A GIS PERSPECTIVE FOR LOCAL LEVEL PLANNING AND DECISION-MAKING: THE CASE OF SPATIAL DATA INTEGRATION, HEALTH AND SANITATION IN THE GA DISTRICT OF GHANA BY RICHARD Y. KOFIE A THESIS SUBMITTED TO THE DEPARTMENT OF GEOGRAPHY ANI RESOURCE DEVELOPMENT, UNIVERSITY OF GHANA, IN FULFILMENT OF THE REQUIREMENT FOR THE AW ARD OF DOCTOR OF PHILOSOPHY (PH.D)) DEGREE JUNE 2001 University of Ghana http://ugspace.ug.edu.gh DECLARATION I hereby declare that except for references cited which have been duly acknowledged, this work is the result o f my own research. It has never been presented anywhere either in part or wholly for the award of any degree. L - L \l PROF.’P.W.K. YANKSON (Advisor)* ' I j i j • • DR. G.T. AGYEPONG RICHARD Y. KOFIE (Advisor) (Candidate) PROF. E. OFORI-SARPONG (Advisor) University of Ghana http://ugspace.ug.edu.gh ACKNOWLEDGEMENTS I am greatly indebted to the people listed below, among others, for the commendable assistance they rendered towards the production of this thesis. The services of lecturers o f the Department of Geography and Resource Development, University of Ghana, Legon, are immensely acknowledged. I am particularly grateful to my Advisors, Prof. P.W.K. Yankson, Dr. G.T. Agyepong and Prof. E. Ofori-Sarpong for their invaluable suggestions and constructive criticisms, which afforded a constant source of encouragement. Their professional influence and flair for the utmost scientific method have been perpetual sources of inspiration. I am highly indebted to Prof. John Nabila who encouraged me to embark upon the Ph.D. programme, Prof. Jacob Songsore, the head of department for his interest in my work and continuous probing and Dr. Alex Asiedu for his support. I wish to express my gratitude to DANIDA, which under the ENRECA Projects, sponsored the research work and my two trips to the Institute of Geography, University of Copenhagen, Denmark, where I received my first instructions in GIS. I owe a debt of gratitude to Prof. Henrik Jeppesen who made the entire sponsorship possible and Dr. Lasse Moller-Jensen who provided constructive suggestions on several aspects of my work. I am indebted to Ms Ulla Kronborg, Dr. Michael S. Rasmussen and Mr. Jens Grudtman of the same University for their co-operation. I also wish to thank the NUFU Programme of the Norwegian Ministry of Foreign Affairs for availing me of the opportunity to spend a semester at the Geografisk Institutt of the Norwegian University of Science and Technology (NTNU) Trondheim, where I audited some courses in Medical Geography. I am grateful to the Council for Scientific and Industrial Research (CSIR), my employers, for granting me study leave to pursue the research and to Mr. George Caiquo of INST1/CSIR for reading through the drafts. University of Ghana http://ugspace.ug.edu.gh My thanks go especially to my colleagues in the Remote Sensing/GIS Application Laboratory in the Department of Geography and Resource Development, Messrs. S.K. Kufogbe, Osman A-R Alhassan, Albert Allotey, Paul Oppong, Morgan Attua, and Opoku Pabi for their continued encouragement, keen interest and remarkable co-operation. We were a happy GIS and Remote Sensing family. I further extend my sincere thanks to Dr. E. Quainoo-Mensah, Director of Health Services (DHMT), Ga District Assembly, Amasaman and her staff both at the headquarters and in the sub-districts for supplying relevant data and background information on the health sector in the Ga District. I cannot mention the Ga District Assembly without acknowledging the co-operation of the District Planning Officer, Mr. George Arckah and the heads of all the decentralized and non-decentralized departments. I am very grateful for their remarkable understanding. Last but not least, words cannot adequately express how deeply indebted I am to my wife Lydia for her unselfish devotion and unparalleled understanding and to my two children, Nadia and Fiifi. It is, however, only fair to add that I remain entirely responsible for any defects of fact, treatment, judgement or style of this thesis. University of Ghana http://ugspace.ug.edu.gh ABSTRACT The devolution of political administration, planning and the decision-making process from over burdened central governments to the local level has been borne out o f one basic fact - that community participation in governance, planning and decision-making will make the process of development more self-sustaining. The assumption being that bringing policy decisions that reflect local conditions closer to the people will lead to a fuller participation in programmes that will bring about improvement in the well-being of the people. This has been the basic idea behind Ghana’s decentralization policy and the District Assembly concept. The concept has led to the creation of basic units of government called the District Assemblies. Even though the framework for pursuing the decentralisation policy and the planning process have been laid down, the tools or techniques to enhance holistic planning have been inadequate, especially for the integration of sets of information held within the various functional agencies in the District Assemblies. The fact is that many of the questions facing planners, policy­ makers, administrators and researchers, among others, are inherently geographical and spatial analysis and mapping are emerging as vital tools for providing answers to such questions. The District Assemblies have not only been seen as the basic units o f government, but understandably the ideal and most manageable units for data acquisition and processing. For holistic plan development and for a more informed decision-making, what is required for the integration of data and making it available in forms that are easily comprehaisible is a GIS. This study considered the application of GIS as a tool for the integration of disparate data sets in the district departments and proposed the elements of a prototype GIS for planning at the district level. It is an attempt to use the integration concept to provide answers to some fundamental planning and policy issues in the health sector. The study is a case type and centered on the Ga District, one of the five districts that make up the Greater Accra Region. Like all other District Assemblies in Ghana, it carries out its administrative, political, planning and decision-making functions within the framework of the laws that established the District Assemblies and the National University of Ghana http://ugspace.ug.edu.gh Development Planning Commission (NDPC). However, planning has been hampered by several factors, basic among which is the lack of a mechanism for integrating data held within the district departments. The study considered the use of GIS as a tool to facilitate the integration of spatial data held within 15 departments in the district. It also proposed the type of approach required for multidatabase design in the context o f the district and for GIS interoperability. The study proposed a scheme, which shows, some of the basic elements for a prototype district GIS. The study showed through the use of the overlay method of analysis that integrating diseases data with environmental data could help provide clues to the causes of major diseases in the Ga District. It has been shown that in many cases the high incidence of the diseases was associated with poor sanitation practices, solid waste disposal and household water supply sources. The technology offers a good way of studying the geographical aspects of diseases and thus contributing to both educational intervention and planning. It also showed the added value of GIS in ascertaining health care services coverage. Here the study was able to demonstrate the additional number of health care facilities and services required to bring coverage closer to the communities. The study recommends GIS as an instrument that can be used to device quick, reliable and scientifically valid methods of rapid assessment and utilization for planning, monitoring and evaluation of programmes at the district level. It will be necessary for the district assemblies to be equipped with the basic facilities for prototype GISs that will enhance the execution of their holistic plans. The GIS facility will not only facilitate spatial data capture, storage, manipulation, analysis and update but also serve as a store of data to meet the needs of any particular department. While saving costs in data collection and avoiding the duplication of efforts, it will also pave the way for uniformity in modes of data representation, scales, standards, updates and data quality levels to allow for interoperability. The present study was based on one district out of the 110 in the whole country. Future studies may require that more districts are studied in terms of their departmental data acquisition and processing operations for plan development. This will set the pace for a national consensus and capacity building for spatial data acquisition. University of Ghana http://ugspace.ug.edu.gh processing standards setting and quality levels among others. It also views the inclusion of geodemographic data or household surveys in the investigation of explanatory causes of diseases as relevant in future studies. vi University of Ghana http://ugspace.ug.edu.gh LIST OF ACRONYMS AMA Accra Metropolitan Assembly CDH Communicable Disease Hospital CDROM Compact Disk Read Only Memory CERSGIS Centre for Remote Sensing and Geographic Information Services CSIR Council for Scientific and Industrial Research DANIDA Danish Agency for International Development DB Database DBMS Database Management Systems DHMT District Health Management Team DHO District Head Office DPCU District Planning Co-ordinating Unit EIS - Environmental Information Systems ENRECA Danish International Development Agency’s Enhancement of Research Capacity Project ESRI Environmental Systems Research Institute FDB Federated Database FP Family Planning GAMA Greater Accra Metropolitan Area GERMP Ghana Environmental Resources Management Project GIS Geographic Information Systems GPS Global Positioning System INSTI Institute of Scientific and Technological Information KVIP Kumasi Ventilated Improved Pit LAM Location-Allocation Modeling LI Legislative Instrument MCH Maternal and Child Health University of Ghana http://ugspace.ug.edu.gh MCLP Maximal Covering Locational Problem MLGRD Ministry of Local Government and Rural Development MOH Ministry of Health NAFGIM National Framework for Geospatial Information Management NDPC National Development Planning Commission NGOs Non-Governmental Organisations NICs New Industrializing Countries NLCD National Liberation Council Decree NTNU Norwegian Technical University, Trondheim NUFU Norwegian Council of Universities Committee for Development Research and Education OPD Out Patients Department PC Personal Computer PHC Primary Health Care PNDC Provisional National Defence Council UK United Kingdom UNDP United Nations Development Programme UNEP - United Nations Environment Programme URTI Upper Respiratory Tract Infections WHO World Health Organisation University of Ghana http://ugspace.ug.edu.gh TABLE OF CONTENTS Declaration ... Acknowledgements Abstract ... List of Acronyms Table of Contents List of Tables ... List of Figures... List of Maps ... List o f Appendices CHAPTER ONE: 1.0 Introduction 1.1 The concept of decentralization ... ... ... ... .. . 1 1.2 The concept of planning ... ... ... ... ... .. . 3 1.3 Decentralization in Ghana ................ ... ... ... .. . 4 1.4 Decentralization and the planning process ... ... ... .. . 6 1.5 The GIS technique ... ... ... ... ... ... .. . 10 1.6 GIS application for district level planning and decision making .. . 10 1.7 The problem ... ... ... ... ... ... ... .. . 12 1.7.1 The problem of district level planning... ... ... .. . 13 1.7.2 The problem of health and sanitation in the Ga District .. . 15 1.8 Literature review ... ... ... ... ... ... .. . 18 ix University of Ghana http://ugspace.ug.edu.gh 1.8.1 Local government application... ... ... .. 1.8.2 Planning application ... ... ... ... ■ 1.8.3 GIS, spatial database integration and interoperability 1.8.5 Health and sanitation application ... ... 1.8.6 Problems of GIS use in developing countries... 1.9 Objectives of the study ... ... ... ... 1.10 Propositions ... ... ... ... ... ... 1.11 Conceptual framework ... ... ... ... 1.11.1 Maps as models and the systems approach ... 1.11.2 GIS / Maps as representational models.. ... 1.11.3 The Systems approach ... ... ... ... CHAPTER TWO: METHODS OF STUDY 2.0 Introduction ... ... ... ... ................ 2.1 The scheme for data integration ... ... ... 2.2 The elements of a district level prototype GIS ... 2.3 Data categories for the GIS analysis ... ... 2.4 Sources of base data ... ... ... ... ... 2.5 Map layers (coverages) ... ... ... ... 2.5.1 Sanitation types and solid waste disposal forms 2.5.2 Health care facilities ... ... ... ... 2.5.3 Household water supply ... ... ... 19 20 22 1.8.4 Spatial accessibility and the use of location-allocation models 24 26 33 35 35 36 36 37 40 43 43 44 45 46 47 47 48 48 University of Ghana http://ugspace.ug.edu.gh 2.5.4 Endemic diseases ... ... ... ••• ... 49 2.5.5 Population and settlements ... ... ... ... ■■■ 50 2.5.6 Road network ... ... ... ... ... ... 50 2.5.7 Major rivers ... ... ... ... ... ... ••• 51 2.6 Summary of the study approach ... ... ... ... ... 51 2.7 Hardware and software systems configuration ... ... ... 52 CHAPTER THREE: BACKGROUND OF THE GA DISTRICT 3.0 Introduction ... ... ... ... ... ... ... ... 54 3.1 Population ... ... ... ... ... ... ... ... 54 3.2 The Ga District Assembly structure and planning ... ... ... 55 3.3 The health sector infrastructure ... ... ... ... ... 57 3.4 Sanitation facilities ... ... ... ... ... ... ... 60 3.5 Household water supply ... ... ... ... ... ... 60 3.6 Solid waste disposal ... ... ... ... ... ... ... 61 CHAPTER FOUR: THE DESIGN OF A SCHEME FOR SPATIAL DATA INTEGRATION AND THE ELEMENTS OF A PROTOTYPE GIS FOR THE GA DISTRICT 4.0 Introduction ... ... ... ... ... ... ... ... 62 4.1 The concept of spatial data integration and interoperability in GIS 63 4.2 Practical problems of data and planning in the Ga District . .. 64 4.2.1 Data types acquired and processed and present levels of inter-departmental collaboration in the district... ... ... 65 4.3 The scheme for spatial data integration ... ... ... ... 66 4.4 The approach to multidatabase design for the district ... 69 University of Ghana http://ugspace.ug.edu.gh 4.4.1 The top-down approach ... ... ... ... ••• ••• 70 4.4.2 The bottom-up approach ... ... ... ... ... ••• 71 4.5 Proposed elements for prototype GIS for the district ... ... 71 4.5.1 Sources and categories of data ... ... ... ... 73 4.5.2 Software components of the prototype GIS ... ... ... 74 4.5.2.1 Data input and verification ... ... ... ... 74 4.5.2.2 Data storage and database management ... ... 75 4.5.2.3 Data output and presentation ... ... ... ... 76 4.5.2.4 Data transformation ... ... ... ... ... 76 4.5.2.5 Interaction with the user (Query Input)... ... ... 77 4.6 The choice of software... ... ... ... ... ... ... 77 4.7 Conclusion ... ... ... ... ... ... ... ... 78 CHAPTER FIVE: AN ANALYSIS OF THE SPATIAL DISTRIBUTION OF ENDEMIC DISEASES, SANITATION TYPES, HOUSEHOLD WATER SUPPLY SOURCES, AND SOLID WASTE DISPOSAL FORMS IN THE GA DISTRICT: THE OVERLAY METHOD. 5.0 Introduction ... ... ... ... ... ... ... ... 80 5.1 Data types utilized and their sources ... ... ... ... 82 5.1.1 Endemic diseases... ... ... ... ... ... ... 82 5.1.2 Environmental factors ... ... ... ... ... ... 82 5.2 Monitoring endemic diseases in the Ga District ... ... ... 85 5.2.1 Spatial incidence of malaria ... ... ... ... ... 85 5.2.2 Spatial incidence of diarrhoea ... ... ... ... ... 87 University of Ghana http://ugspace.ug.edu.gh 5.2.2.1 Diarrhoea and sanitation forms ... • • • 88 5.2.2.2 Diarrhoea and household water supply sources ... ... 89 5.2.2.3 Diarrhoea and solid waste disposal forms ... ... 90 5.2.3 Spatial incidence of chicken pox ... ... ... ••• 91 5.2.3.1 Chicken pox and sanitation ... ... ... • ■ 92 5.2.3. IChicken pox and solid waste disposal ... ... ... 92 5.2.3.3Chicken pox and household water supply sources ... 93 5.2.4 Spatial incidence of acute eye infec t ion............................................... 93 5.2.4.1 Acute eye infection and sanitation... ... ... ... 94 5.2.4.2 Acute eye infection and solid waste disposal ... ... 95 5.2.4.3 Acute eye infection and household water supply... ... 95 5.2.5 Spatial incidence of ear infections ... ... ... ... 96 5.2.5.1 Ear infections and environmental factors ... ... ... 97 5.2.6 Spatial distribution of upper respiratory tract infection (URTI)... 97 5.2.6.1 Upper respiratory tract infection and environmental factors 97 5.2.7 Spatial incidence of skin infections ... ... ... ... 98 5.2.7.1 Skin infections and environmental factors .. . ... ... 99 5.2.8 Spatial incidence of measles ... ... ... ... ... 101 5.2.8.1 Measles and environmental factors ... ... ... 101 5.2.9 Spatial incidence of intestinal worms infection ... ... ... 102 5.2.9.1 Intestinal worms infection and environmental factors ... 103 5.2.9.2 Intestinal worms infection and solid waste disposal ... 104 5.2.9.3 Intestinal worms infection and household water supply ... 105 University of Ghana http://ugspace.ug.edu.gh 5.2.10 Spatial incidence of buruli ulcer ... ... ... ... •• 105 5.2.10.1 Buruli ulcer and environmental factors ... ... .. 107 5.2.10.2 Buruli ulcer and sanitation ... ... ... .. 108 5.2.10.3 Buruli ulcer and solid waste disposal ... ... .. 108 5.2.10.4 Buruli ulce- and household water supply sources .. 108 5.3 CONCLUSION ................................................................................... 109 CHAPTER SIX: SPATIAL ACCESSIBILITY TO HEALTH CARE SERVICES IN THE GA DISTRICT: THE ROLE OF LOCATION-ALLOCATION MODELS USING NETW( ANALYSIS 6.0 Introduction ... ... ... ... ... ... ... ... 111 6.1 Status and capacity of health care facilities in the district ... ... 112 6.2 Problems of accessibility to health care services .. .. 114 6.3 Accessibility and the goals of Ghana’s PHC strategy . . .. 116 6.4 Network analysis and location-allocation modeling... ... ... 117 6.5 Data requirements and approach to network analysis ... 119 6.6 The network analysis ... ... ... ... ... ... ... 119 6.7 Euclidean buffer zones (alternative scenario) ... ... ... 121 6.8 Optimum locations for new health care facilities ... ... 123 6.9 Selecting sites to locate additional facilities ... ... ... ... 123 6.10 Achieving total coverage ... ... ... ... ... ... 125 6.11 Strategy for relocating health care points ... ... .. ... 126 6.12 Alternative algorithms .. ... ... ... ... 127 6.13 Conclusion ... ... ... ... ... ... ... 127 xiv University of Ghana http://ugspace.ug.edu.gh CHAPTER SEVEN: SUMMARY AND CONCLUSIONS Policy implications and suggestions for future research ... ... 136 REFERENCES ................................................................................................139 APPENDICES ................................................................................................150 LIST OF TABLES TABLE Page 1.1 Top ten diseases seen at OPDs in the Ga District ...............................17 3.1 Basic population statistics of the Ga District... ... ... ... 54 3.2 Population by major settlements ... ... ... ... ... 55 3.3 Institutions providing health services by sub-district in the Ga District 58 3.4 Ga District health sub-districts and population projection, 1998 ... 59 6.1 Staff cadre position by sub-district, Ga District ... ... ... 114 6.2 Mode of transportation to health care facilities in the sub-districts ... 