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Using Geographic Analysis to Improve HIV Programs in Tanzania

MEASURE Evaluation worked with local authorities in the Iringa and Njombe regions of Tanzania to illustrate the potential of maps and geographic information systems (GIS) for supporting effective programming of resources and enhancing data-driven decision making in the health sector. The work started with activities designed to gather data on HIV transmission dynamics and service coverage and continued with activities aimed to increase the capacity of district council health management teams to use data to improve resource allocation for HIV programs.

Using Participatory Mapping to Assess Service Catchment and Coverage: Guidance from the Iringa Participatory Mapping Exercise describes a method piloted for estimating catchment areas and coverage. Participatory mapping and site visits were used to identify and map locations and catchment areas of service delivery points providing HIV prevention, care, and treatment. Using open-source GIS software, these sites and catchment areas were mapped, and were combined with population estimates and data from semi-annual and annual U.S. President’s Plan for Emergency AIDS Relief (PEPFAR) reports to map coverage provided by services at each site.

MEASURE Evaluation found that decision makers needed increased monitoring and evaluation capacity to most efficiently analyze service data and use maps for policy and programmatic decision making. MEASURE Evaluation undertook a series of activities with council health management teams to build capacity for using maps for decision making. Using Geospatial Analysis to Improve Resource Allocation for HIV Programs in Iringa Region, Tanzania describes the capacity building process and reviews data gathering activities.

Find more information on GIS tools developed by MEASURE Evaluation.

Attend a Webinar on GIS and Sampling

GIS and Sampling Banner

Join MEASURE Evaluation for a webinar introducing the GIS and Sampling manual on May 21, 2015, at 10am EDT. Authors Peter Lance, John Spencer, and Aiko Hattori will lead the one-hour webinar.

Webinar Details

Many surveys are concerned with particular subpopulations. To cite a few examples:

  • A profile of human welfare in slums requires focus on slum populations;
  • Understanding a health challenge driven by environment requires focus on populations under environmental risk; and
  • Identifying the characteristics of recent migrants to urban areas necessarily involves samples of them.

A common challenge in such cases is efficient sampling. Traditional selection from conventional sampling frames often requires large samples with many selected units not in the subpopulation of interest, resulting in costly rounds of field identification of selected units from those subpopulations. Geographic information systems (GIS) offer a powerful tool for identifying subpopulations in advance, lowering tremendously the time and financial cost of surveys. The richest opportunities involve subpopulations that have a potentially predictable spatial distribution.

As the range of information linkable through GIS continues to grow exponentially, the power of GIS to identify and predict spatial patterns to subpopulations is also rapidly growing; what was not possible through GIS even a few years ago may well be so now. In this webinar, we will explore these amazing possibilities and introduce a new MEASURE Evaluation manual describing the application of GIS to sampling.

Register to attend the webinarAccess the GIS and Sampling manual.

Reading: Communication Practices and the Management of Healthcare Services

Healthcare Management Strategy, Communication, and Development Challenges and Solutions in Developing Countries
Ngwainmbi, Emmanuel, editor. Lanham, MD: Lexington Books, 2014.

This collection of essays analyzes the relationship between communication practices and the management of healthcare services, public health administration, and healthcare policies in developing
countries. The authors argue that intercultural, intergroup, and mass communication practices are weakening the efforts of public health programs and that country leaders must play a key role in information-sharing regarding infectious diseases and good health practices.

Contraceptive Services and Family Planning in Malawi

The Effect of Access to Contraceptive Services on Injectable Use and Demand for Family Planning in Malawi 

Previous studies have identified positive relationships between geographic proximity to family planning services and contraceptive use, but have not accounted for the effect of contraceptive supply reliability or the diminishing influence of facility access with increasing distance.

For this study, kernel density estimation was used to geographically link Malawi women’s use of injectable contraceptives and demand for birth spacing or limiting, as drawn from the 2010 Demographic and Health Survey, with contraceptive logistics data from family planning service delivery points. Linear probability models were run to identify associations between access to injectable services—measured by distance alone and by distance combined with supply reliability—and injectable use and family planning demand among rural and urban populations.

