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Geographic Information Systems

The interest of GHADEF on the Geographic information systems is defined by its obsession to promote the confidence and quality of life in our communities through transparency. Geographic Information Systems (GIS) when implemented give the users an endless ability to access and display real time data, project status, controls and updates in any data driven discipline.

A geographic information system (GIS) utilizes hardware and software, to integrate and capture data for management, analysis, display of all forms of geographically referenced information aspect of concern. The GIS technology involves using locational data to perform geographic analyses and/or to create visual outputs such as maps. it is part of a larger emerging new science with the ability to show the results of complex analyses through maps effective for remote sensing.

GIS will benefit almost every organization, as GIS-based maps and visualizations may transform the understanding of situations, improving communication between different teams, organizations, and the public. It is a powerful tool for data management, and is excellent in not only making decisions, but making correct decisions about location, which is critical to the success of any organization. It could be highly cost effective and efficient and offers a new approach to management- managing geographically

The GIS technology can be used in developing countries to monitor public health, public safety, territorial administration, surveys, building, and construction projects in every department. It may range from road constructions through office building projects, internal security, and boarder patrol.

The article on the next page depicts the possibilities associated with the GIS systems in the public health sector, and will be the standard for proposal submissions that will be accepted by GHADEF. This proposal was a fellowship submission authored by Dr. Akere Anyangwe to the Open Society Foundation (OSF) of New York, in 2013. It is currently being evaluated and investigated by GHADEF for execution in the near future.

 


 

GEOGRAPHIC INFORMATION SYSTEM (GIS) MAP OF THE PUBLIC HEALTH SYSTEM IN CAMEROON

PROJECT PROPOSAL, OPEN SOCIETY FELLOWSHIP PRESENTED TO OPEN SOCIETY FOUNDATIONS

BY AKERE ANYANGWE (MD, MPH) ON JULY 20, 2013



Executive Summary

   Cameroon is among the 20 countries in the world with the highest mortality rate of children under the age of five, with a mortality rate of 150 per 1000 live births. The Infant Mortality Rate is 77 per 1000 live births and the maternal mortality is alarmingly high at 670 per 100,000 births (unicef.org, 2013). Malaria accounts for more than 40 percent of all deaths in this age group and unfortunately, only about 13 percent of children under-five have the opportunity to utilize insecticide-treated nets. Nationally, 30.7 percent of the population lack access to safe drinking water and some 66.9 percent lack adequate sanitation, resulting in regular outbreaks of cholera (tulane.edu, 2013). Cameroon lies within the African meningitis belt with frequent endemic outbreaks, and the HIV/AIDS pandemic is an existing social health concern, with an estimated six to seventeen percent of the population infected (tulane.edu, 2013).

 

Pervasive corruption in Cameroon’s public health system has left the most vulnerable populations without access to basic health services. With little knowledge of their fundamental rights and lack of effective regulatory enforcement within the courts, many Cameroonians have been forced to pay bribes to medical providers for free health services (Transparency Int., 2013). The availability and knowledge of quality health information research evidence is inadequate in the African Region (WHO, 2013). This has resulted in health knowledge gaps and coupled with the failure to apply existing health knowledge, it is impossible to improve the people’s health (WHO, 2013). The latter is related to the issue of sharing and translation of health information, research evidence, or knowledge. Although there are significant structural obstacles, narrowing the knowledge gap will have an impact on sustaining health and development gains, strengthening the national capability to ensure the availability of relevant and reliable quality health information policy and decision making.

 

 This project proposal is to establish a geographic mapping of the public health system in Cameroon to improve transparency and establish a measurable consequence of the impact of corruption in the public health system. A geographic information system (GIS) integrates hardware, software, and data capturing, to manage, analyze, and display all forms of geographically referenced information. Initial data will include information on exact geographic location, population served, facility staffing, job descriptions, past and existing healthcare projects with outcomes, future healthcare projects, information on decision making, quality of services provided, as well as performance measures.