115 6.3 Road-type traveled to health care facilities in the sub-districts ... 116 6.4 Cost of transportation to health care facilities in the sub-districts ... 116 6.5 Population and communities within 8-km travelling distance from health care facilities along main road network ... ... ... 120 6.6 Population and communities covered by 84cm (Euclidean) buffers ... 121 6.7 Population and communities covered by network and buffer analysis 122 6.8 Population and communities covered by proposed sites ... ... 125 6.9 Improved level o f accessibility to health care services ... ... 125 XV University of Ghana http://ugspace.ug.edu.gh LIST OF FIGURES Page 1.1 Structure of the new local government system ... ... . ■ ■ 8 1.2 District development planning system ... ... ... ■■■ 9 1.3 The process of information transformation ... ... ... ... 39 2.1 The scheme with main data categories ................. ... 45 2.2 The "overlay’ or layered database concept ................. ... ... 46 2.3 Hardware and software system configuration ... ... ... 52 3.2 District Assembly structure ... ... ... ... ... ... 56 4.1 Proposed scheme for district level spatial data integration ... ... 68 4.2 The top-down and bottom-up schema designs...... ... ... 70 4.3 The elements of a prototype district GIS ... ... ... ... 72 5.4 Reported cases of major diseases in the Ga District (1997/98) ... 85 5.6 Malaria distribution in the Ga District (1997/98) ... ... ... 85 5.7 Malaria distribution in the Weija sub-district (1997/98) ... ... 86 5.9 Diarrhoea cases in the Ga District (1997/98).. . ... ... ... 87 I. . > 5.10 Top diarrhoea cases in the Madina and Amasaman sub-districts (1997/98) 88 5.13 Communities and sources of household water supply in the Ga District 89 5.15 Forms of solid waste disposal in the Ga District ... ... ... 90 5.16 Diarrhoea in Weija sub-district (1997/98) ... ... ... ... 91 5.18 Chicken pox in Weija (1997/98) ... ... ... ... ... 92 5.19 Top cases of chicken pox in Weija and Amasaman zones ... ... 93 5.21 Acute eye infection in the Ga District( 1997/98) ... ... ... 94 5.22 Top cases of acute eye infections in the Amasaman sub-district (1997/98) 94 5.23 Acute eye infections in Madina (1997/98) ... ... ... ... 95 5.25 Cases of ear infection in the Ga District (1997/98) ... ... ... 96 5.27 Upper respiratory tract infections (URTI) in the Ga District (19997/98)... 97 5.28 Communities with top cases of upper respiratory tract infections (1997/98) 98 5.30 Cases of skin infections in the Ga District (1997/98)... ... ... 99 5.33 Top cases of measles in the Ga District (1997/98) ... ... ... 101 xvi University of Ghana http://ugspace.ug.edu.gh 5.35 Top cases of intestinal worms infection in the Ga District (1997/98).. 103 5.40 Buruli ulcer cases in Amasaman sub-district (1997/98) 106 LIST OF MAPS Page Location of Ga District in Ghana ... ... ... ... ■■■ xix 3.1 Population distribution 1996 ... ... ... ... ... ••• 53b 5.1 Household water supply sources ... ... ... ... ... 81b 5.2 Distribution of solid waste disposal forms ... ... ... ... 81c 5.3 Types of sanitation practices ... ... ... ... ... ... 82b 5.5 Malaria incidence 1997/98 ... ... ... ... ... ... 84b 5.8 Diarrhoea incidence 1997/98 ... ... ... ... ... ... 86b 5.11 Diarrhoea and types of sanitation practices (1997/98) ... ... 87b 5.12 Diarrhoea and household water supply sources ... ... ... 87c 5.14 Diarrhoea and solid waste disposal forms ... ... ... ... 88b 5.17 Chicken pox incidence 1997/98 ... ... ... ... ... 90b 5.20 Incidence of acute eye infections 1997/98 ... ... ... ... 92b 5.24 Incidence of ear infections 1997/98 ... ... ... ................ 95b 5.26 Incidence of upper respiratory tract infections (URTI) 1997/98 ... 95c 5.29 Incidence of skin infections 1997/98 ... ... ................ ... 98b 5.31 Skin infections and sources of household water supply ... ... 99b 5.32 Incidence of measles 1997/98... ... ... ... ... ... 100b 5.34 Incidence of intestinal worms infection 1997/98 ... ... ... 102b 5.36 Intestinal worms endemic areas and sanitation forms ... ... 102c 5.37 Intestinal worms endemic areas and solid waste disposal types ... 103b 5.38 Intestinal worms endemic areas and household water supply sources 104b 5.39 Incidence of buruli ulcer 1997/98 ... ... ... ... 105b 5.41. B urul i ulcer cases and riparian environments... ... ... ... 107b 5.42. Buruli ulcer and sanitation forms ... ... ................ ... 107c 5.43. Buruli ulcer and solid waste disposal forms ... ... 107d University of Ghana http://ugspace.ug.edu.gh 5.44. Buruli ulcer endemic areas and riparian environments ... ... 108b 6.1 Health sub-districts and location of major healthcare facilities ... 111b 6.2 Selected sites for service areas and network analysis... ... ... 118b 6.3 General areas around established health care facilities ... ... 119b 6.4 Eight-kilometres buffers around health care facilities ... ... 120b 6.5 Proposed sites for additional health care facilities ... ... ... 123b 6.6 Service areas for existing and proposed health care facilities ... 124b LIST OF APPENDICES Appendix I. Composition of District Departments... ... ... ... 150 Appendix II. Questionnaire on data integration to enhance district level development planning and policy decision-making ... ... 151 Appendix III. Geographical accessibility to health care facilities in the Ga District ................ ... ... ... ... ... 154 xviii University of Ghana http://ugspace.ug.edu.gh Location of Ga District in Ghana 18000001200000600000 1800000 1200000I200000 Ga District 600000 1200000 1800000 Scale 1 3,500.000 60 90 XIX University of Ghana http://ugspace.ug.edu.gh CHAPTER ONE B A C K G R O U N D TO D E C E N T R A L IZ A T IO N AND LO C A L L E V E L PLA N N IN G IN GH ANA 1.0 In tr od u c t io n 1.1 The con cep t o f d e c en t r a l i z a t i o n D e c e n t r a l i z a t i o n is c ommon ly a s so c i a t ed w i t h the p r o c e s s o f d emo c r a t i s a t i o n in t e rm s o f e conom ic , soc ia l and po l i t i c a l a f f a i r s . It has been d e s c r i b ed as a p ro c e s s th a t a t t emp t s to imp rov e the g ene r a l w e l f a r e and w e l l - b e in g o f p eop le (Ma lo , 1997) . The con c ep t has g a in ed popu l a r i t y in r e c en t t imes among d ev e lop ing c oun t r i e s as a s c h eme and an a l t e r n a t i v e m e ch an i sm in de l i v e r i ng pub l i c s e rv ic e s and good s as we l l as c a r r y in g ou t gov e rnmen t a l f unc t i on s and du t ie s . M any soc i a l p l a nne r s have h e r a l d e d it as a mu l t i f a c e t e d r em edy to o v e r e x t e n d e d and - d e t e r i o r a t i n g de l i v e ry s y s t ems o f soc i a l goods and se rv i ce s . Dec e n t r a l i z a t i o n has its advan ta ge s . As a m ean s o f d e c e n t r a l i s i n g the de l i v e ry o f soc ia l se rv ic e s , the con cep t is t h o ugh t by some as a m ean s to imp rove i ts e f f i c i e n cy and e f f e c t i v en e s s as we l l as m ake such s e rv i c e s a v a i l ab le to p eop l e who need th em mos t ; thus , it p r omo t e s equi ty . L ik ew is e , it mob i l i z e s and a ugmen t s e x i s t i ng r e sou r c e s - human , t e chn ic a l and f inanc i a l . Thi s is done by b r i n g ing d e c i s i o n ­ mak ing , m an ag em en t and r e s pon s ib i l i t y in the a dm in i s t r a t i o n o f r e s ou r c e s c lo s e r to the local l eve l , i .e . , to a c e r t a i n ex ten t , the p r iv a te sec tor . It has been a rgued tha t d e c en t r a l i z a t i o n po l i cy can a l so so lve p r o b l em s b rough t abou t by the lack o f t r a n s p o r t a t i o n and c ommun i c a t i o n f ac i l i t i e s as wel l as s imp l i f y the p r o c edu r e s in d e c i s i o n ­ mak in g . F u r t h e rmo r e , d e c en t r a l i z a t i o n may br ing abou t po l i c y d e c i s i o n s th a t r e f le c t local c ond i t i on s ; and to a ch ie ve its goa ls , loca l c u s t om s and t r a d i t i o n s mus t be ta ken into a ccoun t in po l ic y mak ing , a v a l i d c once rn no t u n d e r s t o o d by na t iona l o f f ic ia l s (Ma lo , 1997) . F i n a l l y , I University of Ghana http://ugspace.ug.edu.gh d e c e n t r a l i z a t i o n can cu t d own red tape p ra c t i c e s wh i ch c ommon ly b e s e t d e v e l o p i n g coun t r ie s . D e c e n t r a l i z a t i o n has a l so been a s so c i a t e d w i th some d i s a d v a n t a g e s wh i ch i n c lude the fo l l ow ing : • the lack o f con t ro l ove r the local or d e c en t r a l i z e d i n s t i t u t i o n s l e ad ing to i n e f f i c i e n cy in manag ing g o v e r nm e n t ’s budge t ; • w i d e n i n g the gap b e tw een r e g ion s / d i s t r i c t s whe r eby w ea l t h y and p r o g r e s s i v e ones cou ld deve lop the i r e c o nomy be t te r and f a s te r wh i l e p oo r e r or less e ndowed r eg ion s /d i s t r i c t s a re le f t b eh ind ; and • i n t e n s i f y i n g r eg io n a l - c en t r e d s en t imen t s at the e xpen s e o f n a t i o n a l un i ty . D ec en t r a l i z a t i o n has been app l ie d in many r eg iona l con t ex t s w i th d i f f e r en t a pp ro a ch e s in a t t emp ts to imp rov e the g ene r a l w e l f a r e and w e l l - b e i n g o f the peop le . For e xamp le , in the ca se s o f th e A s i a n T ig e r s , p o pu l a r l y k n own as the N ew I ndu s t r i a l i s i n g Coun t r i e s (N ICs ) - T a iw an , Sou th Korea , S ingapo re and Honkong - it has been shown tha t e conom ic p owe r and ame l i o r a t i o n o f the p l i g h t o f the m a s s e s c an be a t ta in ed not t h r ough the d i sp e r s i on o f p owe r bu t c o n c en t r a t i o n o f p owe r in the hands o f gove rnmen t . Some c ommen t a t o r s have a rgued tha t the in i t i a l ph a se o f e conom ic d ev e l o pmen t in the sa id coun t r i e s can be c h a r a c t e r i s ed as a p e r io d o f e x t r eme po l i t i c a l r e p r e s s i o n and c e n t r a l i s a t i o n o f power . On the o the r hand , expe r i e nce s o f La t in Ame r i c an coun t r i e s r evea l a no th e r d imen s ion ; here d e c en t r a l i s ed s t ruc tu re s o f a dm in i s t r a t i o n se rved only as a more e f f ec t iv e tool for c en t r a l i s i ng powe r . The loca l gov e rnmen t e xp e r im en t led to chaos in the bu r e auc r acy . As wa s ta c i t ly de sc r ib ed , “d e c is io n s are so le ly made by g o v e rnm en t o f f ic ia l s o f r e g io n a l and d i s t r i c t c omm it te e s wh ile the lo ca l r e p r e s e n ta t i v e s are s i l e n t ; 2 University of Ghana http://ugspace.ug.edu.gh v i l la g e c o u n c i l s as m echan ism s o f p e o p le s p a r t i c i p a t i o n in d e c is io n -m ak in g , do no t have the p ow e r to d e c id e on the a l lo c a t io n o f r e sou rce s . Too often , the w o rd d e c e n t r a l i z a t i o n se em s to c o n vey on ly what the p u b l i c r e la t io n s d e p a r tm en ts w an t it to m ean " (Ma lo , 1997) . In v i ew o f th e d i f f e r en t c oncep t i on s o f d e c en t r a l i z a t i o n , it has been a rgued tha t in o rde r to m in im i s e its n eg a t i v e e f f ec t s and m ax im i s e p o s i t i v e o u t comes , d e c en t r a l i z a t i o n mus t be o p e r a t i o n a l i z e d in v a r i ou s se c to rs . A c omp r e h e n s i v e app roach in the e x e cu t i o n o f d e c e n t r a l i z a t i o n and deep sens e o f c omm i tm en t among im p l em en t e r s ac ro s s se c to r s is n e eded i f s ucces s is expec ted . 1.2 The con cep t o f p lann in g D i f f e r en t au tho r s have v a r i ou s ly de f i n ed p l ann ing , bu t the c ommon th r e ad tha t a ppea r s to run th rough all the c on c ep t s is the goa l o f im p rov i n g the w e l l - b e in g o f commun i t i e s . For e x amp le , L i c h f i e l d e t al. (1975 ) s t a te d th a t p l a nn ing sh ou ld be c on c e r n ed w i t h a c h i e v i n g ob j e c t i v e s w h i c h t h e r eby lead to some im p r o v em en t in the w e l l - b e i n g o f p e r son s w i t h in the commun i t y . P l ann ing is c on c e r n ed w i t h the a l l o c a t i on o f and use o f r e sou r ce s (Eve r s le y , 1973) , the d e v e l o pm en t o f a c t i v i t i e s w i t h in a r eg io n ( i n t r a - r eg iona l ) and the d i s t r i b u t i o n o f r e sou r c e s and a c t iv i t i e s b e tween r eg ion s ( in t e r - r e g ion a l ) (C onye r s , 1984) . It has a lso been in d i c a t ed tha t the ma in o b je c t i v e o f d e v e l o pm en t p l a nn ing p e rh ap s is to l ink ove ra l l n a t io na l d e v e l o pm en t to the av a i l a b l e r e sou r c e s to en su re o rde r ly d e v e l o pm en t as wel l as e f f i c i e n t or o p t im um a l l o c a t i o n o f the scarce n a t i ona l r e sou r c e s (Bo tc h i e , 1986) . D i f f e r en t type s o f p l ann ing can be d i s t i n gu i s h ed . The se i n c l ude phys ic a l p l a nn ing , wh ic h in vo lv e s the a l l o c a t i on o f l and use s and the con t ro l o f b u i l d in g e leva t i on ; e conom ic p la nn in g , wh ic h i n vo lv e s the a l l o c a t i on o f cap i ta l fo r hous i ng , in f r a s t r u c tu r e or i ndus t r i a l pu r po s e s and soc ia l p l a nn ing , whi ch in vo lv e s a l l o c a t i on o f l and , cap i t a l . 3 University of Ghana http://ugspace.ug.edu.gh emp l o ym en t o p po r t u n i t i e s , edu ca t i o n a l and o th e r soc ia l s e rv i c e s , r e v enu e and m anpow e r to p ro j e c t s and a reas w i t h the i n t e n t i o n o f a l t e r i n g the d i s t r i b u t i o n o f real i n comes ; as well as o the r t ype s l ike r e g ion a l p l a n n i n g , wh i ch in vo lv e s the p r e p a r a t i o n o f s t r a t eg i e s i n t e n d ed to o p t im i s e r e sou r c e s , u sua l ly on long te rm bas i s . Ev e r s e l y ( 1 973 ) i n d i c a t e d tha t ‘r e g iona l p l a nn ing is a c on t i n u ou s p ro c e s s , w h i c h does no t imp ly an amo rphou s , i n cohe r en t se t o f g u e s s e s ba s ed on w ide ly d i f f e r en t and w i l d ly imag ina t i v e s c e n a r i o s ’ . It is im po r t a n t to no te th a t wha t ev e r d e c i s i o n the p l ann e r t a k e s a f f e c t s the d i s t r i b u t i o n o f w ea l t h and real i n comes in a very im po r t a n t way . The p l ann ing p ro c e s s i t s e l f may thu s be d e f i n ed as a cou r s e o f a c t i v i t y th a t is i n t e nded to h e ig h t e n und e r s t a n d i n g o f the na tu re o f p r o b l em s r e qu i r i n g e x am in a t i o n , o f the a l t e r n a t i v e po s s i b l e so lu t i o n s t h a t ex is t , and o f the r e la t i v e me r i t s o f th e se a l t e r n a t i v e s (L i ch f i e l d , 1975) . Ano th e r a spec t o f p l ann ing tha t has o f ten been d i s c u s s e d w i t h i n the c on t ex t o f b ro ad e r cove r age is wha t is o f ten t e rmed i n t eg r a t ed p l ann ing . It is p l a nn ing wh i ch a t t emp t s to i n co rpo r a t e all se c to ra l (o r f u n c t i o n a l ) c ompon en t s o f a p l an and wh ic h c on s id e r s the i n t e r - r e l a t i o n s h i p b e tw een th ese se c to r s (and the a genc i e s r e spon s ib l e for t h em ) and r ega rd s the r eg io n as a who le r a th e r th an as a n umbe r o f s e c to r a l pa r t s (Conye r s , 1984). The cu r r en t d e c en t r a l i z e d p l a n n i n g d i s p e n s a t i o n in Ghana ta ke s on a spec ts o f i n te g r a te d p la nn in g . It s ta r t s at the d i s t r i c t or local l eve l and bu i l d s up to the na t i ona l l eve l v ia the r eg iona l l eve l . The f o l l ow ing s ec t i on s p rov id e a b a ckg ro und to d e c en t r a l i s a t i o n in Ghana and the type o f p l a nn ing f r amewo rk w i t h in wh i ch it c u r r en t l y ope ra te s . 1.3 D e c en tra l iz a t io n in Ghana Decen t r a l i s a t i o n as a fo rm o f g r a s s roo t s g ov e rnmen t and a dm in i s t r a t i v e te chn iqu e in Ghana is not new. It has c h a r a c t e r i s ed the coun t r y s d e v e l o pm en t t h i n k ing s ince co loni a l t imes (M in i s t r y o f Loca l 4 University of Ghana http://ugspace.ug.edu.gh Gov e r nm en t and Ru ra l D ev e l o pmen t (MLGRD) , 1994) . For e x amp le , a t t emp t s at local a dm in i s t r a t i o n du r ing the co lon ia l e ra were w i t h na t i v e a u tho r i t i e s tha t r e vo lv ed a round ch i e f s or some un i t s o f loca l r oya l ty . T h e s e na t i v e a u tho r i t i e s a s s i s te d the then co lon ia l g o v e r nm en t to a dm in i s t e r l aw and o rde r wi th l im i te d i n v o l v em en t in loca l a dm in i s t r a t i o n . S ince th en seve ra l po l i cy mea su r e s have been pu t in p l a c e f o l l ow ed by p a s s ag e o f l e g is l a t i on such as: • Loca l G ov e r nm en t O rd in ance 1951 (cap 64); • Loca l G ov e r nm en t Ac t 1961 (Ac t 54); • Loca l A dm in i s t r a t i v e Ac t o f 1971 (Ac t 389) ; and • Loca l Adm in i s t r a t i v e Ac t (Amendmen t Dec ree o f 1974, N LCD258 ) (MLGRD , 1994). The f r e quen t ch ange s in g ove rnmen t s and the lack o f c omm i tm en t to g r a s s roo t s d e v e l o pm en t p l ann ing and d e c i s i o n -m ak in g led to the n o n ­ a t t a i nmen t o f the d e s i r ed resu l t s . P l ann ing and im p l em en t a t i o n o f d e v e l o pm en t p r o g r am s were not d evo lv ed f rom the o v e r b u r d e n e d c en t r a l g o v e rnm en t (A kuoko -F r im pong , 1986) . P r e s en t day d e c e n t r a l i s a t i o n is c on c e i v ed as a g ov e rnmen t a dm in i s t r a t i v e t e c hn iqu e th a t p r omo t e s ra p id e conom ic and soc ia l ch ange s f rom be low , and th e s e have b e en g iven m ean ing th rough the pa s s age o f the fo l l ow ing leg is la t i on : • Loca l Gov e rnmen t L aw o f 1988 (PNDC Law 207) ; • 1992 Cons t i t u t i on ; • Loca l Gov e rnmen t Ac t 462 o f 1993; • Lo ca l G ov e r nm en t (Urban , Zona l and T own Counc i l and Un i t C omm i t t e e s (E s t a b l i s hmen t ) I n s t r umen t 1994 L .1 .1589; • NDPC Ac t 1994, Act 479; • N a t i ona l D ev e l o pm en t P la nn in g ( sy s t em) Ac t 1994 and Ac t 480; and • Civ i l Se rv ic e Law 1993, PNDCL .327 (MLGRD , 1994). The se en a c tmen t s have un ique p r ov i s i o n s g ea r ed t owa rd s e f f e c t i v e a t t a i nmen t o f the goa l s o f d ecen t r a l i s a t i on . One o f t he se u n ique f e a tu r e s is the d e vo lu t i o n o f the d e v e lopmen t p l ann ing proces s . For the p u rpo s e 5 University of Ghana http://ugspace.ug.edu.gh o f e f f e c t i v e g ov e rn an c e and sp read o f s o c i o - e co nom ic d e v e l o pm en t , the c oun t ry has been d iv id ed into 110 ba s ic un i t s o f g o v e r nm en t c a l l e d the D i s t r i c t A s s emb l i e s . The se have been made into the d i s t r ic t p l a n n i n g a u t ho r i t i e s to en su r e pa r t i c i p a t i on , c o - o rd i n a t i o n and i n t e g r a t i o n in to the p r e p a r a t i o n o f the D is t r ic t P lan (G ov e r nm en t o f Ghana , 1993) . The un ique f e a tu re o f th i s sy s t em is the e f f e c t i v e p a r t i c i p a t i o n o f the c ommun i t i e s . It en jo in s eve ry in d iv id ua l in the c ommun i t y to have ‘the r i gh t to be h e a r d ’ (NDPC , 1995). Some c ommen t a t o r s have agr eed tha t , so far , the d e c e n t r a l i s a t i o n p r o g r amme has p r oduc ed some po s i t iv e re su l t s . The loca l p e op l e have been en ab l ed to sh ow i n te r e s t in th e i r own a f f a i r s and p a r t i c i p a t e , even i f m in im a l l y , in p o l i c ie s and p r o g r ammes o f t h e i r a