Access to services was an important predictor of injectable use. The probability of injectable use among rural women with the most access by both measures was 7‒8 percentage points higher than among rural dwellers with the least access. The probability of wanting to space or limit births among urban women who had access to the most reliable supplies was 18 percentage points higher than among their counterparts with the least access.

Product availability in the local service environment plays a critical role in women’s demand for and use of contraceptive methods. Use of kernel density estimation in creating facility service environments provides a refined approach to linking women with services and accounts for both distance to facilities and supply reliability. Urban and rural differences should be considered when seeking to improve contraceptive access.

Tanzania National Most Vulnerable Children Monitoring and Evaluation Plan

National Most Vulnerable Children Monitoring and Evaluation PlanThe purpose of this national most vulnerable children (MVC) monitoring and evaluation (M&E) plan is to provide guidance for tracking the implementation of the Tanzania National Costed Plan of Action for Most Vulnerable Children NCPA II (2013–2017). The NCPA II calls for a government-led and community-driven MVC response to facilitate MVC access to adequate care, support, protection, and basic social services. Because multiple sectors committed to implementing NCPA II, standardized M&E activities are needed for effective and efficient coordination of MVC program interventions. The M&E plan guides stakeholders on how to monitor and evaluate the implementation of the NCPA II and determine whether its goal and objectives are being met.

The Ministry of Health and Social Welfare, through the Department of Social Welfare (DSW) and other stakeholders, implemented the first National Costed Plan of Action (2007–2010) for MVC to respond to the problem of vulnerable children in Tanzania. This plan of action was reviewed in 2011, and the recommendations that resulted were used to guide the development of the Second National Costed Plan of Action for MVC (NCPA II). The NCPA II was launched in February 2013 and is a five-year program (2013–2017).

Access the plan.

Sharing Expertise on World Health Day: Impact Evaluations of Public Health Interventions

In an era of shrinking resources and increasingly complex development environments, governments and donor agencies need to determine the effect of investments in health and health systems on health outcomes. Impact evaluations are one way to obtain information essential for health program planning and to guide resource allocation.

Findings from large-scale impact evaluations can be instrumental for decision making, yet they are not without challenges and costs. On World Health Day, the MEASURE Evaluation project presents a working paper detailing experiences and lessons learned from impact evaluations conducted in nine countries. The working paper draws on practical experiences to illustrate real world challenges in large-scale impact evaluations of public health programs, showcasing some of the solutions employed to design and conduct such studies, especially those with a focus on HIV/AIDS programs.

Impact Evaluations of Large-Scale Public Health Interventions: Experiences from the Field shares field experiences from ten evaluation studies undertaken by MEASURE Evaluation from 2003 to 2014. The series of case studies highlights design and implementation challenges that required creative solutions, and provides an analysis of common and reoccurring themes across the studies that yield valuable lessons for groups implementing impact evaluations. Examples of these cross-cutting themes include:

  • Challenges with identification and selection of program beneficiaries
  • Random assignment in complex environments
  • Identification of a robust comparison or control group for estimating the counterfactual
  • Heterogeneity of program impacts
  • Timing of baseline data collection
  • Absence of baseline data and a counterfactual

Field experiences from the MEASURE Evaluation project demonstrate the need for transparency and collaboration among key partners involved in impact evaluations, the need to balance technical requirements with programmatic priorities, and the importance of flexibility and the ability to adapt designs in order to answer the most salient evaluation questions. Evaluators, implementers, and funders that seek to conduct robust evaluations of health interventions will benefit from lessons learned by MEASURE Evaluation. Such knowledge is relevant for all interested in applying evidence-based research techniques, whose use contributes to greater accountability in health systems.

Reading: Problems, Promises, and Paradoxes of Aid

Picture of Problems, Promises, and Paradoxes of AidProblems, Promises, and Paradoxes of Aid: Africa’s experience
Ndulo, Muna and Nicolas van de Walle, editors. Newcastle upon Tyne, UK: Cambridge Scholars Publishing, 2014.

Does aid support economic development? Using specific case studies, this anthology examines the problems, results, and paradoxes of economic aid in Africa. Criticisms of aid as depending on donors rather than needs of the recipients are discussed, as the authors explore questions about which form development aid should take to increase its effectiveness.

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