 

 Establishing a GIS map of the public health systems in Cameroon will open a new way of scrutinizing the service delivery system to find places that provide healthcare services and to identify patterns. It will map quantities, track, and identify how each area is served. The GIS system will let us measure the density to see the distribution of different health entities, and monitor what is happening and to take specific action by mapping what's inside and around a specific area. It will map any change in an area to anticipate future conditions, decide on a course of action, or to evaluate the results of an action or policy. By mapping where and how healthcare services are provided over a period of time, one can gain insight into the behavior of the service providers (ESRI, 2013).

 

 The availability and use of information enables improved definition of a population, recognition of problems, setting of priorities in the research agenda, identification of effective and efficient interventions, determination of potential impact (prediction), planning and resource allocation, monitoring of performance or progress, evaluation of outcomes after interventions, continuity in medical and health care, and healthy behavior in individuals and groups. It also empowers citizens by enabling their participation in health care, policy and decision processes; and countries and international partners by enabling better transparency and accountability through the use of objective and verifiable processes.

 

 Transparency is a much cherished concept, and it is extremely closely related to accountability. Active disclosure of information in real time on decision making strategies on measures of performance can improve transparency, hence public deliberation, accountability, and informed citizen choice. Geographic Information Systems (GIS) technology involves using locational data to perform geographic analyses and/or create visual outputs such as maps. For example, to view Health Department district office areas, health districts, hospitals, and hospital service areas. This Geographic Approach will allow room to apply knowledge to change the design and planning in our public health systems.

 

 Geographic Information System (GIS) Map of the Public Health System in Cameroon

 

Introduction

 

 Cameroon is among the 20 countries in the world with the highest mortality rate of children under the age of five, with a mortality rate of 150 per 1000 live births. The Infant Mortality Rate is 77 per 1000 live births and the maternal mortality is alarmingly high at 670 per 100,000 births (unicef.org, 2013). About 13 percent of children under-five have the opportunity to utilize insecticide-treated nets and malaria accounts for more than 40 percent of all deaths in this age group. Nationally, 30.7 percent of the population lack access to safe drinking water, and some 66.9 percent lack adequate sanitation, resulting in regular outbreaks of cholera. Cameroon lies within the African meningitis belt with frequent endemic outbreaks, and the HIV/AIDS pandemic is an existing social health concern, with an estimated six to seventeen percent of the population infected (tulane.edu, 2013).

 

 Malnutrition is a significant public health concern in the population. Unfortunately, majority of the victims of the failed health system are children and mothers. Six percent of the under-five population is wasted, twenty-nine percent are stunted, and twenty-two percent are underweight. Eighty-six percent of households consume iodized salt, however, during the 1985-94 period, twenty-six percent of children age 6-11 years had goiters. The prevalence of anemia in Cameroon is twenty-four percent for non-pregnant women, fifty-three percent for pregnant women, and fifty-seven percent for children. The prevalence of Vitamin A deficiency for children and pregnant women is 19.7 percent and 0.5 percent, respectively (unicef.org, 2013). The doctor to patient ratio in Cameroon is about 1: 12,500, compounding the limited access to the prevention of mother-to-child-transmission services, resulting in high mother-to-child transmission rates of the HIV infection (tulane. edu, 2013).

 

 The data described above could be misleading. About 30 percent of births are not registered in Cameroon, effectively denying an identity, access to healthcare, and education to so many children (unicef.org, 2013). A geographic information system (GIS) is a computer system for capturing, storing, analyzing, and displaying data related to positions on the surface of the earth. GIS allows multiple layers of information to be displayed on a single map, enabling people to more easily see, analyze, and understand patterns and relationships. GIS can map quantities of different data related health service entities associated with level of care, tracking and identifying how each area is served. The GIS system will let us measure the density of facilities to see the distribution of different health-related variables, monitor changes, and take specific action in relation to specific geographic locations. It will map any change in an area to anticipate future conditions, decide on a course of action, or to evaluate the results of an action or policy. By mapping where and how healthcare services are provided over a period of time, one can gain insight into the behavior of the service providers (ESRI, 2013).