r ea s (Ayee , 1997) . P eop l e l i v ing in p r ev iou s ly neg l e c t ed ru ra l a r ea s have a l so g a in ed an in c r emen t a l acces s to cen t r a l g o v e rnm en t r e sou r c e s and in s t i t u t i o n s . Con t r a ry to th i s ha s been the v i ew tha t the d e s i r e d r e su l t s have not b een a ch i eved ow ing to l im i t ed r e sour ces . Thi s d i s i l l u s i o n ed e l e c t ed and n om in a t e d r e p r e s e n t a t i v e s such tha t the less e n dowed d i s t r i c t s r e s o r t ed to t a x a t i o n or s e l f -he lp p ro je c t s , mos t l y in c o l l a b o r a t i o n w i t h n o n ­ g ov e rnm en t a l o r g an i s a t i o n s (NGOs) (Ayee , 1997) . The f ac t was tha t e x p e c t a t i o n s we re h igh at the ea r ly s tages o f i n c ep t i o n o f the p r o g r amme , bu t the D is t r ic t A s s emb l i e s neve r r ea l l y a c c ep t ed local r e s pon s i b i l i t y for loca l d eve lopmen t , a l t hough th ey were i n t e n d ed to do so. 1.4. D e c en tr a l i s a t io n and the p lann in g process Dev e l o pm en t p l a nn ing in s ub -Saha r an Afr ica , a c co rd ing to F r i e dm ann (1992) , has a lways been a con te s te d is sue . Unde r c o lo n i a l i sm and in the ear ly i n d ep end en c e pe r iod , p la nn in g fa i led to r ed re ss u n d e r d e v e l o pm en t and b e c ame la rge ly an id eo log ic a l ac t i v i t y i n t e nded to l e g i t im iz e the c o lon i a l and po s t - c o lon i a l s ta te (Hyden , 1983; Rakod i , 1986) . It is on ly in r e c en t t ime s t h a t more neo l i be ra l mode ls wh ich v a lo r i s e the ma rke t 6 University of Ghana http://ugspace.ug.edu.gh as the on ly genu in e mean s to d eve lo p have been put in to p r a c t i c e among some c oun t r i e s (Wa t t s , 1994) . Wi t h it ha s come the r emova l o f the h i t h e r t o s t a t i s t t o p - d own p l ann ing sy s tem and i ts r e p l a c em en t w i t h a m a r k e t - d r i v e n mode l o f d ev e l o pmen t in wh i ch i n d iv idu a l goa l - o r i e n t a t i o n ’ is emph a s i s e d (Mohan , 1996). G h an a is among the few sub -Saha r a A f r i c an c oun t r i e s to have emb a r k e d upon s t r u c tu r a l a d j u s tm en t p r o g r ammes (He rb s t , 1993; L ee cho r , 1994) and wh i l e at it has wo rk ed towa rd s an amb i t i o u s d e c e n t r a l i z a t i o n p r o g r amm e (Ayee , 1991; Mohan , 1993; C rook , 1994) w i t h the n eo l i b e r a l d e v e l o pm en t mode l (as r e g a rd s p l a nn ing ) i n v o l v i n g the b o t t om -up app roach . G h a n a ’s examp le has been c i ted as i n s t r u c t i v e b e c au s e it has been in the fo r e f r on t o f d e v e l o pm en t p l an n i n g , even und e r c o lon ia l ru le w i th the a dv en tu r ou s G ugg i sb e r g P la n o f 1919 (Bo tc h ie , 1986; F r im pong -An s ah , 1991) . The p r e s en t p l a nn ing sy s tem is more a r e a -b a s ed , f l ex ib l e and does no t a l i ena te the mass o f soc i e ty . It beg in s w i t h the N a t i o n a l D ev e l o pm en t P l ann ing Comm i s s i o n (NDPC) p r e s c r i b i n g the f o rma t and c on t e n t o f the d ev e l o pmen t p l ans . H i t he r to , p l a nn ing was c h a r a c t e r i s e d by a long cha in o f a c t i v i t i e s b e tw een the c l i en t ( spec i f ic p ro j e c t in the d i s t r i c t or r eg ion ) and the se rv i c e d e l i ve re r ( n a t i ona l gov e rnmen t ) . P l an n i n g was t h e r e fo r e o v e r - c e n t r a l i s e d wi th seve ra l s tages o f d e c i s i o n -m ak in g . The p r e s en t f r am ewo rk p r e s c r i b e s the p r o v i s i o n o f the d i s t r i c t p ro f i le ba s ed on cu r r en t s ta tu s (NDPC , 1995). I n f o rma t i o n is r e qu i r ed on p hy s i c a l e n v i r o nmen t a l c ond i t i on s , soc ia l and e conom ic c ond i t i on s , p o p u l a t i o n cha r a c t e r i s t i c s and the ma in d ev e lopmen t p r ob l em s o f the d i s t r ic t s . The f r am ewo rk a lso r equ i r e s the use o f g r aph ic i n f o rma t i o n i n c lu d ing maps to i l lu s t r a t e ex i s t i ng (or cur ren t ) c ond i t i on s and the o u t c ome o f p lan p ropo sa ls . The r e qu i r em en t s o f th i s f r amewo rk ind ic a te h ow i n t eg r a t ed the p l ann ing wou ld be and a lso a l l ow for p opu l a r p a r t i c i p a t i o n . The 7 University of Ghana http://ugspace.ug.edu.gh bas ic p l a n n i n g un i t s a re the un i t c omm i t t e e s found in eve ry c ommun i t y t h r o u g h o u t the coun t ry (F igu re . 1.1). F ig u r e 1.1: S t r u c tu r e o f the new local g ov e rnmen t sy s t em REG IONAL CO-ORDINATING COUNC IL . SUB -METROPOL ITAN DISTRICT COUNCILS (13) TOWN i COUNCI A R EA LS (58) UNIT COMM ITTEES | ZONAL COUNCILS (108) M ETRO PO L ITAN A S S EM B LY (3) MUN IC IPA L ASSEMBLY (4) DISTRICT A S S EM B LY (103) URBAN. TOWN & A R EA COUNCILS (34,250.826) UNIT COMM ITTEES UNIT COMM ITTEES 10 I 10 13 1374 16000 Source: . M in is t r y o f Loca l Gove rnmen t and Rura l D ev e l o pmen t , 1994 The 16000 un i t c omm i t t e e s c ons t i t u te the g r a s s roo t s e s t a b l i s hm en t s f rom wh ic h the d ev e lopmen t a l needs and p l ans a re s yn th e s i s ed . Thus , the na t io na l p lan ta ke s on aspec ts o f i n t e g r a t ed p l an n i n g wh i ch c on s id e r s i n t e r - r e l a t i o n sh ip b e tween se c to r s ( f unc t i ona l a g enc i e s at d i s t r i c t l eve l ) , r eg io n s , e tc , r a th e r th an as a n umbe r o f s e c to r a l pa r t s . The c ommun i t i e s are the ta rg e t b en e f i c i a r i e s o f d e v e l o pm en t and th e re is the need to equ ip t h em w i th k now ledge and i n f o rm a t i o n abou t wha t a f f ec t s th e i r l iv ing cond i t i on s and oppo r t u n i t i e s th a t are a v a i l a b l e to imp rove them. F i gu re 1.1 shows tha t the p l ann ing p ro c e s s s ta r t s f rom b e low and move s upwa rd to the 10 Reg iona l Co -o rd i n a t i n g Coun c i l s (one for each r eg ion o f the count ry) . 8 University of Ghana http://ugspace.ug.edu.gh F igu r e 1.2: D is t r i c t d e v e l o pm en t - p l a n n i n g sy s tem Source : M in i s t r y o f Lo ca l Gov e rnmen t and Ru ra l D ev e l o pm en t , 1994. The p l a nn ing s y s t em a lso in vo lv e s c o l l a b o r a t i o n among the v a r i ou s f u n c t i o n a l a g enc i e s in the D is t r i c t A s s emb l i e s . The se f u n c t i o n a l ag enc ie s , a lso r e f e r r ed to as the D i s t r i c t D ep a r tm en t s (F igu r e 1.2), p r e s en t th e i r i nd iv id u a l p lans to the D i s t r i c t P l ann ing C o - o r d i n a t i n g Un i t wh i ch in tu rn subm i t t h em to the Off ic e o f the D i s t r i c t A s s emb ly . The se p l an s a re th en in te g r a te d and made into a ho l i s t i c p l an for the d i s t r ic t . The inpu ts f rom the va r io u s c ommun i t i e s and d e p a r tm en t s a re ve ry c ruc i a l in p ro v i d i n g a th o rough p ic t u r e o f the re a l i t i e s o f the s i t u a t i on s at the g ra ss roo t s . Theo r e t i c a l l y , p l a nn ing r equ i r e s a c t i v e p a r t i c i p a t i o n o f the p o pu l a t i o n (Ward , 1986) . It s hou ld be open , d emoc r a t i c and p a r t i c ipa t i v e . The s tudy l ooked at the aspec ts o f spa t ia l da ta in t e g r a t i o n for p l a n n i n g and d e c i s i o n -m ak in g and opi ned tha t ho l i s t i c p lan d ev e l o pm en t and d e c i s i o n -m ak in g can be ach ie ved by f i nd ing a te chn iqu e for i n t e g r a t i n g 9 University of Ghana http://ugspace.ug.edu.gh se t s o f d a t a / i n f o rm a t i o n he ld by the va r io u s d ep a r tmen t s . Th is is a p r e ­ r equ i s i t e for GIS i n t e rop e r ab i l i t y , e sp e c i a l l y whe r e GIS is to be u s ed as a p l a n n i n g and d e c i s i o n s uppo r t tool in the D i s t r ic t A s s emb l i e s . The s tu dy fo cu s ed on the hea l th and s an i t a t i on se c to r s o f the d i s t r i c t e c o nomy and p r opo s ed a s cheme for d a t a i n t e g r a t i o n and the d e s i g n o f a p r o t o t y p e GIS. 1.5 The G IS te chn iqu e GIS is a c ompu t e r - b a s e d te chn iqu e th a t f a c i l i t a te s th e c ap tu r e or en t ry , s to r age , m an i p u l a t i o n , r e t r i eva l , a na ly s i s and d i s p l ay o f sp a t i a l d a ta (C la rke , 1997) . Becau se th e se da t a can be a cce s s ed , t r a n s f o rm ed , and m an ip u l a t e d i n t e r a c t i v e l y in a GIS, th ey can se rve as a t e s t b ed for, s t u dy ing en v i r o nmen t a l p ro c e s s e s or for a n a ly s i ng the r e su l t s o f t rend® or a n t i c i p a t i n g the po s s i b l e re su l t s o f p l a nn ing d e c i s i o n s (Borroughs 1987) . A c co rd ing to Ca lk in s & Tom l i n s o n (1976 ) , the g ene r a l f u n c t i o n o f GIS is to acqu i r e , s to re , man ipu l a t e and d i s p l ay g eog r a ph i c d a t a for d e c i s i o n -m ak ing . By u s in g the GIS, it is, in p r i n c ip l e , p o s s i b l e for p la nne r s and d e c i s i o n -m ak e r s to e xp lo re a r ange o f p o s s i b l e s c ena r i o s and to ob t a i n an idea o f the con s equen ce s o f a cou rs e o f a c t i on b e fo r e the m i s t a ke s have b e en i r r evocab ly made in the l and sc ape (Bo r r o ugh , 1987) . Maps con s t i t u t e the p r imary sou rce ma t e r i a l fo r su ch sy s tems . O the r sour ce ma te r i a l s inc lude sa te l l i t e da ta , po in t o b s e r v a t i o n s , i . e. , r a in fa l l or t abu la r d a t a a ss oc i a t e d w i th g eog r aph i c a rea s , i .e. c en su s r ecords . 1.6 GIS app l ic a t ion for d is tr ic t leve l p lann in g and d e c i s io n -m ak in g It is no te d tha t loca l g ov e rnmen t or in the G hana i an con t ex t the D i s t r i c t A s s emb ly , is one o f the mos t impo r t an t g roups o f us er s o f GIS . The r ange o f a pp l i c a t i o n in the f ie ld is very con s id e r ab l e , e x t e n d i n g f rom p rope r t y r eg is te r s and h i g hway s m an ag em en t to eme rg en cy and l a ndu se p l ann ing (D ep a r tm en t o f E nv i r onmen t UK, 1987) . V a r i ou s s t ud ie s on the level o f GIS a dop t i on in local g ov e rnmen t have shown a h igh leve l 10 University of Ghana http://ugspace.ug.edu.gh o f c omm i tm en t to the t e c hno logy in sever a l c oun t r i e s i n c lu d i n g the US (W igg i n s & F rench , 1991) , Eu rope as a who le (G reen , 1990) , I t a ly (C rag l i a , 1992) , and the UK (B idd ic k , 1991; W i l l i s & Nu t t e r , 1990; C ampbe l l & Masse r , 1992) . Loca l g o v e rnm en t or the d i s t r ic t a s s emb ly is a good e n v i r o nm en t in wh ic h to s tudy the p ra c t ic a l c o n s e q u e n c e s o f GIS. It is one o f the few o rg an i s a t i o n a l con t ex t s in wh i ch th e r e is p o t e n t i a l l y s i g n i f i c an t in t e r e s t in the ful l range o f a p p l i c a t i o n f i e ld as we l l as be ing one o f the mos t im po r t an t u se r s o f GIS. GIS has been de f in ed bo th as a too l and a d a t ab a s e sy s t em . As a too l , it is a p owe r fu l fa c i l i t y for c o l l e c t i ng , s to r ing , r e t r i e v ing at w i l l , t r a n s f o rm ing and d i s p l a y ing spa t ia l d a t a f rom the real wo r ld (B o r r o ugh & M cDonne l l , 1998) . As a d a ta ba se sy s tem , it f a c i l i t a te s sp a t i a l da t a i n d ex ing and enab l e s the p e r f o rm anc e o f sets o f op e r a t i o n s in o rd e r to a n swe r que r ie s a bou t spa t ia l en t i t i e s in the d a t ab a s e (Sm i th et al. 1987) . An impo r t a n t p roduc t o f GIS is the map . It f a c i l i t a te s the p r o d u c t i o n o f c u s t om i s e d maps at any sca le show ing f e a tu r e s i n d iv idu a l l y or in any numbe r o f comb in a t i o n s . The r e l e vance o f map s for t a k ing i n v en to r y o f ear th r e sou r c e s da te s back to an t i q u i t y (B o r rough , 1987) . Maps gene r a l l y enab le d i s cu s s i on s o f r e s ou r c e s and d ev e l o pm en t p o t en t i a l s ince it is on ly t h r o ugh the i r m ed ium th a t g e og r a ph i c a l r e l a t i o n s h i p s can be c ompa r ed and app r e c i a t ed (Ox fo rd Un ive r s i t y , 1963) . They are i n s t r umen t s for r e co rd ing , c a l cu l a t i ng , d i s p l ay in g , a n a ly s i n g and in gene ra l u n d e r s t a n d i n g the in te r r e l a t i on o f th in gs in th e i r spa t ia l r e l a t i o n s h i p s (R ob in s o n et a l . , 1995). The se bas ic f unc t i on s u nd e r l i e the need for th e i r a p p l i c a t i o n for spa t ia l p l a nn ing and d e c i s i o n -m ak in g at all l eve ls . Keeb le (1969 ) wro te th a t p l ann in g s u rveys and ana ly s i s o f su rv ey s and p l a nn ing p ropo s a l s have to be p r e s en t ed g r aph ic a l l y ; t h o ugh th i s g r aph ic p r e s e n t a t i o n mus t be supp l emen t ed by wo rd s and f ig u re s 11 University of Ghana http://ugspace.ug.edu.gh ( s t a t i s t i c s ) , they are s ubo rd i n a t e d to it. P l ann ing dea ls w i t h land ( sp ace ) and la nd and i ts use a re, fo r the mos t par t , be s t d e s c r i b e d and a n a l y s e d by map s , p la n s and mode ls . Even t h ough w r i t te n and spoken c ommun i c a t i o n s are impo r t an t , they can only p a r t i a l l y and impe r f e c t l y p e r f o rm much wo rk tha t is s imp ly and e f f i c i en t l y done by g r aph i c a l means . GIS app l i c a t i o n at the d i s t r ic t l evel wi l l f a c i l i t a te the s tu dy o f d i v e r s e sp a t i a l p r o c e s s e s and e nhance ana ly s i s o f the r e su l t o f t r e nd s or f'ot- a n t i c i p a t i n g the p o s s i b l e re su l t s o f p l a nn ing de c is io n s . 1.7 The p rob lem The s tudy f o cu se s on two fu nd amen t a l p r o b l em s o f the D is t r ic t . The se a re the g ene r a l p r o b l em o f d a t a / i n f o rm a t i o n i n t e g r a t i o n among the d i s t r i c t a s s emb ly d ep a r tm en t s and the p r o b l em o f he a l t h and s a n i t a t i o n in the d i s t r ic t . The p r o b l em o f spa t ia l d a ta i n t e g r a t i o n has em e r g e d as an impo r t a n t r e q u i r em en t in the d e c en t r a l i z e d p l an n i n g s cheme . I n f o rm a t i o n has been d e s c r i b ed as a v a l u ab l e r e sou r c e in p l a n n i n g (D ias & Poudya l , 1992) at bo th na t i ona l and sub -n a t i o n a l l eve ls . The way da ta is a cqu i r ed and p r o c e s s e d and the adv an t a g e s to be d e r iv ed f rom i n t e r ­ d ep a r tmen t a l d a ta sh a r in g are ye t to be ta ck l ed in the b u s in e s s o f d e c en t r a l i z e d p la nn in g . The p r o b l em o f hea l t h and s an i t a t i on a re among the bas ic i s sue s o f d i s t r ic t l eve l d e v e l o pm en t for wh ich ad equa te da ta and bas ic a n a ly t i c a l too l s are r e qu i r ed to s uppo r t po l ic y d e c i s i o n -m ak in g and p l ann ing . The o c cu r r en ce and d i s t r i bu t i on o f c e r ta in c a t ego r i e s o f d i s e a s e s and th e i r a s s o c i a t i o n w i th c e r ta in s an i t a t i on p rac t i c e s , sol id was t e d i s po s a l fo rms and ty pe s o f h o u s eho l d wa te r supply sou rces need to be in v e s t i g a t ed . Th is cou ld be a t t a in ed th rough the use o f t oo ls th a t a sc e r t a i n no t on ly these r e l a t i o n sh ip s but a lso e s t ab l i sh the type o f spa t ia l d a t aba s e tha t cou ld be u t i l i s ed for p la nn ing and po l ic y d e c i s i o n -mak ing . 12 University of Ghana http://ugspace.ug.edu.gh 1 .7 .1 The p r o b lem o f d i s t r i c t le v e l p la n n in g A p e c u l i a r fe a tu re o f the p l ann ing sy s t em at the d i s t r i c t l eve l is the e f f e c t i v e p a r t i c i p a t i o n o f the commun i t i e s and the c o l l a b o r a t i o n among the v a r i o u s f u n c t i o n a l a g enc i e s in the D i s t r ic t A s s emb ly . The f r am ewo r k for the p la n s ou t l i n ed by the NDPC en jo in s eve ry D i s t r i c t to p r o v i d e a p ro f i l e ba se d on cu r r en t s ta tu s , i n f o rm a t i o n on phy s i c a l e n v i r o nm en t a l c ond i t i o n s , p o pu l a t i o n c h a r a c t e r i s t i c s and the ma in d e v e l o pm en t p r o b l em s o f the d i s t r ic t . The f r am ewo rk a lso r equ i r e s the use o f g r aph i c i n f o rm a t i o n in c l ud ing map s to i l l u s t r a te e x i s t i n g (or c u r r en t ) c ond i t i o n s and the ou t come o f p la n p r opo s a l s (NDPC , 1995) . The f o rma t r e qu i r e s a s yn th e s i s o f the d i s t r i c t ’s p r o b l em s , o b j e c t i v e s and goa l s t h r o ugh se c to ra l i npu t s for the p l ans . Among the f u n c t i o n s o f the D ev e l o pmen t P l a nn ing S u b -C omm i t t e e o f the D i s t r i c t A s s em b l i e s is the d ev e l o pmen t o f an i n f o rm a t i o n b a se on the r e sou r c e s (MLGRD , 1996) . Thi s i n f o rm a t i o n base cou ld be r e f e r r ed to as a d a ta ba se . The in a d equa cy o f i n f o rm a t i o n n e c e s s a r y for p l a n n i n g for the o p t im um u t i l i s a t i o n o f r e sou r c e s in the d i s t r ic t s has led to sho r t f a l l s in i n f o rm ed de c i s i on -mak ing . In many ca ses the da ta a re n o n ­ e x i s t e n t or are found in fo rms tha t a re d i s o rg an i s ed and r equ i r e to be d e c i p h e r e d by the p l anne r . Th is make s da ta g a t h e r i ng exp en s i v e and o f ten lead to loss o f t ime . The f o rma t does no t a l so p r e s c r ib e or s ugge s t the t ype s o f t e c h n i q u e s or too ls to be app l i e d for the i n t e g r a t i on o f the s ec to ra l or d e p a r tm en t a l in pu ts to the d i s t r ic t p lan . It men t i o n s c o l l a bo r a t i o n among the d i s t r ic t d e p a r tm en t s w i t h ou t spe c i f y i ng the na tu re o f c o l l a bo r a t i o n . It is o b v iou s th a t me re c o l l a bo r a t i o n among the se func t i ona l a g enc i e s wil l no t be e n ough to p r oduce an in te g r a te d and ho l i s t i c i n f o rm a t i o n / d a t a b a s e for p l a nn ing for the D is t r ic t s . N e i t h e r wi l l it p rov id e for i n fo rmed 13 University of Ghana http://ugspace.ug.edu.gh po l i c y d e c i s i o n s tha t w i l l l e ad to a more e f f e c t i v e and less w a s t e f u l a dm in i s t r a t i o n and d i s s i p a t i o n o f r e sou rc es . A s t udy o f the d i s t r ic t , ba sed on the da ta t ype s a c qu i r e d and p r o c e s s e d by th e v a r i o u s d ep a r tm en t s , s howed tha t da ta i n t e g r a t i o n for al l a s p e c t s o f p l a n n i n g and po l i c y d e c i s i o n -m ak in g is ye t to be a f e a tu re o f the d e v e l o pm en t p roce s s . Many o f the d ep a r tm en t s c o l l a bo r a t e w i t h ea ch o th e r bu t not in the a r ea o f d a ta e x change in o rde r to save cos t and t ime o f o p e r a t i o n s , among o ther s . So far the v a r i ou s d e p a r tm en t s use t r a d i t i o n a l and a n a logu e me thod s o f sp a t i a l d a ta cap tu re , m an i p u l a t i o n , a n a ly s i s , and d i sp l ay . Da ta is s t o r ed on pape r or in t r a d i t i o n a l f i l e s or d a t a b a s e s . The i r r eu se for n ew app l i c a t i o n s b e come s a p rob l em . Gene r a l l y , the p r e s e n t m e t h od is h a nd i c app ed in seve ra l ways , no t ab ly : (a) p r o c e s s e s i n v o l v ed in i n f o rm a t i o n / d a t a p r e s e n t a t i o n o f t en lead to los s o f i n f o rma t i o n ; (b) p r o d u c t i o n o f seve ra l shee t s o f map s whe r e the v o l um e o f i n f o rm a t i o n is h igh ; (c) d i f f i c u l t y in r e t r i e v ing da t a f rom maps to c omb in e w i t h o th e r sp a t i a l da ta ; (d) p r o b l em s o f u pd a t i n g da ta; and (e) in ca se s whe r e map s are the m ed ium o f e x p r e s s i n g sp a t ia l f o rms , the f ac t r em a in s t h a t the p r i n t ed map is a s ta t ic q u a l i t a t i v e documen t . B o r r o ugh ( 1987 ) has i nd i c a t ed th a t in s uch case s , it b e come s ex t r em e ly d i f f ic u l t to a t t emp t quan t i t a t i v e sp a t ia l a na ly s i s w i t h i n th e un i t d e l i n e a t e d on a t h ema t i c map w i t h ou t r e s o r t i n g to c o l l e c t i n g n ew in f o rma t i o n for the s p ec i f ic pu rpo se on hand . The co l l e c t i o n o f d a t a and the p u b l i c a t i o n o f a p r in t ed map are cos t l y and t im e - c o n sum ing . C on s e qu e n t l y , the e x t r a c t i o n o f s ing le t h eme s f rom a g en e r a l - p u rp o s e map can be p r o h ib i t i v e l y expen s iv e i f the map must be r e d r awn by hand . 