PhD Defense Winnie Nyemera

digital technology in health - assessing the use of geographic information systems technology in health sector organizations in uganda 

Winnie Nyemera is a PhD student in the research group Communication Science. Her supervisor is prof.dr. M.D.T. de Jong from the facutly of Behavioural, Management and Social sciences (BMS). 

This dissertation aims to contribute to the adoption and use of geographical information systems (GIS) in the health care sector of Uganda, so that the services of organizations in this sector can be improved. The research in this dissertation evaluates the use of geospatial data, maps factors encouraging and hindering the sharing of geospatial data, explores factors contributing to non-use of GIS, and investigates the impacts associated with using GIS technologies in health sector organizations. In the research, organizations participated that either use or do not use GIS. GIS technologies aim to guide planning and support decision-making by providing and allocating limited resources to the rightful beneficiaries to optimize health care. In addition, GIS technologies aim to help in developing avenues of a digital system of health records and data storage, and providing strength in collaboration and sharing of geospatial data and services to avoid duplication of services and identify gaps in the service delivery in the health arena.

Many health sector organizations have not been able to successfully adopt, implement and use GIS technologies. Success can be defined as a situation in which the adoption, implementation, and use of GIS technologies have led to a fully established and actively working GIS environment (department, skilled staff, GIS equipment such as big printers for printing maps of A0, A1 size of papers, GIS software, servers, wide screen computers with big capacity to accommodate geospatial layers, space, digital geospatial data). This means that these organizations have to depend on other organizations with an established actively GIS working environment such the Uganda Bureau Statistics, Mapping, Lands and Survey department, Entebbe, and the National Forestry Authority, or outsource to skilled expert individuals or organizations.

To acknowledge the complexities involved in processes of adoption, implementing and using GIS technologies, the following nine types of organizations were included in the research: not-for-profit government organizations, non-government organizations, UN international agencies, government/public organizations, education research institutes, project based organizations, private organizations, semi-autonomous organizations, and funding mechanism. The organizations were located in Kampala and Wakiso, and a few had up-country offices such as in Gulu and Rakai.

Chapter 1 of this dissertation provides the background of the study, the study objectives and the research questions. The research questions were developed with the purpose to find out the nature of the use of GIS technologies for health activities, the extent to which there is a practice of sharing of geospatial data between the health sector organizations, and also understand the effects associated with GIS technologies. After that, the methodology is discussed. A description is provided of the way respondents for the studies were selected.  A combination of qualitative research methods was used as it is known to be good for gathering first-hand information in understanding the views and opinions of people involved (Gillham, 2000). Most of the data were collected using in-depth semi-structured interviews (face-to-face or by phone). Other forms of data gathering used in this dissertation include the analysis of archival records, documentations and artefacts.

Chapter 2 provides a literature review aimed at identifying the uses of GIS technologies in the public health sector in Africa. The chapter starts off with a brief description of what GIS is and what its benefits are, followed by application areas in which GIS technologies have been used and barriers hindering GIS technology adoption in the public health sector. Several solutions are suggested to address the barriers. The study classifies activities for which GIS technologies can be used: disease surveillance (disease mapping and disease modelling), health care research and management (health facility access, utilization and planning), strategic health planning of services, community health profiling, built environment and neighborhoods, health education, crisis management and risk analysis. In Africa, GIS technology is limitedly being used for simple analyses for health activities, such as map production showing disease distributions, navigation and data collection. This in contrast to developed countries, where GIS technology is used for advanced and complex analyses such as, for instance, disease forecasts, risk analysis (risk assessments of water-source, soil, air, contaminants and hazards environmental exposure), and the selection of suitable areas for health facility development.

Chapter 3 examines the uses of GIS technology in health sector organizations in Kampala, Wakiso-Entebbe, Gulu and Rakai, in Uganda. Of the 75 participating organizations handling health-related activities in Uganda, 43 organizations were and 32 were not using GIS technology. The study’s aim was assessing the nature of GIS technology use in the studied organizations, identifying the users of GIS technology and types of GIS training received by GIS users, as well as the purposes of GIS technology use in the organizations, the rationale behind the organizations’ GIS technology use, and the activities for which GIS technology has been used. The results show that even though many organizations use GIS technology, GIS technology use is project based in Ugandan health organizations. Once a project has ended, most organizations stop using GIS technology until another GIS-based project is implemented. Furthermore, even though GIS benefits can be articulated in the health sector, most organizations are lacking the skills and knowledge to be able to adequately apply GIS technology during activities. This study also indicates that GIS technology has only been scarcely used for some activities indicated in the GIS literature (e.g., disease surveillance and modeling, crisis management, and risk analysis), and widely in health care research and management, community health profiling, disease mapping, and strategic health planning. However, it has neither been used in built environments and neighborhoods, nor in spiritual health. The results also show that GIS technology can be used in communication and advocacy of services, the coordination and monitoring of immunization programs, fleet management, vehicle and health-commodities tracking, food security, and health/nutrition livelihood. Furthermore, the results indicate that organizations tend to use basic GIS techniques, and when advanced methods are used, these are outsourced to external contractors with expertise. This illustrates a significant GIS under capacity within the studied health sector organizations. Conclusively, this study shows the importance of creating awareness and sensitizing Ugandan health sector organizations to the use of GIS technology and to its benefits when applied in health-related activities. Although sharing health information acquired through a GIS is beneficial, it is not a given that sharing is the norm.

Chapter 4 presents a study that explores Ugandan health sector organizations’ reasons for sharing and for not sharing geospatial data. The analyses identified key factors (i.e., technical, institutional, social, political, policy, economic, legal, and cultural factors) that encourage or hinder health organizations’ choice to share geospatial data with other health organizations. Based on these factors, we provide recommendations for increasing geospatial-data sharing across the Ugandan health sector. Three overall recommendations are proposed: establish and harmonizes information policy through government, create a health professional GIS user body for collaboration and coordination of activities, and incorporate GIS as courses in the curriculum of universities dealing with health issues.