GIS Based Health Management Information Systems’ made an attempt to integrate GIS as a tool to develop a customised Geographic Information System (GIS) based tool for assisting in the understanding, analysis and enhanced delivery of health programmes in India, under the Revised National Tuberculosis Control Programme (RNTCP).
Objectives
The project aimed to bridge the ‘digital divide’ in health, ensuring that relevant information and the technologies to deliver it, are widely available and effectively used by health personnel: professionals, researchers and scientists, and policy makers. The project has brought together public and private partners under the principle of ensuring equitable access to health information. The core elements of the project are content, internet connectivity and capacity building. The objectives of the project were as follows:
- Design and development of a ‘customised Geographic Information System (GIS) tool’ or ‘GIS based Health Information System’ which is user-friendly, simple and compatible with the existing parameters of the health programmes.
- Assimmilation of database (both spatial and non-spatial) as gathered or provided by the programme managers and its uploading into this ‘customised GIS tool’ for its effective functioning, analysis and use by district and sub-district officials for the pilot area.
Baseline Survey
To execute the project effectively and efficiently, a background study was done for developing a proper understanding about Revised National Tuberculosis Control Programme (RNTCP), requirements for data generation and compilation-reporting system and maintenance of records within LRS Institute of Tuberculosis and Respiratory Diseases and for identifying the whole LRS catchment area in terms of Treatment Unit. From the background study, it was realised that as any data related to Public Health is generally voluminous, it becomes difficult to understand and organise the real content. The data needs to be presented in a way that the temporal and spatial nature of the problem can be brought out in a focused way.
Study Area
There were two applications developed under this project:
- Deogarh district of Orissa
- South Delhi part of Delhi city in India
In the application for the Deogarh district, the prime concern of HIN was to divide it into three Treatment Units (TUs) namely Bamparda, Chhatabar and Tileibani for convenient integration of data for analysis. Each of these TUs had sectors and each sector had sub-centres under it. The data was made available at multiple levels of abstraction and this was logically demonstrated in the application with much simplicity.
The second application was developed to map the TB patients of Delhi in South Delhi districts. The region had total of 20 chest clinics, among which was Lala Ram Swaroop Institute of TB and Allied Disease (LRS), covering a partial area of South Delhi. The total TB patient population of South Delhi is catered by two chest clinics i.e. Chest Clinic LRS Institute of TB and Allied Diseases in New Delhi and Nehru Nagar. The application made it convenient for HIN to retrieve information for each unit and the status of corresponding TB patients receiving treatment at district as well as sub centre level. The application is quite flexible as it can perform the analysis on district level as well as sub centre level, depending on the user’s choice. It also makes easy to demarcate the areas of vulnerability as compared to other areas and accordingly measures can be taken.
Methodology
Intensive field research and stakeholder consultation were conducted to identify the problem areas. As a part of the methodology, identification of individual microscopic centre health boundaries within which it is operating to provide healthcare delivery services was done. It was followed by further identification of the health boundaries of areas covered under a microscopic centre and also identification of health related databases available with the pilot site. The data was procured from conventional source. Primary data was collected by the means of field visits to the pilot areas i.e. Deogarh and LRS Institute of TB and Allied Diseases. The basic data was received from LRS in digital form that consisted of 34 data fields. Data management for the entire process consisted of three steps: data procurement, data processing and data usage. Both spatial and non-spatial data were procured as a part of the data procurement from the respective pilot sites under the project. The source of spatial data was Surveyof India and the basic maps used were Toposheets and City Maps. The processing of spatial data consisted of the following steps:
- Creation of Digital Map of DOTS/Microscopic wise areas
- Specifications specified by the client (LRS), locality level maps
- Acquiring basic locality level maps
- Map rectifications
- Generating locality level maps
The non-spatial data received were in digital format which were changed to comply with spatial data. The exercise of transforming the data included the following steps:
- Understanding the data
- Choosing the indicators
- Extracting information from the relevant data fields
- Mapping the information
- Presentation and analysis of the data
Outcomes
A customised GIS tool was developed which uses independent GIS engine and can run on any PC running windows operating system. The features of GIS based HIMS are as follows:
- Spatial and non-spatial information display
- Basic map viewing facilities like zoom and pan
- Creation of user defined themes
- Manipulation of layers – viewing
- Creation, viewing and modification of mark ups
- Modification of spatial and non-spatial data
- Measuring distances on the map using map ruler
- Capability to handle multiple layers at the same time
