BackgroundThe high rate of maternal mortality in India is of grave concern. Poor rural Indian women are most vulnerable to preventable maternal deaths primarily because they have limited availability of affordable emergency obstetric care (EmOC) within reasonable geographic proximity. Scarcity of obstetricians in the public sector combined with financial barriers to accessing private sector obstetrician services preclude this underserved population from availing lifesaving functions of comprehensive EmOC such as C-section. In order to overcome this limitation, Government of Gujarat initiated a unique public–private partnership program called Chiranjeevi Yojana (CY) in 2005. The program envisaged leveraging private sector providers to increase availability and thereby accessibility of EmOC care for vulnerable sections of society. Under CY, private sector providers render obstetric care services to poor women at no cost to patients. This paper examines the CY's effectiveness in improving availability of CEmOC services between 2006 and 2012 in three districts of Gujarat, India.MethodsPrimary data on facility locations, EmOC functionality, and obstetric bed availability were collected in the years 2012 and 2013 in three study districts. Secondary data from Census 2001 and 2011 were used along with required geographic information from Topo sheets and Google Earth maps. ArcGIS version 10 was used to analyze the availability of services using two-step floating catchment area (2SFCA) method.ResultsOur analysis suggests that the availability of CEmOC services within reasonable travel distance has greatly improved in all three study districts as a result of CY. We also show that the declining participation of the private sector did not result in an increase in distance to the nearest facility, but the extent of availability of providers for several villages was reduced. Spatial and temporal analyses in this paper provide a comprehensive understanding of trends in the availability of EmOC services within reasonable travel distance.ConclusionsThis paper demonstrates how GIS could be useful for evaluating programs especially those focusing on improving availability and geographic accessibility. The study also shows usefulness of GIS for programmatic planning, particularly for optimizing resource allocation.

BackgroundGujarat, a western state of India, has seen a steep rise in the proportion of institutional deliveries over the last decade. However, there has been a limited access to cesarean section (C-Section) deliveries for complicated obstetric cases especially for poor rural women. C-section is a lifesaving intervention that can prevent both maternal and perinatal mortality. Poor women bear a disproportionate burden of maternal mortality, and lack of access to C-section, especially for these women, is an important contributor for high maternal and perinatal mortality in resource limited settings. To improve access for this underserved population in the context of inadequate public provision of emergency obstetric services, the state government of Gujarat initiated a public private partnership program called “Chiranjeevi Yojana” (CY) in 2005 to increase the number of facilities providing free C-section services. This study aimed to analyze the current availability of these services in three districts of Gujarat and to identify the best locations for additional service centres to optimize access to free C-section services using Geographic Information System technology.MethodologySupply and demand for obstetric care were calculated using secondary data from sources such as Census and primary data from cross-sectional facility survey. The study is unique in using primary data from facilities, which was collected in 2012–13. Information on obstetric beds and functionality of facilities to calculate supply was collected using pretested questionnaire by trained researchers after obtaining written consent from the participating facilities. Census data of population and birth rates for the study districts was used for demand calculations. Location-allocation model of ArcGIS 10 was used for analyses.ResultsCurrently, about 50 to 84% of populations in all three study districts have access to free C-section facilities within a 20km radius. The model suggests that about 80–96% of the population can be covered for free C-section services with addition of 4–6 centres in critical but underserved regions. It was also suggested that upgrading of public sector facilities with minimal investment can improve the services.ConclusionThis study highlights utility of Geographic Information System technology for planning service centres to optimize access to vital lifesaving procedure such as C-section. Although the location allocation methodology has been available for decades, it has been used sparsely by public health professionals. This paper makes an important contribution to the literature for use of the method for planning in resource limited settings.

