Using GIS to map condom coverage, quality of coverage and access in hot-zones in Nepal Dr. Prakash Dev Pant Ms. Manisha Shrestha Mr. Peter Oyloe 36th Global Health Conference Washington, May 26-30, 2009 Nepal Social Marketing and Franchising Project N-MARC Introduction • This presentation will focus on following: – – – – – – – Background Objectives Key definitions Methods and materials Study findings Summary of Findings Future Directions Nepal Social Marketing and Franchising Project N-MARC Background • Nepal progressed from “low HIV prevalence” to concentrated HIV epidemic in certain subgroups. • Integrated bio-behavioral surveys (IBBS) 2005 showed that HIV prevalence is – – – – 2% among female sex workers (FSWs) 15.6% injecting drug users 3.6% among men who have sex with men 12.4% in other categories that include spouses of most at risk population Source: Nepal Social Marketing and Franchising Project N-MARC Background • WHY GIS ? – As it gets darker Thamel gets brighter and livelier. More than bars and restaurants, in this fabricated atmosphere, there is something extra going on – the dance restaurants where heavily made-up young girls, high on Bollywood tunes, take off their cloths one after another almost to the nudity. – Soon the trade crosses the boundary of food and drinks to flesh. Thamel is one example. This scenario is visible in many other parts of the Kathmandu valley as well as in other main cities of the country. – The sex is traded almost equally actively in this country, always in combination with food and drink, also in the broad daylight in cabin restaurants where girl as young as 14 are engaged in the business. Nepal Social Marketing and Franchising Project N-MARC Background • And if one looks closely, this underground business is rampant in bars and eateries along the major highway roots and transport stations. • The worrying part is not about the oldest profession in the world but the risky behaviour that people engage into it. • The unprotected sex in Nepal is persistently contributing to the increase in HIV infection among masses. • Targeted interventions in fighting against HIV transmission was difficult as there was no account of hot-spots where sex negotiation or sexual activities occurred. Nepal Social Marketing and Franchising Project N-MARC Background • Geographic Information Systems (GIS) mapping of these geographic locations was piloted in Nepal in 2003 • Since 2006, two rounds of studies have objectively examined product performance measures such as product coverage, quality of product coverage and access to product/services • Study findings are intended for evidence based marketing decisions Nepal Social Marketing and Franchising Project N-MARC Objectives • To increase the availability and usage of condoms among most-at-risk groups (FSWs and clients of FSWs), this study seeks to: • Assist evidence-based programmatic decisions • Monitor product and service performance • Measure condom coverage, quality of condom coverage and access to condom Nepal Social Marketing and Franchising Project N-MARC Key Definitions Coverage • Presence of at least one condom selling outlet per five hot spots in a hot zone – Hot spot: Place where sex negotiation or sexual activity takes place • Dance Restaurants, Hotel, Lodge, Bhatti, Dohori, Massage parlors, Streets – Hot zone: Cluster of hot spots defined as • Buffer area covering a minimum distance of 100m Nepal Social Marketing and Franchising Project N-MARC Key Definitions Quality of Coverage • Hot zones with a condom delivery system that conforms to minimum quality measured by: – Condom stocked in the visible location at outlet – Promotional material available at point of purchase – No incidence of condom stock outs in last month – Sell condoms at night after 8.00 PM Nepal Social Marketing and Franchising Project N-MARC Key Definitions Access • Proportion of hot-spots that have a condom delivery point within its catchments area: a radius of 100m Nepal Social Marketing and Franchising Project N-MARC Methods and Materials 1 Enumerate all hot spots within study