14 University of Ghana http://ugspace.ug.edu.gh P l a n n i n g is a d y n am ic p r o c e s s ac t i v i ty th a t in vo lv e s c h ange and h ow to a d d r e s s t h e change . Thi s p ro c e s s is e nh an c ed w i th the use o f to o l s th a t a l l ow for the p r o j e c t i o n o f a l t e r n a t i v e o u t c ome s or r e v i s i o n o f p l a n s so tha t mo re in fo rmed d e c i s i on s can be made . For e x amp le , the p r e s c r i p t i o n for the use o f g r aph ic i n f o rm a t i o n i n c l ud ing maps to i l l u s t r a t e e x i s t i n g c ond i t i o n s and the o u t c ome o f p lan p r opo s a l s (NDPC , 1995) w ou ld be f a c i l i t a t e d by the use o f the GIS t e chn ique . G e o g r a p h i c a l I n f o rm a t i o n Sys tems t e c hn iqu e s f a c i l i t a t e i n t e g r a t e d and c o n j u n c t i v e a na ly s i s o f l a rge v o lumes o f m u l t i d i s c i p l i n a r y da ta , bo th spa t ia l and n on sp a t i a l w i t h in the same g eo r e f e r en c i n g s cheme ( S a r a f & C houdhu r y , 1998) . G eog r aph i c a l i n f o rm a t i o n t e ch no l o gy is a pp l i e d as a too l to f a c i l i t a t e the i n t e g r a t i o n o f da ta or i n fo rm a t i o n he ld by the v a r i o u s d e p a r tm en t s or se c to rs on s epa ra te l o ca t i on s w i t h i n the d i s t r ic t s . It a l so le ads to s t a n d a rd i s a t i o n and h a rm on i s a t i o n o f da ta. The t e c h n i q u e f a c i l i t a t e s a d i g i t a l en t ry o f e x i s t i ng or c u r r en t c o nd i t i o n s in the d i s t r i c t s and is a l so capab le o f ex e cu t i n g the t ype o f s c ena r i o s r e qu i r e d for p r e d i c t i n g the ou t come o f p l an p ropo sa ls . The th es i s f o cu s e s on GIS and its use as a too l for i n t e g r a t i n g the type o f i n f o rm a t i o n r e qu i r e d for p l a nn ing and for the he a l t h and s a n i t a t i o n s ub - s e c to r s o f the Ga D i s t r i c t A s s emb ly and a l so d emon s t r a t e s its c a p ab i l i t i e s as a d e c i s i o n suppo r t too l . It is a imed at the d e s i gn o f a s cheme for i n t e g r a t i n g se t s o f spa t ia l d a ta or i n f o rm a t i o n he ld w i th in the d e p a r tm en t s in the D is t r i c t A s s emb ly and a lso p rov id e s the e l emen t s for a p r o to t yp e GIS for the d i s t r ic t . 1 .7 .2 The p r o b lem o f h ea l th a n d s a n i ta t io n in the Ga D is t r ic t The Ga D i s t r ic t is one o f the f ive d i s t r ic t s wh i ch make up the G re a t e r A cc r a Reg ion . It is l o ca t ed to the wes t and pa r t ly to the no r t h o f the reg ion . The d i s t r ic t does no t have a d i s t r i c t ho sp i t a l o r a po ly c l i n i c . M a t e rn a l and Ch i l d Hea l t h (MCH) and Fam i l y P l a nn ing (FP) s e rv ic e s 15 University of Ghana http://ugspace.ug.edu.gh are p r o v i d e d by th r e e rura l h e a l t h c en t r e s in the d i s t r i c t , the C ommun i c a b l e D i s e a s e Hosp i t a l (CDH) and the f ive p u r e l y MCH c l in ic s . In add i t i on , g row th mon i t o r i n g and immun i s a t i o n s e rv i c e s a re o f f e r e d on ou t r e a ch bas i s (Ga D is t r i c t A s s emb ly , 1996) . M a jo r he a l t h p r o b l em s a re c a t e r ed for in h o sp i t a l s and po ly c l i n i c s in the A cc r a M e t r o p o l i t a n A s s emb ly (AMA) or in the ho sp i t a l at N s aw am in the A kw ap im Sou th D is t r i c t . The d i s t r ic t has f ive M in i s t r y o f H ea l t h f a c i l i t i e s and th e se f o rm the bas i s upon wh ic h the d i s t r ic t has been d i v i d e d for h e a l t h p l a n n i n g and adm in i s t r a t i o n . The d e l i n e a t i o n o f the h e a l t h s u b -d i s t r i c t s is i l l u s t r a t e d in F i gu re 6.1 in page 111b. S tud i e s show th a t the d i s t r ic t suf fe rs f rom low pa t r o n ag e or u s a g e o f h e a l t h f a c i l i t i e s (Ga D i s t r i c t A s s emb ly , 1996) . Even t h o u g h seve ra l f a c t o r s a c coun t for th i s p h enomenon , it ha s been e xp l a i n ed th a t d i s t a n c e and the na tu re o f c ommun i c a t i o n n e two rk po se p r o b l em s o f a c c e s s i b i l i t y to h e a l t h c a r e f ac i l i t i e s . K ing (1998) i nd i c a t ed t h a t c ommun i t i e s l i v in g a lo ng or c lo se to the ma in A c c r a -N s aw am co r r i d o r a pp ea r ed to p a t r o n i s e hea l t h care f a c i l i t i e s th an thos e f a r th e r away. S to ck (1992 ) a l so fo und d i s t a n c e to be a m a jo r d e t e rm in an t o f fa c i l i t y use. The th e s i s fu r t h e r f ocuse s on the a p p l i c a t i o n o f GIS to a sc e r t a i n the l o ca t i ona l e f f i c i e n cy o f the h e a l t h f ac i l i t i e s . Ma la r i a , d i a r r hoea , a cu te eye in f e c t i on s , ch i ck en pox , ear i n f e c t i o n s , uppe r r e s p i r a t o r y i n f e c t i on s , mea s le s , i n t e s t i n a l wo rm s i n f e s t a t i o n and bu ru l i u lc e r are e nd em ic in the d i s t r ic t . S ub s ta n t i a l ca se s o f bu ru l i u lc e r (M yco b a c te r ium u lc e ran s ) have been r epo r t ed in the d i s t r ic t . For ex amp le , in a su r v e i l l a n c e moun t ed in 1993 by the R eg ion a l H ea l t h M an ag em en t Team , 100 cases o f the d i s e a se were i d en t i f ie d . Ou t o f t he se , 98% o f the ca se s c ame f rom the Ga D is t r ic t (M en s a h -Q ua i n oo , 1997) . 16 University of Ghana http://ugspace.ug.edu.gh Tab l e 1.1 i n d i c a t e s t h a t 39 .8% o f o u t p a t i e n t s ’ d e p a r tm en t (OPD) ca se s is r e l a t e d to m a l a r i a wh i ch is the d om in an t d i sease . T ab l e 1.1: Top ten d i s e a se s seen at OPDs in the Ga D is t r ic t No. D i sea se s No. o f c ases % 1 Ma la r i a 3758 39.8 2 Sk in d i s e a s e s 1756 18.7 3 Uppe r r e sp i r a t o ry in fect . 989 10.6 4 D ia r rhoea l d i s eas e s 796 8.5 5 Acu te eye i n f e c t i on 240 2.5 6 Mea s l e s 159 1.6 7 Ch i c k en pox 126 1.4 8 Ear i n f e c t i on s 69 0.7 9 In t e s t i n a l wo rms 48 0.5 10 All o th e r d i s ea se s 1490 15.7 Tota l 9431 100 Sou rc e : MOH /G h a n a Hea l t h Se rv ic e , 1998. The g ene r a l c au se s o f t he se d i s e a se s a re we l l k nown , and the ro le o f GIS is to f u r t h e r a s c e r t a i n th e i r spa t ia l in c i d ence , l eve l o f e n d em ic i t y and th e i r r e l a t i o n s h i p w i t h e n v i r o nmen t a l f ac to r s su ch as t ype s o f s a n i t a t i o n p r a c t i c e s , f o rms o f so l id wa s te d i spo sa l and s ou r c e s o f h o u s e h o l d wa t e r supp ly . Thi s a spec t o f the s tudy is a im ed at h e l p i n g to provide , e l emen t s for po l ic y d e c i s i o n -m ak in g and for p l a nn ed con t ro l m ea su r e s for th e s e d i s ea se s . In the a r ea o f s an i t a t i on , it is no t ed tha t the Ga D is t r i c t s u f f e r s f rom in d i s c r im in a t e d e f e c a t i o n (Ga D is t r ic t A s s emb ly , 1996) . Pan la t r in e and the Kumas i V en t i l a t e d Imp roved P i t (KVIP ) f a c i l i t i e s ex is t on a smal l sc a l e in some in d iv id ua l homes and c ommun i t i e s . So l id was t e d i spo sa l is m o s t l y by open or c rude dump ing , r e su l t i ng in many u n a pp ro v e d dumps . C on s equen t l y h igh cases o f c ommun i c a b l e d i s e a s e s we re 17 University of Ghana http://ugspace.ug.edu.gh r e p o r t e d in the v a r i ou s hea l t h i n s t i t u t i on s in the d i s t r ic t . N in e o f the d i s e a s e s r e po r t e d at the m a jo r su b -d i s t r i c t h e a l t h i n s t i t u t i o n s in 1998 em e r g e d as the m a jo r ones , w i th m a l a r i a and sk in d i s e a s e s as the d om in a n t cas e s (Tab le 1.1). The c ommun i c a b l e d i s e a s e s c ou ld be c a u s e d by un s an i t a ry and o the r e n v i r o nmen t a l c ond i t io n s . H o u s e h o l d wa t e r s upp ly is ye t ano th e r m a jo r p r o b l em in th e d i s t r ic t . A sub s t a n t i a l p r o p o r t i o n o f the s e t t l emen ts d ep end on we l l s and b o r e ho l e s wh i l e o t h e r s l i v in g a long the ma in r i v e r s and s t re ams d ep end on th e s e s ou r c e s . The v a r i ou s da t a set s can be i n t e g r a t ed t h r o ugh the ov e r l a y m e th o d to show co r r e l a t i o n s th a t cou ld he lp i n fo rm po l i c y and d e c i s i o n ­ m ak in g on con t ro l mea su r e s and edu ca t i o n a l p r o g r amme s wh i c h m i t i g a t e the e f f e c t s o f s ome o f th e se d i s ea se s . The se p r o b l em s can be a na ly s ed in a sp a t ia l c on t ex t and thu s f o rm a good bas i s fo r GIS app l i c a t i on . A c co rd i n g to C la rke (1997 ) , r e su l t s o f sp a t i a l a n a ly s i s a re g ene r a l l y easy to in te rp r e t and a re thu s p owe r f u l t oo ls fo r use in r e sou r c e m anagemen t , p l a nn ing and po l i c y d ev e l o pmen t . 1.8 L i t e r a tu r e R ev iew The po t en t i a l o f g e og r a ph i c i n f o rm a t i o n t e chno log i e s to en te r , s to re , d i s p la y , m an i p u l a t e and ana ly se spa t ia l d a ta has long been r e cogn i s ed . Howeve r , ve ry l i t t l e is k n own abou t the a c tua l impa c t th i s c ompu t e r - b a s ed t e c h n o l o g y is h av ing in p r a c t i c e (C ampbe l l , 1994) . The i n t r o d u c t i o n o f GIS in to o rg an i s a t i o n s c e r t a in ly o f f e r s o p po r t u n i t i e s for a mo re r a t i ona l d e c i s i o n -m ak in g ; th i s l eads to a more e f f e c t i v e and less wa s te fu l a dm in i s t r a t i o n and d is s i p a t i o n o f sc a rce r e sou rce s . Con s i d e r a b l e p rog r e s s has been made in the app l i c a t i o n o f g e og r a ph i c i n f o rm a t i o n t e c hno logy for the a na ly s i s o f spa t ia l d a ta for d e c i s i o n m ak in g and p l ann ing in bo th the d ev e lop ed and d ev e lop ing coun t r ie s . The use o f GIS in d ev e lop ing coun t r ie s for r e sou r c e m a n a g em en t is 18 University of Ghana http://ugspace.ug.edu.gh e x em p l i f i e d by T app an et al. (1991) who d i s c u s s e d the m o n i t o r i n g o f g r a s s h o p p e r and lo cus t h ab i t a t s in S ahe l i an Af r ic a . Fox ( 1 991 ) and P i e t e r v an T e e f f e l e n et al. (1992) have d i s c u s s e d v a r i ou s i n s t i t u t i o n a l i s s u e s e n c oun t e r e d when us ing GIS in a d ev e l o p i n g na t ion . Se t s o f p r o b l em s r e l a t e d to the lack o f su f f i c i e n t and w e l l - o r g a n i s e d i n f o rm a t i o n , l im i t ed f i n anc i a l means and lack o f h uman r e sou r c e s have been e n ume r a t e d . In the f o rme r war to rn L ib e r i a in Wes t A f r ic a , GIS was u s ed for h um an i t a r i a n work . GIS f a c i l i t a t e d a c omp r e h e n s i v e v i ew o f the a r e a ’s i n f r a s t r u c tu r e , p o pu l a t i o n d i s p l a c em en t and the d i s t r i b u t i o n o f the r e l i e f ma te r ia l s (E IS , 1996) . S ch imd t et al. ( 1995 ) em p l o y e d GIS t e c h no l o gy in a s tudy o f land use d yn am ic s and fo r e s t so i l f e r t i l i t y s t a tu s in a w a t e r s h ed in Nepa l . The m e thod s o f r e s ou r c e ev a l u a t i o n d e s c r i b ed in the s tudy we re no t ove r ly s o p h i s t i c a t e d and cou ld be a pp l i e d in s im i l a r s tud ie s in d ev e lop ing coun t r ie s . In Ghana , GIS t e c h n o l o g y has been v a r i ed ly a pp l i e d for l a ndu s e and so i l s u i t a b i l i t y m app ing . The d ig i t i s a t i on o f 351 t o p og r a ph i c a l m ap s has a l so been execu te d . Th e s e p ro j e c t s have been c a r r i ed ou t w i t h i n the f r am ewo rk o f the Ghana Env i r o nmen t a l Re sou r c e M an a g em en t P ro j e c t (GERMP) . D ig i ta l f o rma t s o f the t o pog r a ph i c a l sh ee ts are ob t a i n ab l e . 1.8.1 L o ca l g o v e r nm en t a p p l ic a t io n Loca l g o v e r nm en t is a l eve l o f g ov e rnmen t th a t is be s t e q u i p p e d to as se ss and u nd e r s t a n d loca l needs and mob i l i s e loca l r e s ou r c e s to dea l w i th such needs (WHO & UNEP , 1988) . Whi l e e n cou r a g ing t h em to use th e i r i n i t i a t i v e to f i nd s o lu t i on s to th e i r p rob l ems , it is im po r t a n t to equ ip th em w i t h the r equ i s i t e i n f o rma t i o n tha t wi l l e nhance the u n d e r s t a n d i n g o f th e i r p rob l em s and t h e r e fo r e p lan e f f e c t i v e l y to m i t i g a t e th e i r e f f ec t s . Loca l g ov e rnmen t is one o f the mos t impo r t a n t g roup s o f use rs o f GIS . The local a u tho r i t i e s ex is t p r im a r i l y to p rov id e s e rv i c e s for p eop le and shou ld be ab le to fo rmu l a t e r e l e van t p o l i c i e s to mee t the needs o f c e r ta in c l i en t g roups . The range o f po t en t i a l 19 University of Ghana http://ugspace.ug.edu.gh a p p l i c a t i o n o f GIS in th i s f ie ld is c on s id e r ab l e , e x t e nd ing f r om p rop e r t y r eg i s t e r s and h i g hw ay s m an ag em en t to em e rg en cy and l a ndu s e p l a n n i n g (D e p a r tm en t o f the E nv i r o nm en t UK, 1987) . 1.8.2 P la n n in g a p p l ic a t io n Geog r a ph i c i n f o rm a t i o n sy s t ems a re be in g in c r e a s i ng ly a pp l i e d in p l a n n i n g , f rom s i te d e s i gn to reg iona l s t r a te g ie s . G i l f oy le (1991 ) no t ed the v a r i o u s a d v an t a g e s o f f e r ed by a GIS in th i s d i r e c t i o n in c lu d ing : • r a p id and easy ac ce s s to la rge vo lumes o f r e a d i l y - u pd a t ed da ta; • s e l e c t i o n o f i n f o rm a t i o n by a r ea or t h eme , and me rg ing o f d a t a se ts ; • ab i l i t y to s e a rch fo r p a r t i c u l a r f ea tu re s ; and • s im u l a t i o n and mode l l i n g oppo r tu n i t i e s . O th e r p r a c t i t i o n e r s h ave r epo r te d f a vou r ab ly on the p o t e n t i a l fo r i n t e g r a t i n g the d i f f e r en t ty pe s o f i n f o rm a t i o n he ld by loca l au tho r i t i e s , i n c lu d ing maps , s o c io - e conom ic su rveys , in v en to r i e s and r eg i s t e r s (C ampbe l l , 1990) . The su c c e s s fu l use o f th e t e chno logy in p l ann ing is c i ted in a case s t udy i n v o l v i n g an ev a l u a t i o n o f its a pp l i c a t i o n in ru ra l e n v i r o nm en t a l p l ann ing . S e lman e t al. (1991) s howed tha t the t e c h no l o gy p r o v i d e d i n f o rm a t i o n for po l i c y f o rmu l a t i o n and d e c i s i o n - t a k i n g w h i c h was g enu in e ly h e lp fu l and a cce s s ib l e to p l anne r s . They c o n c lud ed tha t th er e was an e v id en t need for p l anne r s to be ab le to compa re , m an i p u l a t e and d i sp la y c omp l e x g eog r a ph i c da t a se t s on ru ra l r e sou r c e s , and to p r e s en t re su l t s in a v a r ie ty o f ways and to d i f f e r en t aud ie nce s . They a rgued tha t p la nne r s wo rk ag a in s t t i gh t t ime l im i t s and app rop r i a t e GIS t e c h n i q u e s shou ld enab le mo re r ap id i n t e rp r e t a t i on s o f po l i cy and d e t e rm in a t i o n o f in d iv idua l cases. Conv en t i o n a l m e thod s o f l anduse ana ly s i s and p ro j e c t v i s u a l i s a t i o n can be c o s t l y and t ime con sum ing , e spec ia l l y in r emo te rural a reas . I ndeed , it has been c l a im ed tha t the se p r a c t i c a l i t i e s have o f ten con t r i b u t ed to a 20 University of Ghana http://ugspace.ug.edu.gh b l a n k e t r e s t r i c t i v e a t t i t ud e be ing adop te d w i t h in c oun t r y s i d e p l ann ing . A p a r t i c u l a r a dv an t ag e was the ab i l i t y to p i n po in t the p r e c is e l o c a t i o n and bound a r i e s o f a d e v e l o pmen t in the la nd sc ape , for it is o f t en d i f f i c u l t to lo ca te t h e se in the open coun t r y s i d e whe re t h e r e are a few r e f e r e n c e po in ts . F av o u r a b l e r epo r t s have been g iv en abou t p ro j e c t s th a t i n vo l v ed GIS use . The adv an t a g e s e nume r a t e d in c lude the ab i l i t y to s to re va s t amoun t s o f map da t a and r e la ted i n f o rm a t i o n us ed by p l a n n e r s and p o l i c y make r s , the f ac i l i ty to upda te th i s i n f o rm a t i o n ea s i ly and r ap id ly , a nd f r e e d om f rom i n conven i e n c e o f map bounda r i e s . GIS a l so p r o v i d e s th e a b i l i t y to p r oduc e va r io u s h igh qua l i t y maps h i g h l i g h t i n g d i f f e r en t f e a t u r e s or c omb in i n g d i f f e r en t da ta set s , p l o t t e d in any c o lou r s or at any sca le a pp rop r i a t e to the task . Ano th e r key adv an t a g e is the ab i l i t y to e xp lo r e ‘wha t i f ? ’ ty pe que s t i on s ( S e lman et al. 1991) . U s ing mod e l s and a s s ump t i o n s , v a r i ou s s c ena r io s can be d eve loped , d i s p l a y ed and e v a lu a t e d b e fo r e d e c i s i o n s a re t a k en (R ie zbo s , 1991) . N o tw i t h s t a n d i n g the adv an t ag e s i nhe ren t in GIS, it is n o t e d tha t th er e are con s t r a i n t s to its use for p l a nn ing in d ev e lop ing coun t r ie s . The c on s t r a i n t s c omp r i s e t h r ee ca te go r ie s : t r a in in g , p l a n n i n g da ta and mode l s . Even in the s o - ca l l ed d ev e lop ed c oun t r i e s the i n t r o d u c t i o n and use o f GIS r equ i r e s t h o r ough t r a in in g in ope r a t i ng h a r dwa r e and so f twa re . A l t h o ugh mo re a t t e n t i on has been pa id to t r a i n i ng sk i l l ed p e r s onne l to h and l e compu t e r s and GIS, p e r s onne l in th i s f ie ld a re s t i l l i n su f f i c i e n t in d ev e l o p i n g coun t r ie s . Hence th ey are s ough t a f t e r and the i r sk i l l s are ve ry much in demand , in and a lso ou t s id e the wo r ld o f r e g iona l p l ann ing . Reg iona l p l a nn ing r equ i r e s the a dop t i on o f a sy s tem for p l a nn ing wh i ch shou ld be la rge ly ba se d on a g eog r aph i c a l i n f o rm a t i o n sy s tem con t a i n i n g r e le van t g eo - r e f e r en c ed da ta on s o c i o - e c onom ic a sp ec ts and 21 University of Ghana http://ugspace.ug.edu.gh na tu r a l r e sou r c e s , d a ta m an ag em en t f ac i l i t i e s , a n a ly t i c a l t oo ls and m a th em a t i c a l mode ls . The use o f a s y s t em has the a d v a n t a g e o f p r o v i d i n g the n e c e s s a ry i n f o rma t i o n for c ompa r i n g and d e c id ing . F u r t h e rmo r e , it h e lp s in i d en t i f y ing d e f i c i e n c i e s in da ta ty pe s and qu a l i t y (R e i zbo s , 1991) . 