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:
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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
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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
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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
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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
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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