In the third phase of the U.S. President’s Emergency Plan For AIDS Relief, strategic planning is more urgently needed than ever. The following is a guest post by Anita Datar of the Health Policy Project on the role of geographical information systems in that planning.
A subtle yet significant shift is taking place as we transition from PEPFAR II to PEPFAR III. While shared responsibility and sustainability are still key, the focus is now on accelerating, not just scaling-up, core interventions, so that we can deliver the right services, in the right place, at the right time. As we refine our approach, US government guidance now includes an emphasis on taking a geographic approach to the HIV response, with many arguing that if we aren’t emphasizing geographic prioritization, we aren’t doing enough.
What does geographic prioritization really mean and how does it help countries? Do countries have the capacity to take this on? What do countries need to have in place in order to ensure they are doing enough, both in the present and sustainably over time?
UNAIDS shed light on this topic with their 2013 publication, Location, location: Connecting people faster to HIV services. Leveraging the simple, yet quintessential factor that drives real estate, UNAIDS explained how countries worldwide have the potential to achieve tremendous gains in their HIV response by focusing on geographic areas with the greatest concentration of HIV. Using basic mapping technology and available data from sources such as geo-coded Master Facility Lists, Demographic Health Surveys, antenatal clinic, or integrated biological and behavioral surveillance, and other routinely collected facility-level data, countries can actually zoom in and magnify their views of the epidemic, identifying epidemic hotspots at their points of origination.
How is this helpful? Consider a web-based Google map. At the highest level, the views are of continents and oceans. As you magnify the image and scroll, your ability to hone in on a particular geographic area of interest increases—allowing for acuity and clarity. Once you drill down to a certain level, the high-level map turns into a series of coordinated roadways, enabling travel from point A to B and offering clarity and direction to guide a journey. The use of maps in the HIV response offer policy makers and decision makers a similar level of control. As decision makers drill down to the most granular, sub-national level, their ability to distinguish between national HIV prevalence and the nuance of multiple, localized epidemics within counties and districts becomes more precise. Instead of developing strategic plans and allocating resources for an entire country, decision makers can actually determine the priority geographic areas most in need of prevention, care, and treatment funds, allowing for targeted, strategic investments. This means countries can do a great deal more with existing resources to prevent transmission and save lives.
It sounds incredible and powerful — and precisely what is needed to achieve an AIDS-free generation. But do countries really have the capacity to take this on?
It is an important question and one that requires equal reflection and investment. Because once epidemic hotspots are identified, countries will need to have robust geographic information systems in place that align with their national spatial data infrastructures, allowing for routine monitoring and evaluation. Developing a GIS will require governance and multi-sectoral engagement; ongoing strategic planning and financing; a strong policy and regulatory environment; interoperability of existing information systems; and the infrastructure and skilled human resources to carry out analysis and ensure data use. We know these are the key elements because these are the lessons we learned from the first phase of the President’s Emergency Plan For AIDS Relief, when countries urgently needed to establish robust electronic medical records to support care and treatment scale-up. Without a strategic plan or a road map, many countries suffered from multiple, fragmented systems that could not share information.
As the PEPFAR program transitions into its third phase, we have the benefit of knowing where we’ve been and what road we need to take to ensure our core interventions are based on the best available data. While the HIV/AIDS emergency response is over, the urgency now lies in a desire to identify and address program failure in a targeted and strategic way. As we continue to emphasize a geographic approach in our epidemiological and economic analyses, we also need to simultaneously work with countries to develop “Roadmaps for GIS” and strengthen their capacity to conduct analyses and use data for strategic planning and resource allocation. Addressing both sides of the equation—filling the analytic gap while strengthening systems and building capacity—is what is needed to ensure that countries can respond now and over time.
For more information
The USAID and PEPFAR-funded Health Policy Project (HPP) provides short and long-term technical assistance to countries. In the short term, HPP is filling an analytic gap by supporting epidemiological reviews in countries with mapping and spatial analysis. In the long term, HPP is also working with country counterparts to develop strategic roadmaps for GIS and to build the capacity of data analysts and users to strengthen the “data demand and use” cycle. For more information on HPP’s work on geohealth mapping, see Know Your Epidemic, Know Your Response, or email: email@example.com