1.8.3 GIS, s p a t ia l da ta in teg ra t io n a n d the is su e o f in te ro p e ra b i l i t y . D a t a b a s e d e v e l o pm en t and in t e g r a t i o n f rom d i f f e r e n t s ou r c e s is a v i ta l c om pon en t o f any GIS ope ra t i on . In fac t , it is th i s c a p ab i l i t y th a t d i f f e r e n t i a t e s GIS f rom o the r w ide ly used compu t e r p r o g r amme s wh i c h do no t p e rm i t sp a t i a l op e r a t i o n s on da ta (ESRI , 1997) . The p r o c e s s o f u n i f y i n g e x i s t i n g da t a sou rces into a s ing le f r am ewo rk is c a l l ed d a t a b a s e i n t e g r a t i o n (Devoge l e et al. 1998) . It t a kes as i npu t a se t o f d a t a b a s e s ( s c h ema s and da ta in s ta nce s ) , and p r oduc e s as o u t p u t a s i ng le u n i f i e d d e s c r i p t i o n o f the input sc hemas ( ca l le d the i n t e g r a t ed s ch ema ) and the a s so c i a t e d m app in g i n f o rma t i o n suppo r t i n g i n t e g r a t ed a c ce s s to e x i s t i ng da ta i n s t a n c e s t h r ough the i n t eg r a te d s c h ema (B a t i n i e t al. 1986, P a r en t e t al. 1997) . A ve ry impo r t a n t r e q u i r em en t for local or s ub -na t i ona l l eve l p l a n n i n g is d a ta and o f p a r t i c u l a r in te re s t is how th ese can be f e d e r a t ed for e f fe c t iv e use and for the des ig n o f i n f o rm a t i o n sy s t ems . Loca l l evel d ep a r tm en t s c o l le c t and use da ta as a ma t e r o f r ou t i n e for th e i r wo rk . A la rge v o lume o f d a ta is t h e r e fo r e gene r a t ed r o u t i n e ly w h i c h make s it u nn e c e s s a r y to co l l e c t va r ious k ind s o f d a ta f rom s c r a tc h w h en ev e r n eeded (D ia s & Lee l a s ena , 1983) . Some da ta are s ti l l s to r ed on pape r , i n c l ud ing maps and t r a d i t io na l f i l es or d a ta ba se s . Ve ry o f ten t h e i r reuse for n ew a pp l i c a t i o n s becomes a n i gh tma re , due to poo r d o cum en t a t i o n , obscure , s eman t i c s o f da ta , d i ve r s i t y o f da ta se ts (wha t i n f o rm a t i o n is s to red , how it is r e p r e s e n t e d and s t r u c tu r ed , wha t qua l i t y it has , w h i c h da te it re fe rs to, wh ic h sca le is used , e tc . ) , and the h e t e r o g e n e i t y o f e x i s t i ng s y s tems in te rms o f d a t a m od e l l i n g concep ts , d a t a e n cod i n g .22 University of Ghana http://ugspace.ug.edu.gh t e c h n i q u e s , s t o r age s t r u c tu r e s , acces s f u n c t i o n a l i t i e s , e tc . (D evog e l e et al. 1998) . In the GIS doma in it is qu i t e c ommon to f ind such da ta s ou r c e s d e s c r i b i n g , at l e as t par t l y , the same g eog r a ph i c a l space (D evog e l e et al. 1998) . U su a l l y da t a are co l l e c t ed for sp ec i f ic pu rpo s e s , ver y d i f f e r en t f r om one sou rc e to the next . As no conc r e te g u id e l i n e s ex i s t fo r da t a c o l l e c t i o n , the e x i s t i ng sou rces r a r e ly de s c r ib e the s ame sp ace in the same way . Th e r e fo r e , when the d e c i s io n is t a k en to i n t e g r a t e v a r i ou s da t a s ou rc e s in to a s i ng le f r amewo rk , the m a jo r p r o b l em s e n c oun t e r e d are: d e v e l o p i n g a co r r e c t u nd e r s t a n d i n g o f the s eman t i c s o f e x i s t i ng da ta , i .e. , w ha t they r ea l ly mean ; e s t a b l i s h i ng an a ccu r a te c o r r e l a t i o n s t r u c tu r e to avo id wha t Dia s & L e e l a s e n a (1 983 ) r e f e r r ed to as c ompa r i n g app le s and o range s ; and choo s ing a w e l l - s u i t e d i n t e g r a t e d d e s c r i p t i o n , b a s ed on i n t e g r a t i o n goa ls and on the a v a i l a b l e da t a c o nv e r s i o n t e chn iqu e s . The va lu e o f da ta is o f ten l im i t ed by the way in wh i c h th ey are p r o c e s s e d , the leve l at wh ich they are a gg r eg a t ed and the a c c e s s i b i l i t y to t h em (D ia s & Lee l a s ena , 1983) . This p ro b l em can be o v e r c om e i f th e r e is n a t i ona l l eve l a g r e emen t or c on s en su s on the bas ic a rea l un i t fo r da ta c o l l e c t i on . Th is mus t be the s ame for all the a genc i e s even i f th ey are s u b s equ en t l y agg r ega t ed into d i f f e r en t l a rg e r un i t s . L au r i n i (1998 ) has a d voc a t e d the t o p - down app ro ach for d e s i g n ing a d i s t r i b u t e d d a ta ba se , wh i ch s e emed to ag ree w i th D ias & Lee l a s e n a (1983 ) . The bas i c a rea l un i t he r e f e r r ed to as the g loba l s chema cou ld be sp l i t in to d i f f e r en t local s ch emas due to some p l a c emen t s t ra tegy . Spa t ia l d a ta i n t e g r a t i o n in Ghana is r e l e v an t to the c u r r en t d i s p e n s a t i o n o f d e c en t r a l i z ed p la nn ing . The p rob l em has been the p a ro ch i a l m ann e r in wh ich each D is t r i c t d e p a r tm en t a cqu i r e s and uses da ta. Each d ep a r tm en t has b e come an i s land onto i t s e l f in the g e ne r a t i on and use o f 23 University of Ghana http://ugspace.ug.edu.gh data . A dvanc e s in i n f o rm a t i o n t e c hno logy and the e n v i s a g e d g row ing d em and f rom i n f o rm a t i o n use rs to o v e r come the b o t t l e n e c k and co s t o f d a ta c ap tu r e wi l l c ompe l use rs to sha re da ta by t r a n s f e r r i n g t h em f rom one i s la nd to the o the r . It is a l r e ady po s s i b l e to o b t a i n d ig i ta l f o rma t s o f s ome c a t ego r i e s o f d a t a f rom some o rg an i s a t i o n s such as the Su rvey D ep a r tm en t , L ands Comm i s s i o n , Soil R e s e a r c h I n s t i tu te o f the C ounc i l fo r Sc ie n t i f i c and Indu s t r i a l R e s e a r ch and the Cen t r e for R emo t e S en s ing and G eog r aph i c a l I n f o rm a t i o n S e rv ic e s o f the U n i v e r s i t y o f Ghana . It is a dvoca t ed th a t d a t a i n t e r op e r a b i l i t y b e come f e a s i b l e at the D i s t r i c t l eve l to f a c i l i t a te p l a nn ing and po l i c y d e c i s i o n -m ak in g . Th is w i l l p rov id e the m ean s by wh ich s p a t ia l l y d i s t r i b u t e d da ta se t s c an be c o nne c t e d t o g e th e r in a web in orde r to t r a n s p a r e n t l y ex ch ange da t a and some r emo te acce ss to o the r d a ta se rv i c e s (B ish r , 1998) . I n t e r o p e r a b i l i t y is the ab i l i t y o f a sy s tem , or c ompon en t s o f a s y s t em , to p rov id e i n f o rm a t i o n p o r t a b i l i t y and i n t e r - a pp l i c a t i o n c o -o p e r a t i v e p ro c e s s cont ro l . The th e s i s to ok a look at the d e c en t r a l i z ed d ep a r tm en t s o f the D i s t r i c t A s s emb ly ; the type o f da ta a cqu i r ed , p r o c e s s e d and u sed to m e e t th e i r o p e r a t i o n a l m anda t e s , and da ta t ype s / f i l e s th a t cou ld p e rm i t i n t e r o p e r a b i l i t y among the d epa r tmen t s . A s cheme was d e s i g n e d to sh ow the sp a t i a l d a ta types gene r a t ed or r e qu i r ed by the v a r i ou s d e p a r tm en t s and the ty pe o f a pp ro a ch to mu l t i d a t a b a s e de s ig n p r opo s ed . De ta i l s are d i s c u s s e d in C hap t e r Four . 1.8.4 S p a t ia l a c c e s s ib i l i t y a n d the use o f lo c a t io n -a l lo c a t io n mode ls . A fundamen t a l p r o b l em tha t has o f ten con f ron t ed he a l t h p l a n n e r s in d ev e l o p i n g coun t r i e s is the ba t t l e b e tw een im p rov ing h e a l t h c a r e de l iv e ry and the ava i l a b i l i t y o f r e sou r ce s to mee t thi s o b je c t i v e . H ea l th f a c i l i t i e s a re ve ry of ten g eog r aph i c a l l y i n a c c e s s i b l e to the m a jo r i t y o f the p opu l a t i o n , e sp e c i a l l y thos e in the rural a r ea s ( F r eund , 1986; McEve r s , 1980; S tock , 1985) . The cos t o f h ea l t h c a r e makes it e x t r em e ly 24 University of Ghana http://ugspace.ug.edu.gh d i f f i c u l t to imp rov e g eog r aph i c a l a c c e s s i b i l i t y to s e rv ic e s , the m a in im p ed im en t s be ing f i n anc i a l con s t r a i n t s and sh o r t a ge o f h um an r e sou r c e (Ph i l i p s , 1990) . The so lu t i on to th i s p rob l em , a c co rd ing to some expe r t s , has been found in a b e t t e r sp a t i a l o r g a n i s a t i o n o f e x i s t i ng hea l t h c a r e d e l i v e ry sy s t em s . R u sh t o n (1984 ) has a dvoc a t e d s t r ong ly for the ro le l o c a t i o n - a l l o c a t i o n mode l cou ld p l ay in u s in g l im i t ed r e sou r c e s mo re e f f i c i e n t l y to p ro v i d e a c ce s s for thos e cu r r en t l y w i t h ou t access . Oppong & H odg s o n ( 1994 ) a pp l i e d a s imp le l o c a t i o n - a l l o c a t i o n mode l us ing r e ad i l y a v a i l a b l e loca l d a t a to e v a lu a t e a p ub l i c h ea l t h po l ic y , r e c omm end a t i o n for im p r o v i n g a c c e s s i b i l i t y to he a l t h f ac i l i t i e s in rural Ghana . The re su l t o f t h a t s tu dy was t h a t s imp le app l i c a t i o n s o f l o c a t i o n - a l l o c a t i o n mod e l s p rov id e impo r t a n t i n f o rm a t i o n for gene ra l spa t ia l d e c i s i o n -m ak in g . They c on t e nd tha t the mod e l s may be u s ed to imp rove sp a t i a l a c c e s s i b i l i t y w i t h o u t i n c r e a s i n g the n umbe r o f f ac i l i t i e s and a m i n im um d i s r u p t i o n to the e x i s t i ng s y s t em o f f ac i l i t i e s . The i r a n a ly s i s b egan by ev a lu a t i n g , u s in g the /7 -median c r i t e r i on , the a c c e s s i b i l i t y p rov i d ed by the s y s t em o f f a c i l i t i e s in p lace . It d emon s t r a t e d how a c c e s s i b i l i t y cou ld be im p rov ed , and e v a lu a t e d the po te n t i a l for imp rov ing a c c e s s i b i l i t y by p r o v i d i n g add i t i o n a l f ac i l i t i e s . They con c lud ed th e i r wo rk w i t h a d i s c u s s i o n o f how l o c a t i o n - a l l o c a t i o n m od e l l i n g m igh t be i n c lu d ed in p r im a ry h e a l t h c a r e p l a nn ing in Ghana . L o c a t i o n - a l l o c a t i o n mode l l i n g is no t new. A cco rd i n g to M o l l e r - J e n s e n (1997 ) , r e s e a r ch in to the t h eo ry o f th i s con cep t has been c a r r ie d out s ince the 1960s and ear ly 1970s in r e la t i on to the g r ow th o f c ompu t e r s c ie nce in gene ra l . He ma in t a i n ed tha t wha t was m i s s i n g back t h e n wa s the d e ta i l ed d ig i t a l map s and the b ro ad acces s to the n e c e s s a ry c ompu t i n g powe r wh i ch mean t tha t the m e thod s were s e ldom app l i e d to r e a l i s t i c and c omp l e x s i t ua t ions . 25 University of Ghana http://ugspace.ug.edu.gh GIS is a u s e fu l too l in l o c a t i o n - a l l o c a t i o n m od e l l i n g . Seve ra l GIS s o f tw a r e p a ck age s p rov id e the too l s for fas t l o c a t i o n - a l l o c a t i o n m od e l l i n g as a s p ec i f ic type o f n e two rk ana ly s i s tool b a sed on d ig i ta l v e c t o r map s and d a t ab a s e s (Mo l l e r - J e n s en , 1997) . Th is r e qu i r e s t h a t a n e tw o r k o f l i n ea r f e a tu r e s l i nks the a r ea s u r r o u nd i n g a c en t r e . The se l i n ea r f e a tu r e s id en t i f y the fac t th a t t r a n sp o r t a t i o n r e s ou r c e s on the g r ound n o rm a l l y oc cu r a lo ng c e r ta in p r e - d e f i n ed co r r ido rs . Each l i n ea r f e a tu re in the n e tw o rk has an a s soc i a t e d imp ed an c e va lu e i n d i c a t i n g the co s t in te rms o f d i s ta nce , t ime , and amoun t o f fue l e x p e nd e d or o t h e r r e l e v an t un i t , o f t r a n sp o r t a t i o n a long th i s l ine. Th is im ped an c e va lue w i l l o f ten be re l a t ed to spe c i f ic mean s o f t r a n spo r t a t i o n . M 0 l l e r - J e n s en ( 1997 ) app l i e d l o c a t i o n - a l l o c a t i o n m od e l l i n g a s s i g n ing ch i l d r en f r om a r e s i d en t i a l lo ca t io n to the n e a r e s t schoo l for a se l e c t ed a rea o f Cop enh ag en . The ob je c t iv e was to m ax im i s e a c c e s s i b i l i t y wh i l e at the s ame t ime e n su r i n g tha t no one has to t r ave l an ex c e s s i v e l y gr ea t d i s t a n c e to a t t e nd school . This th e s i s us ed some a spec ts o f the m e th o d o l o g y to exp lo r e the p o s s i b i l i t y o f m ax im i s i n g a c c e s s i b i l i t y to he a l t h care f a c i l i t i e s w i t h in the Ga Dis t r ic t . 1.8.5 H ea l th a n d S a n i ta t io n ap p l ic a t io n Works done in the a r ea range f rom ana ly s i s o f spa t ia l a c c e s s i b i l i t y to hea l t h care f a c i l i t i e s , h ea l th f ac i l i ty p l a c emen t , d e t e rm in a t i o n o f the c a t c hm en t p o p u l a t i o n a round hea l th f ac i l i t i e s , pub l i c hea l t h , e p i d em io l o g i c a l s t u d i e s / d i s e a s e m app in g and the r e l a t i o n sh ip b e tw e en s an i t a t i on fo rms and d is ea se i n c id ence . Wi t h the a v a i l a b i l i t y o f powe r fu l p e r sona l c ompu t e r s and s o ph i s t i c a t e d u s e r - f r i e nd ly so f twa r e , wha t used to be a t e d iou s and app rox ima t e p roce s s o f m anu a l l y d r aw ing maps and d i s p l a y ing da ta is less t ime c o n sum ing and more exac t . H ea l t h s p e c ia l i s t s now a t t ach g rea t impo r ta nc e to m ap -b a s ed da t a p r e s e n t a t i o n and ana ly s i s for seve ra l r e a sons (Yoon , 1995) . F i r s t , m ap -b a s e d p r e s e n t a t i o n o f human d is ea se da ta can be bo th i n f o rm a t i v e and 26 University of Ghana http://ugspace.ug.edu.gh in t u i t i v e , s i nce h um an d is e a se s tend to f o l l ow c e r t a i n sp a t i a l and t em po r a l pa t te rn s . Second , the i n f o rma t i o n p r e s e n t e d u s ing m ap s may be e a s i e r for n o n -h e a l t h s p e c ia l i s t s to c omp reh end . Th is is an im po r t a n t i s sue in the i n s t a nc e s when po l i t i c i a n s and non h e a l t h - s p e c i a l i s t s make he a l t h r e sou r c e a l l o c a t i o n dec i s io n s . F i na l l y , the too ls for a n a l y s i s o f spa t i a l i n f o rm a t i o n (GIS) a re now u sed w i th ease by n on -G IS s p e c i a l i s t s for t h e i r work . GIS has had an impac t on ep i d em io l o g i c a l m app in g and m ode l l i n g . Th is d e r i v e s f rom the ag e - o ld pr ac t i c e w i t h i n g eo g r a phy o f u s i ng map s to e x am in e the sp a t ia l in c i d ence o f d i s e a se s (C l i f f & Hagge t , 1996) . For e x amp le , the d i s t r i b u t i o n map s o f y e l l ow feve r p r oduc ed in 1798 are o f t en g iv en p r id e o f p lace . But th e se we re p r e d a t e d by map s o f t op i c s as d i v e r s e as ho sp i t a l c apa c i t i e s and d i s t r i b u t i o n o f d r e s s i n g s t a t i on s on b a t t l e f i e l d s , t h r o ugh to maps o f p e s t i l e n t i a l swamps and ho s t i l e m ed i c a l e n v i r onmen t s . By th e 1820s , the sp re ad o f c ho l e r a f r om Ind i a ove r Eu r a s i a and No r t h Ame r i c a saw the p r o du c t i o n o f a spa t e o f c ho l e r a maps w i th p la te s show ing rou te s o f sp read , and da te s and r eg ion s o f o ccu r r ence . The b r e a k t h r o u g h in d i s e a se m app ing occu r r ed in the m idd l e o f the n in e t e e n th c en tu ry w i t h the cho le r a map p r o du c ed by Snow ( 1854 ) for the s e cond ed i t i o n o f his p r i z e -w inn ing es say On the mode o f comm un ica t io n o f cho le ra , (C l i f f & Hagge t , 1996) . Wha t m ade S n o w ’s wo rk un ique was no t the c a r t og r aphy (dot maps , wh i ch we re a we l l - e s t a b l i s h ed c a r t o g r a ph i c devi ce , to show the g eog r aph i c a l d i s t r i b u t i o n o f in d iv idua l c ho l e r a dea th s ) , bu t hi s i nduc t i v e r e a son ing f r om the map. By show ing wha t he te rmed the ‘ to p o g ra p h y o f the o u tb r e a k ', S now was ab le to d r aw i n f e r ence abou t the ma in sour ce o f i n f ec t ion . The a dven t o f GIS has made the m app ing o f d i s ea se d i s t r i b u t i o n by c h lo r op l e t h and p o i n t - p a t t e r n me thod s a r e l a t iv e ly s t r a i g h t f o rw a rd task . 27 University of Ghana http://ugspace.ug.edu.gh Bu t s e r iou s wo rk in th i s f ie ld i nvo lv e s two a p p ro a ch e s fo r w h i c h GIS may u l t im a t e l y p rove c ruc i a l : • as an a id to sp a t i a l e p i d em io log i c a l m od e l l i n g and f o r e c a s t i n g , and • as a v eh i c l e to tes t hypo th e s i s abou t m apped d i s t r i bu t i on s . A cen t r a l i s su e r a i s ed by the g row ing n umbe r o f d i s e a s e maps ( e sp e c i a l l y c ompu t e r - p r o d u c ed maps ) is the ex te n t to wh i ch th ey are e f f e c t i v e in e n h an c i n g our u nd e r s t a n d i n g o f d i s e a s e p r o c e s s e s . Wh i l e maps a re o f te n u sed to good v isua l e f fec t , t h ey can ob s cu r e e v id en c e , s u gge s t bogu s c o n c en t r a t i o n s , and s ta r t fa l se t r a i l s . C l i f f & Hagg e t ( 1 996 ) c on t end howeve r , th a t w i th ca re fu l use , GIS has the a b i l i t y to r ap id ly s i f t the v i s ua l c o r r e l a t i o n b e tw een d is e a se d i s t r i b u t i o n s and cove r s o f e x p l a n a t o r y v a r ia b le s . The t e c h no l o gy a l so has the c ap ab i l i t y o f c omb in i n g such ev id en c e w i th s t a t i s t i c a l and m a th em a t i c a l m od e l l i n g in a m ann e r th a t may both sha rpen ou r a p p r e c i a t i o n o f the v a lu e o f d i s e a s e maps and r educe e r ror s o f i n te rp re ta t i on . GIS is v a r i e d ly u sed as a too l to con t ro l d i se a se s . A c c o r d i n g to Yoon (1995 ) th e re a re t h r ee o bv iou s uses: (i) as a s u rv e i l l a n c e and mon i t o r i n g too l ; . - . , i ( ii ) as an an a ly t i c a l too l ; and ( i i i) as a p r e s e n t a t i o n a l too l . By a l l ow ing the u se r to r ap id ly r e t r ie v e and d i s p l ay da ta a s s o c i a t e d w i t h a g eog r a ph i c a l a rea, GIS can be c on s id e r ed an idea l too l for the s u r v e i l l a n c e and mon i t o r i n g o f t r op ic a l d i se a se s . GIS can ea s i ly d i sp la y , fo r e x amp le , p r eva l enc e leve l s o f s ch i s t o s om ia s i s fo r ea ch t own a round a body o f wa t e r u s ing co lou r s . U s in g long i t u d in a l da ta , GIS can be u s e d to i d en t i f y the towns w i th in c r e a s i ng p r ev a l en ce ove r a p e r i o d o f t ime . GIS has been app l i e d in many d ev e lop ing c oun t r i e s for d i s e a s e s mon i t o r i n g and con t ro l . An examp le o f th i s was in N o r th e r n B o t sw an a whe r e a p r o g r amme was ca r r ie d ou t to con t ro l s c h i s t o s om ia s i s 28 University of Ghana http://ugspace.ug.edu.gh (M okgw ee t s i n y a n a , 1995) . E nv i r o nm en t a l and he a l t h da t a we re i n t e g r a t e d in to GIS to ana ly se the co r r e l a t i o n b e tw e en the d i s t r i b u t i o n o f the d i s e a s e and o th e r sp a t ia l i n f o rm a t i o n (e .g. , p o p u l a t i o n d en s i t y , g r o u n dw a t e r and s an i t a t i on ) . The p r o g