Case Study: Using GIS Information to Target Health Services in Slum Areas in Bangladesh
Point of Entry
The MEASURE Evaluation conceptual framework for the information system is represented as a cycle that connects data demand, data collection and analysis, information availability, and information use. Data demand and use activities are designed to enter the cycle at any of these points, depending on the particular situation. The first step in influencing data demand and use is to determine where to enter the cycle. In Bangladesh, the entry point was data demand.
The pronounced trend toward urbanization in lower-income countries is likely to continue for decades to come. This growth is largely driven by rural to urban migration, with many of the migrants settling in densely populated areas of concentrated poverty and environmental vulnerability (i.e., slums) within cities. Bangladesh is typical in this respect. Its urban population is projected to more than double in the next quarter century. Slum formation and growth has been, and is anticipated to be, central to this process.
Bangladeshi cities, and particularly the slums within, will become increasingly important arenas for health policy. There will soon need to be a fundamental policy shift away from programs traditionally focused on the rural poor to address expanding and worsening poverty within impoverished and crowded cities. Unfortunately, very little is known about the implications of slum life for health or broader human welfare. The lack of such information had made it very difficult for stakeholders interested in targeting health- and human welfare-related programs to slum populations to do so efficiently. To help rectify this, the U.S. Agency for International Development (USAID) and the government of Bangladesh requested technical guidance for a survey of health in urban areas in which slums were to receive particular attention.
Data Collection and Analysis
To resolve the information deficit, an effort was made to map the location of, obtain a population estimate for, and collect basic socio-economic characteristics of each slum in the six city corporations of Bangladesh. The outputs of the activity needed to serve the purposes of a range of stakeholders and, therefore, multiple stakeholders were involved in the process.
The Centre for Urban Studies (CUS), an independent research nongovernmental organization (NGO) implemented the census of slums. Technical assistance was provided by the International Centre for Diarrhoeal Disease, Bangladesh (ICCDR, B), the National Institute of Population Research and Training (NIPORT), USAID, and the MEASURE Evaluation project.
The 2005 census and mapping of slums (CMS) had three phases. The first phase involved the development of baseline maps of the city corporations (which serve as administrative seats for the six main divisions of the country) that would identify suspected slum settlements and provide an accurate overall organizing framework for later field investigation. This was done using official maps and satellite photographs, which were geo-referenced and used to visually identify the suspected slums. During the second phase, teams assessed conditions on the ground in each ward of the city corporations. In the final phase, the information from the checklists gathered in the course of field operations was entered into a geographic database containing a list of slums and their attributes in each of the six city corporations. The integrated maps and database were then made publicly available.
This activity produced a number of valuable outputs, including:
- Highly accurate, detailed ward-level maps of slum settlements in the six city corporations
- Database describing the exact location of the settlements visited by field teams, as well as their social and economic characteristics (information in the database is integrated with that contained in the maps, allowing, for instance, maps based on alternative slum designations to be generated quickly and easily)
- Detailed report published in 2006 summarizing the findings of the survey
- Web site through which these materials were made public
The results of the project were presented at a meeting held in Dhaka in May 2006. Over 125 stakeholders were present at the dissemination, including over 30 news media representatives. The event received wide coverage in major Bangladeshi daily newspapers and television news programs. Afterward, city- and ward-level slum maps and a slum database were made available.
Results have been presented by CUS staff at different meetings on urban issues in Bangladesh.
Health services are being targeted to those in need. The tools and information developed under this activity have proven extremely popular, and are being used to help provide health services to those in need. A few major examples include the following:
- The Bangladesh Rural Advancement Committee (BRAC) is using the maps to place birthing huts in slums and will use the information to target expansion of their health program for the urban poor.
- The Bangladesh AIDS Program is using the information to plan the future location of counseling and treatment centers for most-at-risk populations (e.g. sex workers, drug users, truck drivers, rickshaw pullers, etc.), who disproportionately reside in slums.
- The USAID-funded NGO Service Delivery Program is using the maps to identify locations for its main and satellite clinics for its next five-year phase.
- Family Health International (FHI)/Bangladesh intends to use the maps to track its own intervention sites and areas of program coverage for various programs.
Other human welfare services are being targeted to those in need. In addition to improving the targeting of health services to those in need, organizations involved in other development initiatives are using the information to improve the delivery of their services. Two examples include the following:
- The United Nations Development Programme (UNDP)-funded Local Partnership for Urban Poverty Alleviation has requested the maps for use in targeting its efforts during its next seven-year phase.
- The World Bank, which is currently working with the water and sewer authorities of the city corporations to extend water and sanitation to the urban poor, has requested the maps of Dhaka and Chittagong to help identify slums not serviced by the present grid. The maps are being used to redirect the allocation of water and sanitation lines.
The CMS generated detailed and accessible slum maps integrated with a database of slum characteristics, allowing one to identify and locate slums exhibiting certain combinations of circumstances. The database is proving to be immediately useful for those engaged in the practice of public health and other human welfare services.
The data demand and use case studies give examples of how interventions have successfully facilitated data demand and changed how information is used from a variety of settings. Examples are from Bangladesh, Ghana, Kenya, Rwanda, Tanzania, and nine Caribbean countries.