 

Description of Project, Arguments

 

 The proposal in this discussion is to establish a geographic mapping of the public health systems in Cameroon to breach the gaps in health information knowledge, improve transparency, and establish a measurable consequence of corruption and unethical practices in the public health system, improving people’s health with reliable and accessible data. Initial data will include information on exact geographic location, population served, facility staffing, job descriptions, past and existing healthcare projects with outcomes, future healthcare projects, how decisions are made, quality of services provided, as well as measures of performance. The availability and use of information enables improved definition of a population, recognition of problems, setting of priorities in the research agenda, identification of effective and efficient interventions, determination of potential impact (prediction), planning and resource allocation, monitoring of performance or progress, evaluation of outcomes after interventions, continuity in medical and health care, and healthy behavior in individuals and groups.

 

 A geographic information system (GIS) utilizes hardware and software, to integrate and capture data for management, analysis, display of all forms of geographically referenced information. Considering the limited availability of existing GIS data for the index country, most of the data will be captured with boots on the ground through primary data techniques in remote settings. Secondary data capture techniques and analysis of issues associated with managing data capture will be considered, and will include location of rivers and roads, hills and valleys, as well as data collected by satellites showing land use (farms, towns, or forests) and data on population information. Questionnaire-based qualitative data (quality of care) will be achieved through focus group interviews to determine areas of concern, to provide details on knowledge, attitudes, and practice. It also helps to define terms, clarify actions of corruption, inform the development surveys, and allow for follow-up. It is important to note that social desires may influence results, and to get full cross-cultural meaning will require careful attention to translation. If applicable, existing control systems will be reviewed for inherent risks, given existing operating procedures and safeguards against unethical practices to provide deep analysis of particular facilities or units.

 

Existing Terrain and Newness of Concept

 

 Corruption is an economic crime; it is an awfully big problem that disproportionately affects the socioeconomically disadvantaged in the society. Public health officials and the government have the ethical responsibility to address this problem to protect their communities and prevent health disparities. Transparency International has defined corruption as the ‘misuse of entrusted power for private gain’ and commonly occurs when officials with the authority to promote the public good, use their position and power to benefit close counterparts and themselves (Transparency Int., 2013). Pervasive corruption in Cameroon’s public health system has left the most vulnerable populations without access to basic health services. With little knowledge of their fundamental rights and lack of effective regulatory enforcement within the courts, many Cameroonians have been forced to pay bribes to medical providers for free health services (Transparency Int., 2013). Transparency is a much cherished concept, and it is extremely closely related to accountability. Active disclosure of information in real time on decision making strategies on measures of performance can improve transparency, hence public deliberation, accountability, and inform citizen choice.

 

 Major approaches and theories to examine corruption in the health sector have suggested intervention methods, most of which fall in line with methods to increase accountability, transparency, and citizen voice (Vian, 2008). Detecting corruption and controlling discretion to reduce monopoly are complementary to these suggestions. Behavioral scientists have studied how different parameters including customs, cultures, attitudes, and individual beliefs can influence corruption. Despite the concern for others and moral obligation that potentially influence behavior, eroding professional and public service values have created a vacuum that seem to justify corruption, especially among those in the medical professions and the public service (Vian, 2008).

 

 Geographic Information Systems (GIS) technology involves using locational data to perform geographic analyses and/or to create visual outputs such as maps. For example, to view health department district office areas, health districts, hospitals, and hospital service areas. Geographic information systems (GIS) are increasingly being used in public health and medicine. Basically a tool for spatial research and policy analysis, it is part of a larger emerging new science with the ability to show the results of complex analyses through maps effective for remote sensing (Mullner et al, 2004).