r amme i nvo lv ed the use o f the i n f o rm a t i o n p rov i d ed by the GIS for m on i t o r i n g the d i s e a s e and p l an n i n g for e n v i r o nmen t a l and c ommun i t y con t ro l . It a l so i n t e g r a t e d o th e r d i s e a s e da ta (e.g. ma l a r i a and d i a r r h o ea ) in to the s y s t em and e xp lo r ed the p o t en t i a l fo r p l ann ing o f con t r o l mea su r e s . The m e th o d o l o g y c o n s i s t e d o f c on s t r u c t i ng base maps in A r c l n f o f o rma t s . S ch is to da ta ( in a p r e l im in a ry tab l e ) c omp i l e d and d e f i n i t i v e l y a n a ly s e d s ince 1985 were e n t e r ed into Dbase III f i les. The da ta i n c lu d e lo ca l i t y or schoo l , age , sex and quan t i t a t i v e faeca l s .m a n so n i egg coun ts . C l a rk et al ( 1997 ) d e s c r i b ed GIS app l i c a t i o n for the con t ro l o f r i v e r b l i n dn e s s , as pa r t o f a r eg iona l pub l i c h e a l t h i n i t i a t iv e , in the in a c c e s s i b l e r e g ion s o f s ix t r op i c a l L a t in Am e r i c a n coun t r i e s i n c l u d ing the Am azo n Bas in . The p ro je c t used GIS to i d en t i f y c ommun i t i e s su sp ec t ed to be in f e c t ed by the r i v e r b l i n dn e s s d i se a se , p r o g r amm ed the de l i v e ry o f m ed i c a t i o n , m ea su r ed p e r f o rm an c e o f hea l t h w o rk e r s and d e t e rm in ed impac t o f t r e a tmen t . The m e th odo l o gy i n vo lv ed d i g i t i s i n g maps o f the e nd em ic zones , i d en t i f y i ng su spec t and en d em ic c ommun i t i e s u s ing bu f f e r zones o f k n own vec to r b r e ed ing s i tes , and lo ca t i ng c ommun i t i e s w i t h the he lp o f GPS uni t s . It a l so i n vo l v ed the p ro du c t i o n o f map s to mea su r e the p e r f o rm anc e o f hea l t h b r i g ad e s in the de l i v e ry o f m ed i c a t i o n at the c ommun i t y leve l , and m e a su r i n g the end em ic i t y and t r end o f the d i sea se . The GIS too l u s ed was A t la s GIS v e r s io n 3.0 for w indows . Da ta ba s e s we re in Xba se f o rma t and the a pp l i c a t i on for g a th e r i ng and k e ep ing da ta we re wr i t te n in FoxP ro and Ep i l n fo . The wo rk a imed at s h ow ing tha t GIS is a powe r fu l too l for manag ing and mode l l i n g pub l i c h e a l t h p r o b l em s in d ev e l o p i n g coun t r ie s whe re d ig i t a l map s are non ex i s t e n t , 29 University of Ghana http://ugspace.ug.edu.gh a cce s s is d i f f i c u l t and fund s a re scarce . Maps we re p r o du c e d , for e x amp le , on the d i s t r i b u t i o n o f e nd em ic on cho c e r c i a s i s r i s k a r ea s ba s ed on 5 -km f l ig h t ra nge ( o f the f ly) bu f f e r zone ; and o n c h o c e r c i a s i s p r e v a l e n c e ba sed on sk in sn ips . A ma l a r i a f ie ld s tu dy in Wes t e rn K enya a l so a s c e r t a i n ed the u s e f u ln e s s o f GIS by u s i ng the G loba l P o s i t i o n ing Sy s t em (GPS ) in d i f f e r e n t i a l mode (DGPS ) to o b t a i n h i gh ly a ccu r a t e l o ng i t u d e s and a l t i t u d e s o f a n um be r o f h ou se s , h e a l t h c en t r e s , mo squ i t o b r e e d ing s i tes , and some wa t e r s ou rce s (Ombok et al., 1997) . L o ca t i o n da ta we re e n t e r ed in to a g eog r a p h i c i n f o rm a t i o n sy s t em for map p r o du c t i o n and l i n k ed w i th v a r i ou s d a t ab a s e s fo r sp a t i a l ana ly se s . S tud ie s ba sed on l o c a t i o n - a l l o c a t i o n o f h ea l t h f a c i l i t i e s u s i ng GIS t e c h no l o gy have a l so been done in a d e v e lop ing coun t r y . A p ro j e c t s p on so r e d by WHO in N ig e r i nvo lv ed the use o f GIS for h e a l t h c en t r e p l a c em en t (Long , 1995) to a s s i s t in b r i ng ing h e a l t h c ov e r a g e to a bou t 45% o f the popu l a t i o n . The m e t h odo l o gy i n c l uded the p r o d u c t i o n o f a u t oma t e d base maps show ing l o ca t ion o f e x i s t i ng h e a l t h cen t r e s , a dm in i s t r a t i v e b ounda r i e s , r oads , and v i l l a g e loca t io n s . P o pu l a t i o n f i gu re s wer e add ed f r om the 1988 censu s and p r o po r t i o n a t e c i r c le s us ed to dep i c t p o p u l a t i o n s for v i l l a g e s and towns . Thi s was to a l l ow for the v i s u a l i s a t i o n o f the p o pu l a t i o n d i s t r i b u t i o n a round each h e a l t h cen t r e and se a rch for be s t p o s s i b l e s i tes for n ew he a l t h c en t r e s u s i ng GIS te chno logy . The a t t r i bu t e s c on s id e r e d were p o pu l a t i o n w i t h in 5 -km r ad iu s o f a t a r g e t ed v i l l age . Th is r e p r e s en t ed the c a t chmen t a r ea o f the hea l t h cen t re . By add ing up the p opu l a t i o n o f ea ch v i l l age , it was p o s s i b l e to e s t ima te the tota l p o pu l a t i o n se rved by the hea l th fac i l i ty . V i l l a g e s we re l i s ted in orde r o f s ize o f c a t chmen t popu l a t i on ; so th o se w i t h the h i g h e s t c a t c hm en t p opu l a t i o n we re mos t d e s i r ab le for s e le c t i on . By 30 University of Ghana http://ugspace.ug.edu.gh a dd ing (one by one ) n ew cent re s to the v i l l ag e s , b e g i n n i n g at th e top o f the l is t , and r e c a l c u l a t i n g the to ta l n umbe r o f p eop le s e rv ed in the s y s t em and th en c a l c u l a t i n g the r e su l t i ng p e r c e n t a g e o f the p o p u l a t i o n s e rv ed , one cou ld b r in g the expec t ed to ta l h e a l t h c ov e r ag e up to the d e s i r e d 45% na t i ona l goal . U s i n g th i s t e c hn iqu e , it is po s s i b l e to e s t a b l i s h the m in im um n um b e r o f n ew he a l t h c en t r e s n e c e s s a ry to b r in g the he a l t h c ov e r ag e up to 45% n a t i o n -w id e (Long , 1995) . The te c hn iqu e , even t h o ugh v a lu ab l e for a n a ly s i s o f p o t en t i a l s i t es for new he a l t h c en t r e p l a c emen t , c ou ld be e n r i c h ed w i t h the use o f o the r f ac tor s such as d i s t a n c e s f rom ex i s t i ng h e a l t h cen t r e s , the p o pu l a t i o n s ize o f the s e t t l emen t s s e l e c t ed , l o c a t i o n a l e f f i c i e n cy and the cen t r a l p la ce fu n c t i o n i n c l u d i n g e x i s t i n g and d ev e l o p ed i n f r a s t r u c tu r e base. The p ro j e c t e n coun t e r e d d a ta ba se p r o b l em s tha t mos t GIS app l i c a t i o n s face in d ev e l o p i n g coun t r i e s . The c en su s da ta cou ld no t be m a t c h ed to all v i l l a g e s d i g i t i s e d f rom the o r i g in a l base map. Th is was due to v i l l a g e n ame in con s i s t e n c i e s . Spe l l i ng d i f f e r enc e s b e tw een n ame s in the two d a t a b a s e s c a u s ed many m i sm a t c h e s when comb in i n g or j o i n i n g th em. M any v i l l a g e s had mu l t i p l e names , some had been r e l o c a t ed s ince the base map s we re p r oduced , and n ew v i l l age s had been e s t ab l i s h ed . It was no t ed tha t , for th e who le o f N ige r , on ly 35% o f the c en sus v i l l a g e s c ou ld be m a t c h ed to the d i g i t i s ed v i l l a g e s f rom the o r ig ina l bas e maps . In Ghana , th e la t e s t bas e maps p ro duced by the land Survey D ep a r tm en t a re ove r 24 ye ar s old. This po se s p r ob l em s for s e t t l emen t s i d e n t i f i c a t i o n and loca t i on . The i ssue o f i n c on s i s t e n c i e s in p l a ce n ame s r e nd i t i o n has a l so p o s ed p rob l em s to GIS r e s e a r ch e r s and o th e r spa t ia l d a ta ba se manage r s . The bas ic p rob l em l ies wi th j o i n i n g da ta se t s f rom d i f f e r en t d a t ab a s e s (m isma tc h ) . 31 University of Ghana http://ugspace.ug.edu.gh A GIS a p p ro a ch to the d e t e rm in a t i o n o f c a t c hmen t p o p u l a t i o n s a r ound loca l h e a l t h f a c i l i t i e s was p r opo s ed for Kenya (O ranga , 1995) . In the f ace o f e co nom ic d i f f i c u l t i e s , the r a t i ona l a l l o c a t i on o f sc a rce r e s o u r c e s on the ba s i s o f p o pu l a t i o n s ize has b ecome p r ime in mos t d e v e l o p i n g coun t r i e s . In K enya the fundamen t a l i s sue has been the w e a kn e s s e s in the h e a l t h i n f o rm a t i o n sy s t em . Some h ig h ly d e s i r ab l e i n f o rm a t i o n su ch as p o p u l a t i o n - b a s e d e p i d em io logy , s e rv ic e q ua l i ty da ta and s o c i o ­ cu l t u r a l i n f o rm a t i o n is no t be ing co l l ec ted . P r o b l em s ex is t in the f low o f i n f o rm a t i o n f rom the f ie ld , i n c lud ing de la y s , n o n - r e p o r t i n g , n o n ­ r e s p on s e , and a g ene r a l l y u n s a t i s f a c t o r y q ua l i ty o f g en e r a t ed da ta . The K eny an p o p u l a t i o n is h e t e r og en eou s w i th e thn ic , r e l i g i o u s and s o c i o - e c o n om ic d i f f e r en c e s i n f l u enc ing i l ln es s c oncep t s and d emand s for h e a l t h care. H oweve r , the on ly av a i l ab le i n f o rm a t i o n on th e loca l p o p u l a t i o n is the Cen su s o f Popu l a t i on , n o rma l l y c onduc t e d eve ry ten year s , wh i ch does no t co in c id e w i t h the ac tua l c a t c hm en t p o p u l a t i o n s s e rv ed by he a l t h f ac i l i t i e s . The hea l th i n fo rm a t i o n sy s t em s hou ld r e f le c t th e se c i r c um s t a n c e s , bu t a va i la b le da ta are a lmos t e x c l u s i v e l y a bou t c a r e - s e ek i n g c l i en ts and th e i r se rv ic e u t i l i s a t i on . A need ex i s t s for a mo re p r e c is e and c omp le t e d e s c r ip t i on o f the c a t c hmen t p o pu l a t i o n and hea l t h s i t u a t i on . It is impo r t an t to gene r a te th i s i n fo rm a t i o n at v i l l a ge , c ommun i t y and d iv i s i o n or d i s t r ic t l eve l . The m e th o d o l o g y i n c l u d ed the a c qu i s i t i o n o f da ta t h ro u gh f i e ld su rveys , a n a ly s e s o f e x i s t i ng s e conda ry da ta f rom maps , aer i a l p h o t o g r a ph s , r epo r t s and o the r d ocumen t s . The ma in empha s i s o f d a ta a n a ly s i s wou ld be on the p r o du c t i o n o f maps o f d emog r aph i c data . This a c t i v i t y w i l l re ly on the c o l l e c t i o n o f po in t d a ta f rom known l oca t i on s , and the use o f the GPS to r e co rd p r ec is e l o ca t ion s whe r e samp le da ta a re lo ca ted . It is c o n c l u d ed by the Kenyan s tudy tha t a s tudy to f ind the be s t lo ca t io n for hea l t h fa c i l i ty would s ta r t by i d en t i f y ing home s t e a d s , road 32 University of Ghana http://ugspace.ug.edu.gh n e tw o rk s and h e a l th f a c i l i t i e s in the s tudy area . Fo r th e a l lo c a t io n o f h e a l th f a c i l i t i e s , a n um be r o f v a r ia b le s such as road c o n d i t io n s / ty p e s and t r a v e l t im es w il l h ave to be in co rp o ra te d in to th e d a ta b a se b e fo re r u n n in g th e a l lo c a t io n func t ion . The v a r io u s so lu t io n s g en e ra te d w il l h ave to be ev a lu a te d ag a in s t the c r i te r ia sp e c i f ie d fo r s i t in g the h e a l th f a c i l i t i e s . Such c r i t e r i a m ay be to lo ca te a f a c i l i ty w he re t rav e l co s ts are m in im ised . 1.8 .6 P rob lem s o f G IS use in d e v e lo p in g c o u n tr ie s In te r e s t in GIS use is in c re a s in g among m any th i rd w o r ld c o un try s c ie n t i s t s , p la n n e r s , p o l ic y m ake rs and p ro je c t m an ag e rs (T e e f f e le n e t a l, 1992). It is n o ted h ow eve r , th a t a c tu a l a p p l ic a t io n s are s t i l l l im i ted . It is on ly the n a t io n a l m app ing ag en c ie s th a t h ave p ro g re s s e d m o s t in u s in g G IS . T he se a g en c ie s indeed w ere among the f i r s t o rg a n i s a t io n s in the d e v e lo p in g c o u n t r ie s , w h ich in t ro d u c ed c om pu te r t e c h n iq u e s . M os t o f th e se th ro u g h the la rg e s s o f m u l t i - la te r a l a g en c ie s n o ta b ly , the W or ld B ank , UNDP , and DAN IDA . The re a son s fo r th is are o b v io u s . The c r e a t io n o f t o p o g r a p h ic and o th e r m aps t r a d i t io n a l ly c a r r ie d ou t in a p a in s ta k in g way by p ro fe s s io n a l d ra u gh tsm en o f ten tak e m any y ea rs ; ev en m in o r u pd a te s m ean t th a t m aps had to be c om p le te ly red raw n . C on seq u en t ly , p la n n in g ag en c ie s f r e q u en t ly had to cope w i th th e lack o f u p - to -d a te m ap s , w h ich w ere h a rd ly ev e r a v a i la b le at su i ta b le s ca le s . D ev e lo pm en ts in c om pu te r - s u p p o r te d d a tab a se and e le c t ro n ic c a r to g ra p h y e n c o u ra g ed m any o rg an is a t io n s to r e so r t to th is n ew te c h no lo gy . N a t io n a l and reg ion a l p la n n in g ag en c ie s to ok ad v an ta g e o f th is and thu s in t ro du c ed the use o f c om pu te r - s u p p o r te d m app in g p ro c ed u re s to d i sp la y th e ir p hy s ic a l and s o c io -e c o n om ic d a ta on d i f f e r e n t a dm in i s t r a t iv e leve ls . The te ch no lo gy was a lso p rom in en t ly app l ie d in the f ie ld o f u rban p lann ing . In sp i te o f the t r a n s i t io n tow a rd s a m ore th o ro ugh a d o p t io n o f GIS sy s tem s it is n o ted th a t the p ro ce s s is f r a ugh t w ith p rob lem s . T e e f f e len 33 University of Ghana http://ugspace.ug.edu.gh e t a l , (1 9 92 ) m en t io n ed the p rob lem o f la ck o f w e l l -o rg a n is e d sp a t ia l in fo rm a t io n . W here the d a ta ex is ts a t all it is no t ea sy to use w i th o u t c o n s id e r a b le p ro c e s s in g . B o r rough (1992 ) for in s ta n c e d i s c u s s e d the p ro b lem s th a t o ccu r when sp a t ia l da ta se ts , d i f f e r in g in sp a t ia l s c a le and q u a n t i t a t iv e d e ta i l , a re to be com b in ed . For th is , he b e l ie v e s th a t it w il l t a k e y e a r s b e fo re m o s t d ev e lo p in g c o un t r ie s p o s s e s s fu l ly o p e ra t io n a l G IS . He th e re fo re c au t io n ed ag a in s t a t tem p ts to in s ta l l su p e r sy s tem s q u ic k ly . On the c o n t ra ry , a m ode s t s ta r t w ou ld p ro v id e some g u a ran te e s u c c e s s in r e la t iv e ly sho r t t im e . To th is end , it has been a d v o c a te d th a t a s ta r t w i th w ha t is d e s c r ib ed as ‘lo w - e n d ’ PC -b a sed GIS sy s tem s to d e v e lo p bas ic in -h ou se e xp e r t i s e in the m an ip u la t io n o f g e o g ra p h ic da ta is p r e f e r a b le . (M e i je r & K u ip e rs , 1992). S e cond ly , l im i ted f in a n c ia l m eans o f ten im po se p ra c t ic a l r e s t r i c t io n s on the a d o p t io n and e s ta b l i s hm en t o f GIS. L ack o f hum an r e so u rc e seem s to fu r th e r c om pound the p rob lem . W h ile a dm i t t in g the u s e fu ln e s s o f GIS fo r r e g io n a l p lan n in g , R ie zbo s (1991 ) in d ic a te d th e re are seve ra l o b s ta c le s im p ed in g i ts im p lem en ta t io n in p la n n in g p ra c t ic e . He m en t io n e d the i s su e o f th o ro ugh t r a in in g in th e u se o f GIS and the r e q u i r em en t o f f a c i l i t i e s , w h ich are no t a lw ay s av a i la b le . S e cond ly , th e re are o f ten p ro b lem s reg a rd in g the s e le c t io n o f d a ta r e l e v a n t for p la n n in g , d a ta c o l l e c t io n m e thod s and da ta an a ly s is . In a d d i t io n , i n c om p a t ib i l i ty o f d a ta may h am pe r the use o f GIS in p la n n in g p ro c edu re s . C le a r ly , a c co rd ing to h im , g e og rap h ic a l in fo rm a t io n sy s tem s can no t be b lam ed fo r th e se k ind s o f p ro b lem s . In m any ca se s such p ro b lem s on ly b ecom e app a ren t w hen GIS is b e ing im p lem en te d . In G hana the g ene ra l la ck o f u p - to -d a te ba se maps is a m a jo r se t b ack to fu l l GIS d a tab a se d ev e lo pm en t and u t i l i s a t io n . A va i la b le d ig i ta l fo rm a ts o f b a se m aps w ere d e r iv ed from hard copy shee ts p u b l i sh ed in the ea r ly 70s. T hu s fo r e x am p le , new ly d ev e lo p ed t r a n sp o r ta t io n n e tw o rk , s e t t l em en ts and o th e r spa t ia l fe a tu re s canno t be r e p re s e n te d ex cep t w ith 34 University of Ghana http://ugspace.ug.edu.gh th e a id o f a GPS . At th e D is t r ic t lev e l , m aps c o n s t ru c te d so fa r h ave a rb i t r a ry b o und a ry d e l in e a t io n , w h ich pose p ro b lem s for p la n n in g and re s e a rc h . Am ong v a r io u s d ep a r tm en ts m aps and d a ta ty p e s u sed v a ry to the e x te n t th a t th ey are v i r tu a l ly u nu sab le in a GIS due to d i f f e r e n c e s in sca le . A lso n o tab le is the gene ra l o rg an is a t io n o f sp a t ia l d a ta se ts . The v a r io u s s e c to ra l a g en c ie s d em a rc a te d i f fe re n t a dm in i s t r a t iv e u n i ts fo r th e i r own p u rp o se s ; m any o f th em do no t n e c e s s a r i ly c o in c id e . In m any s i tu a t io n s , th e d a ta c o l le c te d by one d e p a r tm en t m ay no t r e la te to the a rea l u n i t for w h ich a n o th e r ag ency co l le c t s da ta . It is th e r e fo r e no t p o s s ib le to r e la te d a ta se ts fo r d i f f e re n t d a ta e lem en ts , w h ich p ro v id e s som e o f the m os t u se fu l in fo rm a t io n . 1.9 O b je c t iv e s o f the s tudy The s tudy fo cu se s on the use o f GIS as a d e c is io n su ppo r t and p la n n in g too l and is a p p l ie d in the in te g ra t io n o f d a ta and a n a ly s i s o f the p ro b lem s o f h e a l th and san i ta t io n in th e Ga D is t r ic t . S p e c i f ic a l ly , the s tu dy is b a sed on the fo l low in g ob je c t iv e s : (a). To a s c e r ta in the sp a t ia l da ta n eed s o f the Ga D is t r ic t d e p a r tm en ts and d e s ig n a sch em e for the in te g ra t io n o f such da ta se ts fo r p la n n in g and d e c is io n m ak ing pu rp o se s , (b). To id en t i fy the e lem en ts o f a p ro to ty p e GIS fo r the Ga D is t r ic t , (c). To app ly th is in te g ra t iv e fo rm a t fo r th e a n a ly s is o f p ro b lem s o f h e a l th and s a n i ta t io n in the Ga D is t r ic t u s in g the o v e r lay and o th e r t e c h n iq u e s in v o lv in g da ta on m a jo r endem ic d is e a se s , and (d). To a s c e r ta in g e og rap h ic a l a c c e s s ib i l i ty to h e a l th c a re s e rv ic e s in the Ga D is t r ic t u s in g n e tw o rk ana ly s is . 1.10 P rop o s i t io n s The Ga D is t r ic t A ssem b ly , l ike all o th e r d i s t r ic t s in the co un t ry , is p la g u ed w ith the p rob lem o f p rop e r da ta d o cum en ta t io n , lack o f da ta in te g ra t io n , h a rm on is a t io n and s ta n d a rd is a t io n . For ex am p le , v a r io u s 35 University of Ghana http://ugspace.ug.edu.gh fo rm s o f d a ta r e la t in g to the same p rob lem are h e ld in d i f f e r e n t fo rm s w i th in th e d is t r ic t d e p a r tm en ts . A th o ro u g h u n d e r s ta n d in g o f th e h e a l th and s a n i t a t io n se c to rs and the r e la t io n sh ip b e tw een th e se and d is e a se ty p e s can on ly be a ch iev ed th rough the use o f a p p ro p r ia te to o ls . The ro le s o f G IS to in te g ra te d a ta , s to re such da ta , d isp lay and se rv e as a qu e ry and re t r ie v a l sou rce for p o l ic y d e c is io n -m ak in g and p l a n n in g is v e ry imm en se . GIS se rv es a lso as a u se fu l too l fo r the a n a ly s i s o f the in t e r - r e la t io n s h ip b e tw een v a r iou s p h en om en a th ro u g h the o v e r la y p ro c e s s . B a sed on th e o b je c t iv e s o u t l in e d above and the p o te n t i a l s o f GIS fo r D is t r ic t lev e l d e v e lo pm en t p la n n in g and d e c i s io n -m ak in g the f o l low in g p ro p o s i t io n s are made: (a). T ha t GIS c o n s t i tu te s a u se fu l p la t fo rm fo r th e in te g ra t io n o f v a r io u s sp a t ia l d a ta se ts r e le v an t for p la n n in g and d e c is io n m ak in g in the Ga D is t r ic t . (b). The GIS too l is u se fu l fo r in v e s t ig a t in g the a s s o c ia t io n b e tw een en d em ic d is e a se s in c id en ce and e n v i ro nm en ta l f a c to rs , and (c). T ha t GIS c o n s t i tu te s a u se fu l p la t fo rm fo r the a n a ly s i s o f sp a t ia l a c c e s s ib i l i ty to h e a l th care s e rv ice s . 