Munyaneza Fabien, Hirschhorn Lisa R, Amoroso Cheryl L, Nyirazinyoye Laetitia, Birru Ermyas, Mugunga Jean Claude, Murekatete Rachel M, Ntaganira Joseph
College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.
Int J Health Geogr. 2014 Dec 6;13:49. doi: 10.1186/1476-072X-13-49.
Geographic Information Systems (GIS) have become an important tool in monitoring and improving health services, particularly at local levels. However, GIS data are often unavailable in rural settings and village-level mapping is resource-intensive. This study describes the use of community health workers' (CHW) supervisors to map villages in a mountainous rural district of Northern Rwanda and subsequent use of these data to map village-level variability in safe water availability.
We developed a low literacy and skills-focused training in the local language (Kinyarwanda) to train 86 CHW Supervisors and 25 nurses in charge of community health at the health center (HC) and health post (HP) levels to collect the geographic coordinates of the villages using Global Positioning Systems (GPS). Data were validated through meetings with key stakeholders at the sub-district and district levels and joined using ArcMap 10 Geo-processing tools. Costs were calculated using program budgets and activities' records, and compared with the estimated costs of mapping using a separate, trained GIS team. To demonstrate the usefulness of this work, we mapped drinking water sources (DWS) from data collected by CHW supervisors from the chief of the village. DWSs were categorized as safe versus unsafe using World Health Organization definitions.
Following training, each CHW Supervisor spent five days collecting data on the villages in their coverage area. Over 12 months, the CHW supervisors mapped the district's 573 villages using 12 shared GPS devices. Sector maps were produced and distributed to local officials. The cost of mapping using CHW supervisors was $29,692, about two times less than the estimated cost of mapping using a trained and dedicated GIS team ($60,112). The availability of local mapping was able to rapidly identify village-level disparities in DWS, with lower access in populations living near to lakes and wetlands (p < .001).
Existing national CHW system can be leveraged to inexpensively and rapidly map villages even in mountainous rural areas. These data are important to provide managers and decision makers with local-level GIS data to rapidly identify variability in health and other related services to better target and evaluate interventions.
地理信息系统（GIS）已成为监测和改善卫生服务的重要工具，尤其是在地方层面。然而，农村地区往往无法获取GIS数据，且村级地图绘制资源密集。本研究描述了利用社区卫生工作者（CHW）的督导员对卢旺达北部一个山区农村县的村庄进行地图绘制，以及随后利用这些数据绘制安全饮用水可及性的村级差异图。
我们以当地语言（基尼亚卢旺达语）开展了一项以低识字率和技能为重点的培训，以培训86名CHW督导员以及25名在卫生中心（HC）和卫生站（HP）负责社区卫生的护士，使用全球定位系统（GPS）收集村庄的地理坐标。通过与分区和县级的关键利益相关者开会对数据进行验证，并使用ArcMap 10地理处理工具进行合并。成本使用项目预算和活动记录进行计算，并与使用单独的、经过培训的GIS团队进行地图绘制的估计成本进行比较。为了证明这项工作的实用性，我们根据CHW督导员从村长那里收集的数据绘制了饮用水源（DWS）图。根据世界卫生组织的定义，将DWS分为安全和不安全两类。
培训后，每位CHW督导员花费五天时间收集其覆盖区域内村庄的数据。在12个月的时间里，CHW督导员使用12台共享的GPS设备绘制了该县573个村庄的地图。制作了分区地图并分发给当地官员。使用CHW督导员进行地图绘制的成本为29,692美元，比使用经过培训的专业GIS团队进行地图绘制的估计成本（60,112美元）少约两倍。本地地图的可及性能够迅速识别DWS的村级差异，居住在湖泊和湿地附近的人群获得DWS的机会较低（p < 0.001）。
即使在山区农村地区，也可以利用现有的国家CHW系统以低成本快速绘制村庄地图。这些数据对于为管理人员和决策者提供地方层面的GIS数据非常重要，以便快速识别卫生和其他相关服务的差异，从而更好地确定干预措施的目标并进行评估。