 

 Current GIS technology can translate data into usable information as has been utilized to create a healthcare atlas for the Veterans Health Administration in the United States. The Atlas overviews the location of Veteran Affairs’ hospitals, profiles its patient populations, examines service utilization and identifies patterns in use of healthcare by specific disease cohorts. It also examines variations in geographic locations, in relation to costs (Cowper et al, 2004). McLafferty and Grady elaborated on GIS analysis of prenatal care need and clinic services in Brooklyn, New York. Maps of the density of mothers and corresponding maps of the density of prenatal clinics were used to show a positive association between clinic densities with early initiation of prenatal care. This analysis also identified underserved areas with large numbers of needy women and few clinics. Municipalities in the state of New York use GIS technology to identify and target low-income women with poor access to prenatal care, improving access and services (McLafferty & Grady, 2004).

 

 Establishing a GIS map of the public health systems in Cameroon will open a new way of scrutinizing the service delivery system to find places that provide healthcare services and to identify patterns. It will map quantities of healthcare variables, track service delivery, and identify underserved areas.

 

Impact

 

 The existing national policy on public health care in Cameroon was adopted in 1989 with the aim of providing services on a continuous basis and integrating the Ministry of Health activities at the local level (Essomba, Bryant, and Bodart, 1993). Among other reasons, poor policy promotion, limited health information system, poor coordination of research activities, coupled with incompatibilities of the Ministry’s organizational chart and the new health policy were identified obstacles to a successful implementation (Essomba, Bryant, and Bodart, 1993).

 

 The Cameroon Academy of Science (CAS) and the National Forum on Public Health (NFPH) under the sponsorship of the Interacademy Medical Panel (IAMP) held a seminar on August 30, 2012 with the objective to discuss the inadequacy between the education given to health professionals and the needs of the population. The seminar identified the need to analyze the situation of healthcare and health education to bring out assessment seeking improvements in the needs of the population (iamp, 2012). Global Health and Development Foundation (GHADEF), a recently founded U.S. based nonprofit organization, is poised to make a difference in the lives of the most vulnerable populations, as well as educate the next generation on the impact of corruption on the public health system in Cameroon (ghadef.org, 2013). The Cameroon Public Health Association (ACASAP) is poised to advance the awareness and practice of public health, promote the development and revision of public health policies and strategies, to strengthen the national health systems.

 

 With the understanding that public health is an evidence based discipline, establishing a GIS mapping of the public health systems in Cameroon will provide the service delivery system with reliable and accessible data to establish credible stakeholder organizations that can support the implementation of government healthcare access policies that may reinforce or establish regulatory authorities. These authorities will be responsible for basic reviews of consumer complaints, to issues such as corruption or violation of fundamental rights. This will raise awareness among consumers about their rights to basic healthcare services, and establish the need for regulatory training of public healthcare service providers. This will translate into an open system that monitors and evaluate changes in provider practices, consumer behavior, and the incidence of corruption and fundamental rights violations in the public health care system.

 

 This Geographic Approach will allow room to apply knowledge to change our public health systems through design and planning. GIS will benefit almost every organization for GIS-based maps and visualizations may transform the understanding of situations, improving communication between different teams, organizations, and the public. It is a powerful tool for data management, and is excellent in not only making decisions, but making correct decisions about location, which is critical to the success of any organization. It could be highly cost effective and efficient and offers a new approach to management; managing geographically (ESRI, 2013).

 

 Communications and Outreach Strategy

 

 The public health system in Cameroon is a dysfunctional system that has left the most vulnerable populations without access to basic health services. The availability and knowledge of quality health information research evidence is inadequate in the African Region. This has resulted in health knowledge gaps, and coupled with the failure to apply existing health knowledge, it is impossible to improve the people’s health (WHO, 2013). The initial goal is to establish a visual relationship of the distribution of public health-related facilities in Cameroon, the consequences of the lack of access to such facilities, and the population distribution of the most vulnerable in the society, due to the lack of a transparent public health system.