1.11 C on cep tu a l f r am ew ork 1.11.1 M aps as M od e ls a n d the S y s tem s A p p ro a ch The use o f G IS as an a pp ro ach to the a n a ly s is o f p ro b lem s o f p la n n in g and as a d e c is io n s u ppo r t too l s tem s f rom the c ap ac i ty o f the t e c h n o lo g y to in te g ra te d i f f e r e n t c a teg o r ie s o f in fo rm a t io n and m od e l l in g th em to re v e a l rea l w o r ld s i tu a t io n in w ays th a t are e a s i ly c om p re h e n s ib le . GIS is a m od e l l in g too l th a t o f fe rs among o th e rs , o p p o r tu n i t ie s fo r r e d u c in g h i th e r to com p lex sp a t ia l p h enom ena to e a s i ly o b se rv ab le and a s s im i la b le fo rm . The bas ic com pon en t o f a GIS tha t f a c i l i t a te s the p e r fo rm an c e o f th is fu n c t io n is the map. M aps are re g a rd ed as ic on ic or r e p re s e n ta t io n a l m ode ls em p loy ed to c omm un ic a te som e th in g o f the n a tu re o f the rea l w o r ld (B oa rd , 1967). 36 University of Ghana http://ugspace.ug.edu.gh GIS a lso o f fe r s the too l fo r d em on s t r a t in g the i n te r r e la t io n s h ip b e tw een the v a r io u s fu n c t io n a l ag en c ie s or com pon en ts o f th e d i s t r ic t e c o nom y and in te g r a t in g them to revea l its u n i f ie d w ho len e s s . A c co rd in g to Y oon ( 1 9 9 5 ) , G IS a l low s the d isp lay , a n a ly s is and u n d e r s ta n d in g o f d a ta f rom d iv e r s e so u rc e s in w ha t cou ld be c a l led a h o l i s t i c a p p ro a ch to da ta m an ag em en t , a n a ly s i s and p re s e n ta t io n . T h is a sp e c t o f G IS ’s c a p a b i l i t i e s can b es t be e x p la in ed away by th e sy s tem s co n c ep t and a p p ro ach . The s tudy th e re fo re lends i t s e l f to the use o f m ap s as r e p r e s e n ta t io n a l m ode ls and to the sy s tem s co n cep t w h ich e x p la in s the in t e r r e la t io n s h ip b e tw een the v a r io u s se c to rs and su b - s e c to r s o f the d i s t r i c t e co nom y and how these w o rk to g e th e r to e x p la in th e n a tu re o f the d i s t r i c t as a u n i f ie d en ti ty . 1 .11 .2 G IS /M ap s as r e p r e s e n ta tio n a l m ode ls In ou r a t tem p t to e x p la in the in te r r e la t io n sh ip b e tw een the la rg e and com p lex p h en om en a th a t c on ce rn us, it b e com es n e c e s s a ry to redu ce th em in o rd e r to be ab le to b r ing th em in to v iew (R ob in so n e t al. 1995). The m ap o f fe r s the too l for do ing th is . Jack E s te s and J e f f re y S ta r in d e f in in g GIS s ta te d as fo l low s : “An in fo rm a t io n sy s tem th a t is d e s ig n ed to w o rk w i th d a ta r e f e r e n ced by sp a t ia l or g eog rap h ic c o -o rd in a te s . In o th e r w o rd s , a GIS is bo th a d a taba se sy s tem w ith sp ec i f ic c a p a b i l i t i e s for sp a t ia l ly r e f e r e n ce d da ta , as well as a se t o f o p e ra t io n s fo r w o rk in g w ith the d a ta ” (S ta r & E s te s , 1990). The re fe ren ce to g e o g ra p h ic c o ­ o rd in a te s is an im po r ta n t one b ecau se the c o -o rd in a te s are l i t e r a l ly how we are ab le to l ink d a ta w ith the map . M aps th e re fo re c o n s t i tu te the m ed ium by w h ich sp a t ia l da ta is r e p re s e n te d to he lp ex p la in the rea l w o r ld or s ig n i f i c a n t a sp e c ts o f the rea l w or ld . As re p re s e n ta t io n a l too l the map is a c o n cep tu a l m ode l c o n ta in in g the e s sen ce o f some g e n e ra l i s a t io n abou t r e a l i ty (B oa rd , 1967). In th a t ro le 37 University of Ghana http://ugspace.ug.edu.gh m aps are u se fu l a n a ly t ic a l to o ls w h ich he lp in v e s t ig a to r s to see the rea l w o r ld in a new l ig h t o r even a l low th em an en t i r e ly n ew v iew o f r e a l i ty . In h is d i s c u s s io n s abou t cy c le s o f m ap m ak ing , B oa rd (1 967 ) in d ic a te d two m a jo r s tag e s . The rea l w o r ld c o n c en t r a te d in m ode l fo rm and the m ode l b e ing te s te d ag a in s t r e a l i ty . In p ra c t ic e , the in v e s t ig a to r who m ak e s such m aps has a new v iew o f th e rea l w o r ld . It is a lso o b v io u s th a t the cy c le m ay b eg in aga in w ith th e re v is e d v iew o f th e w o r ld . B oa rd c i te s the e x am p le o f an a re a w ith m in im a l map cov e r bu t w ith s e em in g ly in te r e s t in g v a r ia t io n s in la ndu se p a t te rn . T he se v a r ia t io n s cou ld be b ro u g h t to v iew th ro ugh the m ed ium o f m aps , w h ich r e co rd s the s ig n i f i c a n t e lem en ts o f the landu se p a t te rn . Once c om p le te d the m ap o f la n du se is t a k en in to the f ie ld or is c om pa red w ith re a l i ty in some o th e r way . S p e cu la t io n s on the r e la t io n sh ip b e tw een la n du se and p h y s ic a l , e c o nom ic and cu l tu ra l f a c to rs m ay be te s ted . In m any c a se s such te s ts w il l in v o lv e the d e s ig n and c o n s t ru c t io n o f n ew m aps o f bo th t r e n d s and r e la t io n s h ip s in an a t tem p t to u n rav e l some o f the c om p lex p a t t e rn s o f the rea l w o r ld . S om e t im es the p ro c e s s o f in v e s t ig a t io n s ta r ts w ith a m ap w ho se e lem en ts som ehow g ive r ise to some s p e cu la t io n s in r e l a t io n to the o r ig in of, fo r ex am p le , a d ra in age p a t te rn or some p e c u l ia r i ty in a m aze o f p ro p e r ty b o und a r ie s . In th is case the m ap , w h ich is a l r e ady a m ode l o f w ha t it p o r t r a y s , is d i s s e c ted as is the la nd sc ap e or the e n v i ro nm en t o f the rea l w o r ld (C onzen , 1960). A f te r such an in v e s t ig a t io n som e o f the r e su l t s m ay w e ll be p re s en ted in m ap fo rm , thu s e n te r in g ye t a n o th e r pha se o f the cyc le . As a r e p re s e n ta t io n a l too l , lev e ls o f in fo rm a t io n t r a n s fo rm a t io n ta k e s p la ce d u r in g the p ro c e s s o f m ap c o n s t ru c t io n . A cco rd in g to T ob le r the m app in g p ro ce s s is a se r ie s o f in fo rm a t io n t r a n s fo rm a t io n , e a ch o f w h ich has the p ow e r to a l te r the a p p ea ran ce o f the f in a l p ro d u c t 38 University of Ghana http://ugspace.ug.edu.gh (T ob le r , 1979). For e x am p le , the a c tu a l p h en om en a are a l t e r e d th ro u g h the p ro c e s s e s o f d a ta c o l le c t io n , th a t is, g round su rv ey s , r em o te s en s in g and d a ta c om p i la t io n . The da ta is fu r th e r a l te red th ro u g h the a b s t r a c t io n p ro c e s s o f m app in g , such as da ta s e le c t io n by the map com p i le r , da ta m a n ip u la t io n and s ym bo l i s a t io n (F igu re 1.3). The ac ts o f r e a d in g and in te rp r e t in g the f in a l m ap (s ) fu r th e r ch ange the da ta . F ig u re 1.3: The p ro c e s s o f in fo rm a t io n t r a n s fo rm a t io n The im po r ta n c e o f the m ap as a m ode l and as an e s s e n t ia l c om pon en t o f a GIS is seen in i ts a b i l i ty to f a c i l i t a te the d ep ic t io n o f d i f f e r e n t c a te g o r ie s or lay e rs o f in fo rm a t io n h e reby r e fe r red to as ' c o v e r a g e s ’ . As B oa rd (1967 ) pu t it, sp e cu la t io n s on r e la t io n sh ip b e tw een seve ra l f a c to r s can be te s te d u s ing maps in o rd e r to un rave l som e o f the c om p lex p a t te rn s o f the real world . The fac t is th a t each o f th e se te s ts w ill in v o lv e the c o n s t ru c t io n o f new m aps , w h ich in the t r a d i t io n a l and an a lo gu e s e t t in g is labo r io u s and t im e con sum ing . The te s t here re fe r red 39 University of Ghana http://ugspace.ug.edu.gh to , c o n s i s t o f c o v e ra g e s pu t to g e th e r th ro u g h the o v e r la y p ro c e s s to u n r a v e l e x is t in g p a t te rn s o f r e la t io n sh ip b e tw een the fa c to r s u nd e r in v e s t ig a t io n . F o r a D is t r i c t G IS , th is m od e l l in g c a p a b i l i t i e s , w h ich are d e s ig n e d to e n h an c e p la n n in g and a m ore in fo rm ed d e c is io n m ak ing , is f a c i l i t a t e d by the ‘o v e r l a y ’ p ro c e s s w h ich a l low s for th e e x e cu t io n o f p la n n in g sc e n a r io s . For ev e ry s c en a r io , a new m ap o f t r e n d s and r e la t io n s h ip s b e tw een the v a r io u s p h en om en a is c o n s t ru c te d . B e s id e s , G IS h as the a d v an ta g e o f d a tab a se q u e ry and a n a ly s is . F o r each th em e on the m ap an a t t r ib u te d a ta ta b le is a v a i la b le to w h ich a d d i t io n a l d a ta f ie ld s c o u ld be ad d ed , q u e r ie d and n ew in fo rm a t io n gene ra ted . N o tw i th s ta n d in g the imm en se ad v an tag e s in h e re n t in the m ap , the is su e o f in fo rm a t io n t r a n s fo rm a t io n at the v a r io u s s tage s o f m od e l l in g the D is t r i c t p h e n om en a c anno t be lo s t s igh t of. W ith ou t doub t th e re a r is e s i s su e s o f d ig i t i s in g e r ro rs , da ta m ism a tch , s e t t l em en t p la c em en t due to same n am es o c cu r r in g for s eve ra l c omm un i t ie s , s ym bo l i s a t io n , g e n e ra l i s a t io n , etc. 1 .11.3 The S y s tem s A p p ro a ch The l in k ag e or sp a t ia l r e l a t io n sh ip b e tw een the v a r io u s c om pon en ts o f the d i s t r i c t e co nom y (a sy s tem here d eno ted by the o p e ra t io n s o f the fu n c t io n a l a g en c ie s or d i s t r ic t d ep a r tm en ts ) can be d em on s t r a te d in a GIS . A GIS does th is by l ink ing d a ta se ts or c o v e ra g e s to f a c i l i t a t e a m ore th o ro u g h u n d e r s ta n d in g o f the re la t io n sh ip am ong the v a r io u s p h en om en a unde r s tudy . Th is c ap ab i l i ty lends GIS t e c h n iq u e to the sy s tem s ap p ro ach ; an app ro ach th a t is im p l ic i t in m os t g e o g ra p h ic w o rk (C ho r ley & H agge t t , 1967). The w ord sy s tem im p l ie s an o rg an is a t io n o f ‘t h i n g s ’ th a t are l in k ed to g e th e r . V ery s im p ly a sy s tem can be d e f in ed as a c o l l e c t io n o f 40 University of Ghana http://ugspace.ug.edu.gh com po n en t s , p a r ts o r e v en ts w h ich are l inked to g e th e r in su ch a way as to fo rm a w o rk in g u n i t or un i f ie d w ho le (T ivy & O ’H are , 1990) . As a r e s u l t any ch ange in one p a r t o f the sy s tem w il l im pac t on , and be r e f l e c te d in c h ange s in, all the o th e r pa r ts . The sy s tem s co n cep t has been app l ie d in d iv e r se s tu d ie s in c lu d in g e c o lo g y , g e om o rp h o lo g y and h yd ro logy . Fo r e x am p le , in a d o p t in g a g e n e r a l - s y s t em a t i c a p p ro ach to the s tudy o f l a n d fo rm s , it is h e ld th a t the em pha s is shou ld l ie in the o rg a n is a t io n and o p e ra t io n o f th e sy s tem as a w ho le or as l in k ed com pon en ts , r a th e r th an in d e ta i le d s tu dy o f in d iv id u a l sy s tem e lem en ts (Von B e r ta la n f fy , 1962). T an s ley (1 9 46 ) in a p p ly in g the e c o sy s tem concep t in to e co logy fo r bo th the b iom e and its h a b i ta t s ta te d as fo l low s : “A ll the p a r ts o f such an e co sy s tem o rg an ic and in o rg an ic b iom e and h ab i ta t m ay be reg a rd ed as in te r a c t in g fa c to r s w h ich , in a m a tu re e co sy s tem , are in a p p ro x im a te e q u i l ib r ium : it is th ro u g h th e i r in te r a c t io n s th a t the w ho le sy s tem is m a in t a in e d ” . The th e s i s v iew s the d i s t r ic t as an in te g ra l sy s tem , th a t is to say , a u n i f ie d e n t i ty and the c om ponen ts or in pu ts from the fu n c t io n a l a g en c ie s ( d i s t r i c t d e p a r tm en ts ) as the id e n t i f ia b le p a r ts o r s ig n i f ic a n t e lem en ts . It is a s sum ed th a t a ch ange in the f u n c t io n in g o f a p a r t o f the d i s t r ic t sy s tem w il l im pac t on and be r e f le c ted in the sm oo th w o rk in g o f o th e r p a r ts . An a n a ly s i s o f the in te r a c t io n s b e tw een the c om pon en ts o f the d i s t r ic t is w ha t is hop ed to b r ing abou t the e f fe c t iv e f u n c t io n in g o f the d i s t r i c t as a w ho le . Fo r ex am p le , the p la n n in g sy s tem fo r the d i s t r i c t in v o lv e s am ong o th e r s an e f fe c t iv e c o l la b o ra t io n among the v a r io u s fu n c t io n a l a g en c ie s w i th in the D is t r ic t A ssem b ly . A sy n th e s i s o f the D i s t r i c t ’s p ro b lem s , o b je c t iv e s and goa ls th ro ugh se c to ra l in pu ts has been p re s c r ib ed as a ba s ic r e q u i rem en t fo r the D is t r ic t p lan s (NDPC , 1995). 41 University of Ghana http://ugspace.ug.edu.gh The ro le o f G IS in such a sy s tem is to p ro v id e the m ean s o f f a c i l i t a t in g the in te g r a t io n o f in fo rm a t io n ap p ly in g the la y e red d a ta or o v e r la y co n c ep t w i th the v iew to h e lp in g exp la in the i n te r r e la t io n s h ip b e tw een the v a r io u s fa c e ts o f the econom y . It is a lso to f a c i l i t a te the a n a ly s i s o f i s su e s th a t are r e le v an t to p lan n in g and d e c is io n -m ak in g . The s tu dy has c o n s id e re d as a m a jo r face t , the in te g ra t io n o f se ts o f s p a t ia l d a ta lo c a ted w i th in the d is t r i c t d ep a r tm en ts . The h e a l th and s a n i t a t io n s u b ­ s e c to r s s tu d ie d cou ld be v iew ed as s u b sy s tem s o f the d i s t r i c t w ho se c om pon en ts t o g e th e r p ro v id e ty p ic a l ex am p le o f how d e c is io n c o u ld be m ade th ro u g h the in te g ra t io n o f da ta as a fo rm o f an a ly s is . 42 University of Ghana http://ugspace.ug.edu.gh CHAPTER TWO M ETH O D OF STUDY 2.0 In tr od u c t io n The s tu dy is in two pa r ts . The f i r s t p a r t is c o n c e rn ed w ith the d e s ig n o f a s ch em e fo r d a ta in te g ra t io n at the d i s t r ic t leve l and the id e n t i f i c a t io n o f the e lem en ts o f a d i s t r ic t leve l p ro to ty p e G IS . The se cond p a r t d ea ls w i th the a p p l i c a t io n o f GIS to the a n a ly s is o f p ro b lem s o f h e a l th and s a n i t a t io n in the d i s t r i c t th ro ugh the in te g ra t io n o f v a r io u s d a ta c a te g o r ie s such as on s a n i ta t io n types , h o u seh o ld w a te r supp ly sou rce s , fo rm s o f so l id w as te d i sp o sa l , end em ic d i s e a se s , h e a l th c a re f a c i l i t i e s , m a jo r w a te r b od ie s , s e t t l em en ts , p o p u la t io n and road n e tw o rk . The p u rp o se is to see how the s u p e r im po s i t io n o f som e o f th e se da ta c a te g o r ie s or lay e rs o f in fo rm a t io n or co v e rag e s h e lp s to show the ty p e s o f r e l a t io n s h ip s am ong th em in o rd e r to p ro v id e in fo rm a t io n th a t w il l s u p po r t d e c is io n m ak in g and po l ic ie s in the h e a l th and s a n i t a t io n su b se c to r s . It is a lso to show how d isp a ra te d a ta se ts f rom v a r io u s sou rce s bu t o f th e sam e sca le cou ld be c om b in ed w i th in the c o n te x t o f a d i s t r ic t .to p ro du ce new in fo rm a t io n for d e c is io n -m ak in g and p lan n in g . 2 .1The sch em e for data in teg ra t ion Da ta in te g r a t io n is r e le v an t w i th in the co n tex t o f lo ca l or s u b -n a t io n a l leve l p la n n in g . It fo rm s the b as is fo r m e rg ing d a ta se ts a c q u i r e d and p ro c e s s e d by in d iv id u a l d i s t r ic t d ep a r tm en ts and thu s h e lp s r em ove the b o t t l e n e c k s o f co s t o f da ta a cq u is i t io n . The f r am ew o rk fo r p lan s o u t l in e d by the NDPC for the d i s t r ic ts en jo in ed a h o l i s t ic a p p ro ach to p lan d e v e lo pm en t th ro u g h sec to ra l or d e p a r tm en ta l inpu ts . The s tudy t a k e s th is in to v iew and sough t to app ly th is con cep t to the in te g r a t io n o f d a ta se ts f rom the d is t r ic t d ep a r tm en ts and a lso to see how the i n te g ra t io n o f d i f f e r e n t c a te g o r ie s o f d a ta in d i f fe re n t c om b in a t io n s ( th ro u g h the o v e r lay p ro c e s s ) cou ld he lp suppo r t p la n n in g in h e a l th and s a n i t a t io n su b se c to r s o f the Ga D is tr ic t . 43 University of Ghana http://ugspace.ug.edu.gh An o p e n -e n d e d q u e s t io n n a i r e on sp a t ia l da ta ty p e s a c q u i r e d and p ro c e s s e d was d raw n and a dm in is te r e d at all the d e c e n t r a l i s e d and n o n ­ d e c e n t r a l i s e d d is t r i c t d ep a r tm en ts . In a ll, 15 d e p a r tm en ts w e re id e n t i f i e d as p ro d u c in g sp a t ia l da ta . The q u e s t io n n a i r e a s c e r t a in e d the m and a te s and fu n c t io n s o f the d ep a r tm en ts , the d a ta ty p e s th ey g en e ra te and use , and the sp a t ia l sca le s at w h ich they c o l le c t such d a ta se ts . It w as a lso to h e lp show in the f ina l a n a ly s is a g loba l c o n c ep tu a l s chem a . The s tu dy a lso c o n s id e re d the b a s ic a p p ro ach e s to m u l t id a ta b a s e d ev e lo pm en t and in te g ra t io n . F o l low ing a f te r L au r in i ( 1 998 ) , the a p p ro a ch is d i s c u s s e d in C hap te r Four. 2 .2 The e lem en ts o f d is t r ic t leve l p ro to typ e GIS The e lem en ts o f the p ro to ty p e GIS fo r the d i s t r i c t w ere c o n c e p tu a l i s e d and b a sed on the fo l low ing : m a in sou rce s o f d a ta - e n com pa s s in g all d i s t r i c t d e p a r tm en ts a c q u i r in g and p ro c e s s in g sp a t ia l da ta , d a ta c a te g o r ie s g e n e ra te d or a cqu ired c o n sequ en t to the o p e ra t io n s o f the d i s t r ic t d e p a r tm en ts - e n com pa s s in g seve ra l a sp e c ts o f e n v i ro nm en ta l d a ta and so c io -e c onom ic and c u l tu ra l da ta , m ean s o f g e n e ra t in g such da ta (u s ing bo th GIS and R em o te S en s in g ) , s o f tw a re c om pon en ts o f the GIS show ing the th e o re t ic a l b a s e s for m odu le s for d a ta inpu t , d a ta s to rag e , d a ta p r e s e n ta t io n , d a ta t r a n s fo rm a t io n and a n a ly s is and que ry inpu t. T hese p ro v id e d the b a s ic in g red ien ts fo r the d e s ig n o f a schem e show n and d is c u s s e d in C h ap te r four. Th is was b a sed on a g en e ra l s tu dy o f the s t ru c tu re o f the d i s t r ic t th ro ugh d is c u s s io n s w i th o f f ic ia l s o f the D is t r ic t C o -o rd in a t in g D i re c to ra te and on g ene ra l k n ow ledg e o f the th e o re t ic a l b a s is fo r GIS im p lem en ta t io n . For e x am p le , B o r ro ugh s (1998 ) has d i s c u s s e d the b a s ic so f tw a re m odu le for a GIS. 44 University of Ghana http://ugspace.ug.edu.gh 2.3 Data c a te g o r ie s for the GIS ana ly s is The s tu dy w as b a sed on da ta c a te g o r ie s th a t h ave h e a l th and s a n i t a t io n as th e m a in com pon en ts . These da ta c a te g o r ie s or lay e rs o f in fo rm a t io n w ere l in k ed to base m aps and a t t r ib u te d a ta tab le s . T h e se are i l lu s t r a te d as a sch em e and p re s e n te d in F igu re 2.1 be low . The o th e r c om pon en ts o f the schem e in c lude m a jo r d i s e a s e s , h o u s e h o ld w a te r s u pp ly , p o p u la t io n and s e t t lem en ts , ro ad n e tw o rk , s o l id w as te d i sp o sa l fo rm s , s a n i t a t io n ty p e s , e n v i ro nm en ta l f a c to rs and h e a l th c a re f a c i l i t i e s lo c a t io n . The p u rp o se o f th e se d a ta c a teg o r ie s is to f a c i l i t a te GIS a n a ly s i s by in te g ra t in g th em th ro u g h the ‘o v e r l a y ’ m e thod . H ere d i f f e r e n t g eo g ra p h ic a l a t t r ib u te s are r e p re s e n te d by s ep a ra te se ts o f C a r te s ia n a r ray s to c re a te la y e red d a tab a se s . T h eo re t ic a l ly , the d i s t r i c t ( rea l w o r ld ) s i tu a t io n is p o r t ra y ed by a se r ie s o f o v e r la y s or th em e s in each o f w h ich one a sp e c t o f re a l i ty (e .g . s an i ta t io n , h e a l th ca re , p o p u la t io n e tc .) has been r e c o rd ed such as is shown in F igu re 2 .2 . The o b je c t iv e is to a l low for th e d isp lay o f d i f f e ren t s c en a r io s , w h ich can lead to b e t te r in fo rm a t io n and th e re fo re im p roved d ec is io n s . 