BackgroundIndia is known to be endemic to numerous infectious diseases. The infectious disease profile of India is changing due to increased human environmental interactions, urbanisation and climate change. There are also predictions of explosive growth in infectious and zoonotic diseases. The Integrated Disease Surveillance Project (IDSP) was implemented in Gujarat in 2004.MethodsWe analysed IDSP data on seven laboratory confirmed infectious diseases from 2005–2011 on temporal and spatial trends and compared this to the National Health Profile (NHP) data for the same period and with other literature. We chose laboratory cases data for Enteric fever, Cholera, Hepatitis, Dengue, Chikungunya, Measles and Diphtheria in the state since well designed vertical programs do not exist for these diseases. Statistical and GIS analysis was done using appropriate software.ResultsOur analysis shows that the existing surveillance system in the state is predominantly reporting urban cases. There are wide variations among reported cases within the state with reports of Enteric fever and Measles being less than half of the national average, while Cholera, Viral Hepatitis and Dengue being nearly double.ConclusionsWe found some limitations in the IDSP system with regard to the number of reporting units and cases in the background of a mixed health system with multiplicity of treatment providers and payment mechanisms. Despite these limitations, IDSP can be strengthened into a comprehensive surveillance system capable of tackling the challenge of reversing the endemicity of these diseases and preventing the emergence of others.

Use of GIS in public health is currently limited to tracking immunizations, disease surveillance, and establishing new service areas. The potential of GIS to improve planning, implementation and monitoring of programs and to inform policymaking processes for universal access to healthcare is grossly underutilized. Major reasons for restricted use are paid access to GIS software and difficult interpretation for non-GIS professionals. WebGIS technologies present an opportunity for non-GIS public health professionals to present complex data and findings in simpler manner. Conventional GIS methods and Geovisualization are compared and contrasted in this paper using data from the MATIND project in the Gujarat state of India. In-depth literature review on GIS techniques used in health implementation research was conducted. In this paper, MATIND data have been used for comparing conventional GIS methods with a newer web based GIS tool-Geovisualization. GIS software is more useful for analytical purposes; whereas web based geovisualization techniques are much better for visualization and easy interpretation of results by non GIS public health researchers. As the images are easy to interpret, interactive/dynamic and not much technical expertise is required to perform basic analysis, the tool is useful for policy makers and planners. Geovisualization provides a user-friendly tool for presenting large scale community based survey data. Increased use of this tool will help to present implementation research in a creative way to the program planners and policy makers. For program managers, it is a useful tool to monitor implementation and impact of a program to improve health of population.

Geographic information systems or geographic information science is a combination of computer-mapping capabilities with additional database management/data analysis tools. GIS is widely used in various sectors such as environmental science, urban planning, agricultural applications etc. Public health is another focus area, where GIS has been used for research and practice areas such as epidemic surveillance and monitoring, among others. The journey of use of GIS in public health spans more than a century and GIS application in public health has evolved from the simple maps to the higher level geostatistical analysis and interactive WebGIS in recent times. GIS is an analytical tool which differs from conventional computer-assisted mapping and any statistical analysis programs in its ability to analyze complex data and visual presentation of spatial data. Specialized GIS techniques such as network analysis, location-allocation models, site selection, transportation models, and geostatistical analysis are well established and used in many developed and developing nations. Unfortunately owing to the high cost of licensed software and specialized skills for advanced data analysis, use of these techniques is limited mainly for the research and by few experts. GIS is proved to be useful for various public health practices and research purposes including epidemiological surveys/investigation, implementation research, program/policy decision making and dissemination of information. The advantage of using GIS is that maps provide an added dimension to data analysis, which helps in visualizing the complex patterns and relationships of public health issues, thus many unanswered questions in public health, can be understood well through use of GIS techniques. Use of GIS in public health is an application area still in its infancy. Wider use of GIS for public health practice such as program planning, implementation and monitoring in addition to building evidence base for the policy making will help reduce inequities in health and provide universal healthcare. Overall, GIS is a helpful and efficient tool especially for public health professionals working in low resource settings. In the future with inclusion of advanced GIS technology like WebGIS can help reach the goal of optimal health care services globally.