 

 The target audiences include the stakeholders, the vulnerable populations, and the next generation of public health leaders (evolving public health professionals). The stakeholders are the Ministry of public health, Cameroon Academic Society, National forum on public health, Cameroon medical association, Global Health and Development Foundation, and Cameroon Public Health Association. Messages and communication materials will be pre-tested with representative groups of the target audiences and based on the results, they will be implemented, assessed, and modified. Partnership development will lay emphasis to harness the credible outreach strategies and resources of for-profit, non-profit and governmental organizations.

 

Qualification for the Project

 

 There are several reasons that make me suitable to carry out this project. With over nine years of experience as a primary care physician in a resource limited setting, I did recognize the needs of the vulnerable groups of the population, and I am determined to make a difference in their lives. My personal experience together with the rich network I have with professionals in the field and access to continued academic resources puts me in the right position to share my expertise and educate the next generation, on the impact of lack of transparency on the public health system in Cameroon. Following my acquisition of a Masters’ degree in public health from Walden University, I have gained documented project management experiences in initiating, planning, and executing programs. Currently, I work as a lead project manager and quality assurance on the on the Skilled Nursing Facility project with the Life Care Management Partners Medical Review Center.

 

 I do have working public health knowledge of the factors which influence local, national and global legislative and social policies with broad-based, quantitative and qualitative skills needed for problem solving, including an in-depth understanding of the managed healthcare system. I also possess an in-depth knowledge and understanding of the evolving concepts of the electronic healthcare and medical records with the benefits as is related to the Centers for Medicaid and Medicare, managed healthcare organizations, and other private organizations that deliver care. As a health resource specialist in the development of multidisciplinary and collaborative strategies for solving health-related problems, I played the lead role as a post graduate intern in the initiation, planning, and implementation of integrating behavioral healthcare into the primary healthcare system in Howard County, Maryland, United States.

 

 I am highly skilled in clinical data management and electronic data capturing, discrepancy management, validation rules, research (development/evaluation) tools, and database reconciliation processes. I am intelligent, organized, detail oriented and independent, able to multitask, and prioritize activities, with outstanding interpersonal communication, leadership and mentorship capabilities, and the ability to work independently or in a team, and able to lead and motivate others as well. I am currently on track to be a Unix System Administrator, and as a member of the Project Management Institute (PMI), I am on target to be a Project Management Professional (PMP) with PMP certification eligibility by December, 2013.

 

 I am the founding member of the Global Health and Development Foundation (GHADEF), a nonprofit organization dedicated to making a difference in the lives of the most vulnerable population on the impact of corruption on the public health system in Cameroon. This project establishes a foundation for future work of this project and similar organizations. GHADEF will bring nouvelle social change models to integrate index communities, and expand on the successes of local organizations with a wider range of talent and evolving behavioral change models. GHADEF will utilize an integrated approach to diversity across all its activities to bring new skills, and fresh perspectives to promote global health (ghadef.org, 2013). The project timeline will last about 12 months, with due considerations of impending logistics difficulties.

 

 

 Engagement with OSF

 

 The objectives of the Open Society Foundations (OSF) are ‘to build vibrant and tolerant societies whose governments are accountable and open to the participation of all people’ (OSF, 2012). Data limitations in the public health systems of Cameroon make it difficult to assess the extent to which the government can be held accountable to its people. The Open Society Initiative for West Africa is active in nine countries in the region (Benin, Cote d’Ivoire, Ghana, Guinea, Liberia, Niger, Nigeria, Senegal, and Sierra Leone). An extension to Cameroon, a seemingly docile but very much closed society with a public health system engraved with corruption and lack of regulatory oversight will promote its initiative to pursue the development of open societies by supporting and building partnerships with local and regional groups that promote inclusive democratic governance, transparency and accountability, and active citizenship.