area (to establish sampling frame) using GPS 2 Prepare hot-zones from hot-spot points 3 Use LQAS method to sample hot-zone 4 Enumerate and audit condom-selling outlets in sampled hot-zones GPS and audit-tool 5 Calculate condom coverage, quality of coverage & access 6 Produce GIS maps showing condom coverage & access Nepal Social Marketing and Franchising Project N-MARC Study Findings Condom Coverage Quality of Condom Coverage Access to Condoms Nepal Social Marketing and Franchising Project N-MARC Study Regions with Commercial Sex Activities • 26 of 75 districts were identified with commercial sex activities. • 26 districts are divided into six segments for GIS study • Two rounds of data collection completed in 4 of 6 segments Nepal Social Marketing and Franchising Project N-MARC Programmatic Interventions • Round 1 provided baseline measures of the key indicators • Key programmatic interventions included – Dissemination of hot zone maps to condom-selling partners – Targeted distribution activities by partners in the hot zones – Focused marketing and branding activities in hot zones • Round 2 serves as an intermediate point to assess progress and refine interventions Nepal Social Marketing and Franchising Project N-MARC Condom coverage • Condom coverage increased in all four study area. Average coverage between round 1 and 2 has increased from 69% to 88 % 100% 95% 95%95% 95% 95% 88% 80% 80% 80% 70% 69% 60% 40% 20% 0% Kathmandu Dhading Rupandehi Kaski Overall Study Area Note: The percentages are based on LQAS table and the overall coverage is also calculated as suggested by LQAS Nepal Social Marketing and Franchising Project N-MARC Mapping Condom Coverage • Zone 106: Total hotspots = 63; Total condom-selling outlets = 16 • Criteria of coverage: 1:5. Status at survey: Covered Nepal Social Marketing and Franchising Project N-MARC Average quality of coverage for major project supported condom brands in Round 1 & II 100.00% 90.00% The quality of coverage, except night time condom availability, has improved 80.00% 70.00% 65% 60.00% 50.00% 47% 47% 38% 40.00% 27% 30.00% 20% 20% 22% 20.00% 10.00% Stopck at visible location Promotional material at visible location Out of stocl last month Shops opens at night Nepal Social Marketing and Franchising Project N-MARC Access of Hotspots to Condoms Across Study Segments in Round 1 & II Access increased overall, but decreased in Kathmandu and Rupandehi 80% 72% 70% 69% 68% 62% 61% 58% 60% 66% 62% 61% 59% 50% 40% 30% 20% 10% Kathmandu Dhading_Chitwan RupendehiKanchanpur Kaski Overall access Nepal Social Marketing and Franchising Project N-MARC Mapping Access to Condoms Nepal Social Marketing and Franchising Project N-MARC % of Hot Spots with Access to Condom-selling Outlets at Different Proximity Intervals, 2008 14 27 37 46 58 66 20m 40m 50m 60m 80m 100m Nepal Social Marketing and Franchising Project N-MARC Summary of Findings Coverage • Overall condom coverage increased from 69 % to 88 % • Condom coverage increased in three of the four study region, it was constant in Dhading Nepal Social Marketing and Franchising Project N-MARC Summary of Findings Quality of Coverage • Condom stock at visible location in general has improved, but needs further effort to get better result. • Condom promotional materials at visible location has improved only in Katmandu, and is very poor in other regions. • Condom stock out experienced in Katmandu seems to have gotten worse. While this indicator remains constant for other study regions. • Night time condom availability has deteriorated as compared to earlier period in all regions. Nepal Social Marketing and Franchising Project N-MARC Summary of Findings Access • Condom access within 100 meter radius from the hotspots in Dhading and Kaski has improved • The situation in Katmandu and Rupendehi has deteriorated. • Overall, the access indicator has increased from 63 to 65 percent Nepal Social Marketing and Franchising Project N-MARC Program Implications Product • Initiate efforts to increase condom coverage to 95% • Target product distribution in those hot zones with