 

 Public health is a fundamental human rights issue as represented in the primary objectives of public health law which calls for excellent physical and mental health standards that reflects social justice (Gostin, 2008). Social justice represents the search for the common good and requires that societal burdens and benefits should be equally distributed, irrespective of social or economic status (Beauchamp, 1976). This represents the focus on law, justice and human rights, and economic and political governance, which are core values of the OSF. The application of innovative human rights concepts and methods in research, policy, and capacity building, will promulgate the development of tools for analysis, monitoring and evaluation, at the forefront of developing practical and effective responses to global public health challenges. These challenges include but are not limited to issues such as corruption, otherwise referred to as the lack of transparency in our public health systems.

 

 Corruption in the public health systems is an economic crime and a grievous issue with the high probability of negatively affecting the socioeconomically disadvantaged in the society. Public health has an ethical responsibility to address this issue in order to protect our communities, and prevent the inevitable widening gap in health disparities (Gostin, 2008). Based on evidence, public health can achieve social justice in this situation through knowledge empowerment with proper community health education, dissipating the understanding that strong and independent goodwill groups play a vital role in ensuring that health programs, healthcare institutions, and their governments are held accountable to the communities they serve, or are designed to serve (OSF, 2012).

 

References

Beauchamp, D. (1976) Public Health as Social Justice. Inquiry: 13, 1976. pp. 1-14.

Community Tool Box (2013): Rabinowitz, P; Berkowitz, B ().Geographic Information Systems: Tools for Community Mapping; Retrieved from: http://ctb.ku.edu

Cowper, D., Yu, W., Kuebeler, M., Kubal, J., Manheim, L., Ripley, B., (2004) Using GIS in Government: An Overview of the VHA's Healthcare Atlas, FY-2000 Journal of Medical Systems; June 2004, Volume 28, Issue 3, pp. 257-269

ESRI, (2013); Understanding our world; what is GIS? Retrieved from: http://www.esri.com/what-is-gis/overview

Essomba, R., Bryant, M., Bodart, C. (1993); the reorientation of primary health care in Cameroon: rationale, obstacles, and constraints. Health Policy and Planning; 8(3):232-239.

Ghadef.org, (2013); Global Health and Development Foundation; retrieved from: http://ghadef.org/about-us

Gostin, L. (2008). Public Health Law Course Text: Gostin, L. O. (2008). Public health law: Power, duty, restraint (2nd Ed.). Berkeley, CA: University of California Press.

IAMP, (2012); National Forum on Public Health: Analytical appraisal of the report on “Health Professionals for a new century: Transforming Education to Strengthen Health Systems in an Interdependent World”. Retrieved from http://www.iamp-online.org/sites/iamp-online.org/files/Cameroon.pdf

McLafferty, S., Grady, S., (2004); Prenatal Care Need and Access: A GIS Analysis. Journal of Medical Systems; June 2004, Volume 28, Issue 3, pp. 321-333

Mullner, R., Chung, K., Croke, K., Mensah, E., (2004) Introduction: Geographic Information Systems in Public Health and Medicine Journal of Medical Systems; June 2004, Volume 28, Issue 3, pp. 215-221

Open Society Foundations (OSF) (2012). Accountability in Health; Retrieved from: http://www.opensocietyfoundations.org/topics/accountability-health

Transparency International (2013) Corruption in Health: The problem, the Solution; retrieved from: http://www.transparency.org/topic/detail/health

Tulane.edu (2013) Country summary, Cameroon; retrieved from: http://www.tulane.edu/~internut/Countries/Cameroon/cameroonxx.html

Unicef.org (2013); Cameroon http://www.unicef.org/search/search.php?q=Cameroon

Vian, T., (2008); Review of corruption in the health sector: theory, methods and interventions; Health Policy and Planning 2008; 23:83–94. doi:10.1093/heapol/czm048; Retrieved from: http://heapol.oxfordjournals.org/content/23/2/83.full.pdf

World Health Organization, (2013); Health Evidence Network; Retrieved from: http://www.euro.who.int/en/

 

 

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