poor coverage Place/ Distribution • Open new outlets/motivate outlets to increase access • Ensure condom availability round the clock in outlets that reported out-of stock last month • Prioritize point-of-purchase promotional activities Promotion Price • Initiate BCC/IPC activities in hot zones to reduce stigma against selling condoms • Ensure condom brands have maximum retail price printed on packaging and encourage retailers to follow this guideline (analyzed but not shown here) Nepal Social Marketing and Franchising Project N-MARC Future Directions • Adaptation of GIS mapping for monitoring family planning service delivery coverage through public and private sector • Integration of GIS mapping into Government’s strategic planning activities • Development of district-level maps to assist in decentralized programmatic decision-making Nepal Social Marketing and Franchising Project N-MARC OTHER APPLICATIONS OF GIS Nepal Social Marketing and Franchising Project N-MARC Other applications of GIS Ñ Ñ Ñ ÑÑ Ñ ÑÑ ÑÑ Ñ ÑÑÑ Ñ ÑÑ ÑÑÑ Ñ ÑÑÑÑÑÑ Ñ ÑÑ Ñ ÑÑ ÑÑ ÑÑ Ñ ÑÑ Ñ Ñ ÑÑ Ñ Ñ Ñ Ñ Ñ Ñ Ñ Ñ Ñ ÑÑ Ñ Ñ Ñ Ñ Ñ ÑÑ Ñ Ñ Ñ Ñ Ñ ÑÑ ÑÑ Ñ ÑÑ Ñ Ñ Ñ Ñ 7.8 Moyenne Guinée Basse Guinée 6.9 Haute Guinée 8.9 5.9 Conakry Guinée Forestière Ñ Ñ Ñ Ñ Ñ 5 4. Mapping of aggregated data from KAP Survey : « % of women having used FP 5. Proximity analysis of Heath facility clinics network in Kathmandu Valley (Nepal) Nepal Social Marketing and Franchising Project N-MARC Nepal Social Marketing and Franchising Project N-MARC Other applications of GIS 3. Trend in Monthey condom sales by district (Nepal) Nepal Social Marketing and Franchising Project N-MARC Location of health facilities and population distribution in the administrative region of Labé, Guinea Ñ Ñ Ñ Ñ Ñ Ñ Ñ Ñ Ñ Ñ Ñ Ñ Ñ Ñ Ñ Ñ Ñ Ñ Ñ Ñ Ñ Ñ ÑÑ Ñ ÑÑ Ñ Ñ Ñ Ñ Ñ Ñ Ñ Ñ Ñ Ñ Labé Ñ Ñ Ñ Ñ Ñ Ñ Ñ Ñ Ñ Ñ Ñ Ñ Ñ Ñ Ñ Ñ Ñ Ñ ÑÑ Ñ Ñ Ñ Ñ Ñ Ñ ÑÑ Ñ Ñ Ñ Ñ Ñ Ñ ÑÑ Ñ Ñ Ñ Ñ Ñ Ñ Ñ ÑÑ Ñ Ñ Ñ Ñ Ñ Ñ Ñ Ñ Ñ ÑÑÑ Ñ Ñ Ñ ÑÑ Ñ Ñ Ñ Ñ Ñ Ñ Ñ Ñ Ñ Ñ Ñ Ñ Ñ Ñ Ñ Ñ Ñ Ñ Ñ ÑÑ Ñ Ñ Ñ Ñ Ñ Ñ ÑÑ Ñ Ñ ÑÑ Ñ ÑÑ Ñ Ñ Ñ Ñ ÑÑ ÑÑ Ñ Ñ Ñ Ñ Ñ Ñ Ñ Ñ Ñ Ñ Ñ Ñ ÑÑ Ñ Ñ Ñ Ñ ÑÑ Ñ Ñ Ñ Ñ Ñ Ñ Ñ Ñ Ñ Map produced by UNFPA-Guinea, March 2005 - Source: MEPUGIS/USAID Nepal Social Marketing and Ñ Franchising Project N-MARC Ñ Nepal Social Marketing and Franchising Project N-MARC Meteorological Station Network 311 30 107 301 313 101 102 108 103 201 306 307 202 211204 Latitude (°N) 104 203 218 217 214 29 105 215 106 209 302 309 305 308 205 210 206 401 402 403 410 208 405 406 212 207 411 415 417 408 28 27 81 303 310304 418 404 513 413 412 409 420 416 419414 312 612 623 610 624 625 601 608 604 820 607 806 616 629 816 628 606 626 615 619828 621 627 511 801 824 609 821 504 512 814 1001 802 813 818 830 605 829 507 614 804 823 613 722 1054 622 630 508 811 807 505 805 1055 725 515 509 1002 620831 815 407 1057 1058 826 817 808 809 701 1016 715 1025 1004 1078 1006 810 726 1005 1017 827 702 1008 1007 1009 1027 1018 1071 721 1317 1074 1035 1079 1077 1039 1038 510 1020 1059 1062 1202 1063 1102 703 1043 1030 704 706 723 1015 1101 1076 1036 1052 1029 1023 1073 1103 915 1024 902 1060 905 710 903 1049 1028 1022 904 1075 920 1224 1301 1403 716 728 707 708 1104 705 12071219 1404 1220 727 1115 1123 1203 925 906919 1325 1405 1204 1420 1117 1206 907 1321 1107 1303 1222 1324 1406 1108 909 910 1210 1305 1314 1419 1121 1109 911 1304 921 1110 1211 1306 912 918 1307 13221308 1309 1213 1112 923924 14071410 11181120 1119 1416 1316 1311 1411 922 1212 1215 1111 1320 1408 1415 1216 1122 1409 1312 1226 14211412 1223 1319 82 514 501 502 83 84 85 86 87 88 Longitude (°E) Nepal Social Marketing and Franchising Project N-MARC Nepal Social Marketing and Franchising Project N-MARC Nepal Social Marketing and Franchising Project N-MARC Nepal Social Marketing and Franchising Project N-MARC Nepal Social Marketing and Franchising Project N-MARC Nepal Social Marketing and Franchising Project N-MARC Nepal Social Marketing and Franchising Project N-MARC Nepal Social Marketing and Franchising Project N-MARC Thank you Hope you are not confused Nepal Social Marketing and Franchising Project N-MARC
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