45 University of Ghana http://ugspace.ug.edu.gh F ig u re 2 .2 : The ‘o v e r l a y ’ o r lay e red d a tab a se c o n cep t A f te r B o r ro u g h , 1987 2 .4 Sou rc e s o f base data A d ig i ta l fo rm a t o f b a se m ap da ta co v e r in g the s tu dy a re a w as o b ta in ed f rom the Su rvey D ep a r tm en t . Th is da ta was o r ig in a l ly d ig i t i s e d f rom the 1 :50 ,000 topo sh ee ts se r ie s o f 1974. F rom the C en tre fo r R em o te S en s ing and G eog ra ph ic In fo rm a t io n S e rv ic e s (C ERSG IS ) , U n iv e r s i ty o f G hana was o b ta in ed a d ig i ta l copy o f bo th m ap and a t t r ib u te d a tab a se o f the s tu dy a rea . T h is da ta was b a sed on a f e ed e r ro ad s p ro je c t e x e cu ted by the C en tre and in c lu d e s road n e tw o rk , p o p u la t io n and s e t t l em en t l i s t in g fo r the Ga D is t r ic t . S u pp lem en ta ry base map in fo rm a t io n w as o b ta in ed from the D is t r ic t Town and C oun try P la n n in g D ep a r tm en t . F ie ld t r ip s and the use o f the GPS f a c i l i t a te d m o d i f ic a t io n s to be m ade to th e e x is t in g d is t r ic t b ound a ry d e l in e a t io n . It a lso en ab led the in c lu s io n o f a rea s h i th e r to no t shown on the b a s ic m aps o f the d is t r ic t . Some road n e tw o rk da ta was a lso c ap tu red th ro u g h the use o f a c o n t in u o u s ly lo gg ing GPS. 46 University of Ghana http://ugspace.ug.edu.gh 2.5 M ap layer s ( c o v erag e s ) D e ta i l s o f m ap lay e rs o r c o v e rag e s b ased on the c a te g o r ie s o f d a ta o u t l in e d in F ig u re s 2.1 and 2 .2 are d i s c u s s ed be low . The se c a te g o r ie s o f d a ta w e re e n te red as f ie ld s in to an a l re ady e s ta b l i s h e d a t t r ib u te d a ta b a s e , w h ich has 1984 p o p u la t io n and s e t t lem en ts d a ta as the c omm on f ie ld . The se ts o f d a ta c o l le c te d d id no t in vo lv e h o u seh o ld su rv ey s w h ich are o f te n th e r e l ia b le way to ge t c ru c ia l d a ta fo r a g iv en p o p u la t io n e sp e c ia l ly fo r p r im a ry h e a l th ca re (PHC ) e v a lu a t io n s (E l B in d a r i - H amm ad and Sm ith , 1992). Th is is due to p ro b lem s p o sed w hen m app in g dyn am ic hum an p o p u la t io n s / f e a tu r e s r a th e r th an d i s c r e te p h y s ic a l o b je c ts in a GIS m il ie u (M ar t in , 1991). T hu s a t th e s ca le o f m app in g , on w h ich the th e s is was b a sed , d a ta se ts w e re a g g re g a te d at in d iv id u a l t ow n /s e t t l em en t (p o in t ) leve l . In th is way the g en e ra l s a n i t a t io n ty p e s , s o l id w as te d ispo sa l fo rm s and h o u seh o ld w a te r su p p ly sy s tem were d ep ic te d fo r each s e t t lem en t . Th is m ean s th a t on a m ap face th e sym bo l fo r the e n v i ro nm en ta l fa c to r common in th e s e t t lem en t was used . T he se w ere the bas ic th em a t ic in fo rm a t io n r e q u i r e d to d e sc r ib e the s i tu a t io n for each s e t t lem en t . The case fo r d a ta on the m a jo r d i s e a se s o b ta in ed f rom p a t i e n t s ’ d ia g n o s t ic re co rd s w as no less d i f fe ren t . H e re th e m a in em pha s is was on the n um be r o f ca se s r e p o r te d f rom the v a r io u s c omm un i t ie s . These w ere th en ag g reg a te d as g ra d u a te d s ym bo ls fo r each commun i ty . 2.5.1 S a n ita t io n ty p e s a n d s o l id w a ste d isp o sa l fo rm s Data on s a n i t a t io n type s and fo rm s o f so l id w as te d i sp o sa l w ere •) o b ta in ed th ro ugh p e r so n a l e nqu ir ie s at the D is t r ic t H ea l th M an ag em en t and the E n v i ro nm en ta l H ea l th Un its . No sam p le s were taken . The d a ta se ts w ere c o l le c ted at in d iv id u a l town or v i l la g e leve l based on da ta co v e r in g the en t i re d i s t r ic t c om p i le d by the E nv i ro nm en ta l H ea l th U n it as p a r t o f the ro u t in e da ta a c q u is i t io n for e n v i ro nm en ta l h e a l th 47 University of Ghana http://ugspace.ug.edu.gh m on i to r in g . The p re d om in a n t s an i ta t io n ty p e s or p r a c t ic e s and so l id w a s te d i sp o sa l fo rm s at each comm un i ty w ere ch o sen as b e in g the g en e ra l . S p e c i f ic a l ly , th e fo l low ing c a te g o r ie s w ere c o n ta in ed in the s a n i t a t io n them e: f lu sh to i le t s or w a te r c lo se ts , KV IP s , p i t l a t r in e s and op en d e fe c a t io n . The so l id w as te d i spo sa l th em e is a m ap lay e r c o n ta in in g the fo l low in g c a tego r ie s : hom e co l le c t io n , b a cky a rd d um p in g and s a n i ta ry land f i l l . The re le v an ce o f th e se da ta se ts w as to e s t a b l i s h the sp a t ia l r e l a t io n sh ip b e tw een them and d is e a se in c id en c e in the d is t r ic t . 2 .5 .2 H ea lth ca re fa c i l i t i e s Th is is a co v e rag e or th em e th a t show s the sp a t ia l d i s t r ib u t io n o f the m a jo r h e a l th ca re fa c i l i t i e s . In a ll , f iv e M in is t ry o f H ea l th f a c i l i t i e s w e re m apped . T he se are the m a in f a c i l i t i e s p ro v id in g p r im a ry h e a l th ca re and s u p p o r t in g o u t r e a ch se rv ic e s in the d is t r ic t . On the b as is o f th e i r lo c a t io n , th e d i s t r ic t has been d iv id ed in to 5 su b -d i s t r i c t s . An a s s e s sm en t o f the lo c a t io n a l e f f ic ie n cy o f th e se f a c i l i t i e s w as done u s in g n e tw o rk a n a ly s t fu n c t io n a l i ty in A rcV iew . Th is is an a sp e c t o f lo c a t io n - a l lo c a t io n m od e l l in g , w h ich d e te rm in e s sp a t ia l a c c e s s i b i l i t y ' t o the m a jo r f a c i l i t i e s b a sed on map da ta o f p o p u la t io n and l in e a r f e a tu re s such as th e road n e tw o rk . D a ta for th is c om pon en t o f th e s tu dy was o b ta in ed f rom the D is t r i c t H ea l th M an ag em en t U n it . P o p u la t io n and road n e tw o rk d a ta w e re a lready e s ta b l i sh ed in the m a in a t t r ib u te d a ta ta b le and w as u sed as the l in e a r fe a tu re fo r the an a ly s is . 2 .5 .3 H o u se h o ld w a te r su p p ly C lo se ly re la te d to h e a l th and s an i ta t io n is the is sue o f h o u seh o ld w a te r . S ou rce s o f h o u seh o ld w a te r supp ly w ere en te red as c o v e ra g e s or th em es . The c a te g o r ie s are p ipe bo rne sy s tem s , w e l ls , b o re h o le s and r iv e r s o r s t ream s . D a ta for th is was o b ta in ed f rom the D is t r ic t C o ­ o rd in a t in g U n it w he re th rough the sc a log ram m e th od s o f a n a ly s i s m a tr ic e s o f c omm un i t ie s and the in f r a s t ru c tu re r e q u i r em en ts w ere 48 University of Ghana http://ugspace.ug.edu.gh com p i le d for a l l e le c to ra l a rea s in the d is t r ic t . T h is w as su p p lem en te d w i th d a ta o b ta in ed f rom the E nv i ro nm en ta l H ea l th U n it . D i r e c t f ie ld o b s e rv a t io n s w ere a lso m ade o f the h ou seho ld w a te r s o u rce s to c o n f i rm the g en e ra l s i tu a t io n s . The da ta c a te g o r ie s w ere e n te r e d as f ie ld s c re a te d in the m a in a t t r ib u te d a tab a se ag a in s t eve ry in d iv id u a l c omm un i ty and c o nv e r te d in to sh ap e f i le s . G radu a ted co lo u rs w e re u sed to sh ow the d i f f e r e n t c a tego r ie s . 2 .5 .4 E nd em ic d ise a se s Endem ic in the d is t r i c t a re m a la r ia , b u ru l i u lc e r , sk in in f e c t io n s , u p p e r r e s p i r a to ry t r a c t in f e c t io n s , d ia r rh o ea , a cu te eye in f e c t io n s , m ea s le s , c h ic k en pox , ea r in f e c t io n s and in te s t in a l w o rm s in f e c t io n (M OH /G h an a H ea l th S e rv ic e s , 1998). D a ta co v e r in g a p e r io d o f o n e -y e a r (O c to b e r 1997 and S ep tem b e r 1998) was o b ta in ed f rom h e a l th d ia g n o s is r e co rd s o f in d iv id u a l p a t i e n t s at the f ive m a in MOH fa c i l i t i e s . The f iv e fac ili t ie .s are su p p o sed to se rve f ive m a jo r g e o g rap h ic a l or c a tc hm en t a rea s in the d is t r ic t . F o r c omm un i ty leve l da ta , ca se s r e p o r te d by p a t i e n t s w e re ag g reg a ted . Th is w as done fo r the p re v a le n t d i s e a se s l i s te d above on m on th ly bas is . The a im was to a s c e r ta in th e sp a t ia l in c id en c e and lev e ls o f e n d em ic i ty o f th e v a r io u s d is e a se s in th e d i s t r ic t w i th th e v iew to p ro v id in g in d ic a t io n s o f th e i r c au ses . In th i s w ay po l ic y m ak e rs are equ ip p ed w i th the r e le v an t in fo rm a t io n to a s s i s t in con tro l and m i t ig a t io n m easu re s . Th is was a ch iev ed by o v e r la y in g the d is e a se s cov e rag e on each o f the e n v i ro nm en ta l fa c to r c o v e rag e s , n am e ly s a n i ta t io n ty p e s , so l id w as te d i spo sa l fo rm s and so u rc e s o f h o u seh o ld w a te r supp ly . A l th o u g h bu ru l i u lc e r was no t r anked among the top d is e a se s in the d is t r i c t in te rm s o f r e p o r te d num be r o f ca se s , it was g iv en sp ec ia l a t te n t io n . N o ta b le is i ts d e b i l i t a t in g e f fe c t on the a f fe c ted c omm un i t ie s and th e soc ia l s t igm a a t ta ch ed to it. A case s tudy o f the d is e a se in 1997 by the D is t r ic t D i r e c to r o f M ed ica l S e rv ic e s p rov id ed som e d a ta on 49 University of Ghana http://ugspace.ug.edu.gh d is t r i b u t io n p a t te rn o f ca se s ob se rv ed . C l in ic a l r e co rd s fo r th e p e r io d b e tw e e n O c to b e r 1997 and S ep tem be r 1998 f rom Am asam an and O bom H e a l th C en tre s a lso su p p l ie d some d a ta th a t was u sed to show end em ic c omm un i t ie s . B u f fe r zone s o f the end em ic a rea s w ere c o n s t r u c te d and e n v i ro nm en ta l f a c to rs th a t cou ld exp la in the c a u se o f the d i s e a se w ere m o d e l le d u s in g the o v e r la y m e thod o f a n a ly s is . 2 .5 .5 P o p u la tio n a n d s e t t lem e n ts The p o p u la t io n d a ta b a se was u sed as a sou rce ta b le fo r m uch o f the a t t r ib u te da ta se ts u sed in the GIS. It h e lp ed to d e f in e th e r e g io n b e in g r e f e r r ed to as the Ga D is t r ic t ( fo rm e r ly Ga R u ra l ) and th is was p r in c ip a l ly o b ta in ed f rom the 1984 cen su s . T h is a lso p ro v id e d the l i s t o f s e t t l em en ts and the r e la te d a t t r ib u te da ta . In th e a b sen ce o f any re c en t p o p u la t io n c en su s da ta on th e d is t r i c t annua l g row th ra te o f 6 .2% was com pu te d to o b ta in the p ro je c t io n s fo r 1996. 2 .5 .6 R oad n e tw o rk The road n e tw o rk th em e was in c lu d ed as a l ay e r f rom the base d a ta o b ta in ed f rom S u rvey D ep a r tm en t and the F e ed e r R oad s P ro je c t o f CERSG IS . P a r t o f the n e tw o rk was a lso c ap tu red u s in g the G a rm in 12XL GPS. A t t r ib u te s such as road leng th , road type , d i s ta n c e , t rav e l t im e , and su r fa ce ty p e w ere in c lu d ed as p a r t o f the da ta . As l in e a r f e a tu re th e ro ad n e tw o rk laye r was u sed no t on ly to show the g en e ra l c omm un ic a t io n n e tw o rk bu t a lso to fa c i l i t a te l o c a t io n - a l lo c a t io n m od e l l in g (LAM ). LAM is a sp ec i f ic type o f n e tw o rk too l b a sed on d ig i ta l v e c to r m ap s and d a taba se s . A b ackg ro und s tudy o f th e m a jo r c om ponen ts o f g eo g rap h ic a l a c c e s s ib i l i ty to h e a l th care s e rv ic e s in the d i s t r i c t was done . T h is was th ro ugh a q u e s t io n n a i r e a dm in is te r e d on a sam p le o f 22 p a t ie n ts f rom d i f fe re n t c omm un i t ie s in each o f th e f iv e s u b -d is t r ic t s r e p o r t in g at the MOH fac i l i t i e s . T h is w as the a v e rag e num be r o f c omm un i t ie s from w h ich p a t ie n ts c ommu ted to the hea l th f a c i l i t i e s da i ly . 50 University of Ghana http://ugspace.ug.edu.gh 2 .5 .7 M a jo r r iv e r s A th em e fo r th e m a jo r r iv e r s o r s t re am s in th e d i s t r ic t w as d ig i t i s e d on s c re en f rom the o r ig in a l r iv e r s and s t re am s laye r a lso o b ta in e d as p a r t o f the base d a ta f rom S u rvey D epa r tm en t . It was b a s ic a l ly r e q u i r e d fo r a s tu dy o f the a s so c ia t io n b e tw een some o f the m a jo r d i s e a se s and w a te r bod ie s . 2 .6 Sum m ary o f the s tudy approach G en e ra l ly , the s tu dy a p p ro ach was d iv id ed in to th re e p h a se s , n am e ly : c o n c e p tu a l d a tab a se d e s ign , p h y s ic a l d a tab a se d e s ig n , and the d ev e lo pm en t o f th e u se r in te r fa ce . C o n c ep tu a l d a tab a se d e s ig n or ra th e r to say in i t ia l d e s ig n f ram ew o rk in c lu d e d the fo l low in g m u tu a l ly r e la ted a c t iv i t ie s : (a) I d e n t i f i c a t io n and d e s ig n o f a schem e for the in te g ra t io n o f the v a r io u s c a te g o r ie s o f da ta u nd e r h e a l th c a re , s a n i ta t io n , h o u s e h o ld w a te r s ou rc e s , so l id w as te d i spo sa l fo rm s , e n v i ro nm en ta l c o n d i t io n s , e n d em ic d is e a se s and p o p u la t io n in the d is t r ic t . A lso c o n s id e re d was a g en e ra l sch em e o f d a ta in te g ra t io n to a l low fo r i n t e r - d e p a r tm en ta l d a ta sh a r ing . ■ ■ ' i. (b) C o l le c t io n and c a te g o r i s a t io n o f d a ta as well as e v a lu a t io n o f th e i r u s e fu ln e s s fo r p la n n in g and d e c is io n m ak ing . (c) D e te rm in a t io n o f th e scope and co n ten ts o f G IS d a tab a se fo r the h e a l th and s a n i t a t io n sec to rs a long w i th the d ev e lo pm en t o f the d a ta b a se m ode l and its c om ponen t d a tab a se d o cum en ta t io n etc. The s e cond ph a se w as the d e s ign o f th e p h y s ic a l d a tab a se . It in c lu d ed : (a) A cq u i s i t io n and p r e p a ra t io n o f base da ta in d ig i ta l and an a lo gu e f o rm a t s . In th is c ase the d ig i ta l da ta was o b ta in ed from Su rvey D ep a r tm en t and the CERSG IS . D a ta o b ta in ed f rom the f ie ld w e re fed in to the a t t r ib u te d a tab a se , c onv e r ted in to sh ap e f i le s and u sed as lay e rs o f in fo rm a t io n or themes . 51 University of Ghana http://ugspace.ug.edu.gh (b) M ap p r e p a r a t i o n . S ev e ra l th em a t ic m aps w ere p re p a re d and e d i t e d in the v iew w indow and fo r map c om po s i t io n or b e t te r c a r to g ra p h ic e f fe c t th ey w ere c om po sed in the layou t . The th i rd phase , w h ich is b a s ic a l ly an in te r a c t iv e one , in v o lv ed the use o f in te g ra te d se t o f c om pu te r - a s s i s t e d p ro c ed u re s and e x te n s io n s to f a c i l i t a t e the d a tab a se que ry and an a ly s is . The r e su l t s w ere d is c u s s e d and show n in C hap te r s f iv e and six. 2 .7 H ardw are and so f tw are sy s tem s con f igu ra t ion The s o f tw a re u sed w ere E S R I ’s PC A rc ln fo V e rs io n 3.5.1 and A rcV iew GIS V e r s io n 3 .0 a and 3.1. S eve ra l e x te n s io n s o f A rcV iew w ere u t i l i s e d . T h is in c lu d ed the n e tw o rk an a ly s t , the g eo p ro c e s s in g to o l , b u f f e r w iz a rd and le g end too l . The so f tw a re and h a rdw a re sy s tem s u sed and th e i r c o n f ig u r a t io n is sh ow n in F igu re 2.3 . F ig u re 2 .3 : H a rdw a re and so f tw are sy s tem c o n f ig u ra t io n It in c lu d e s a 0 .98GB d isk c ap ac i ty P en t ium II MXX CPU 64 .0MB RAM , a 2 0 ” P h i l ip s C o lo u r M on i to r , C a lC om p D ig i t i s in g B oa rd and a H ew le t t -P a c k a rd D e sk Je t 1120c P r in te r . The GIS p ro je c t s w ere ex e cu ted in the R em o te S en s ing A pp l ic a t io n s L abo ra to ry o f the D ep a r tm en t o f G eog raphy and R e sou rc e D eve lopm en t , U n iv e r s i ty o f G hana and in the 52 University of Ghana http://ugspace.ug.edu.gh GIS L ab o ra to ry in th e In s t i tu te o f G eog raphy , U n iv e r s i ty o f C o p en h ag e n , D enm ark . 53 University of Ghana http://ugspace.ug.edu.gh Figure 3.1: Population distribution -1996 / r* / • / Akwapiai South District / ^ fc • Jw f %** • °"/ • Otto / . *$72 1 f CVJofnpnJjA Aifc«n H.crfo^ ^ : • . * * \ X « V • / [Terna Municipa fc \ Area V*VT\ % , \ \ - ^W t r - rm»n • V■aAahan Q A # OOejM V • • ^A#»aiaiin £ , • • OtotM Mmnai •• Qcvnal • ’ - i*enfmn ^ V>\\ 7> v • JZ4*. # J m • I fI Maltam ^ I / V \ ftoknftN* g G u ^0#uy»# e £ i» 0 ( D 1129000 Scale 1: 336,000 0 5 3 b University of Ghana http://ugspace.ug.edu.gh CHAPTER THREE B A C K G R O U N D OF THE GA D ISTR IC T 3 .0 I n tr od u c t io n The G a D is t r i c t is one o f the f ive d is t r ic t s m ak in g -u p the G re a te r A cc ra R eg io n . It is lo c a ted to th e w es t and p a r t ly to th e n o r th o f the R eg ion . T ow a rd s the ea s t , it is b o rd e red by the A b lek um a , O ka iko i and A yaw aso d i s t r i c t s o f the A cc ra M e t ro p o l i ta n A ssem b ly . The Ew u tu -E fu tu -S e n y a d i s t r i c t o f the C en t ra l R eg ion b o rd e rs the d i s t r i c t to the w est . N o r thw a rd is th e A kw ap im Sou th D is t r ic t o f th e E a s te rn R eg ion . To the n o r th - e a s t is th e T em a M un ic ip a l A ssem b ly and to the sou th , th e G u l f o f G u in ea . It has a to ta l land a rea o f 859 squa re k i lom e t re s . 3.1 P op u la t io n The D is t r i c t has b e en d iv id ed in to 42 e le c to ra l a rea s and the e s t im a te d p o p u la t io n by 1996 was 2 80 ,656 at a g row th ra te o f 6 .2% ; a ra te w h ich is c o n s id e r e d tw ic e the n a t io n a l av e rage o f 3 .1% (Ga D is t r ic t A s sem b ly , 1996) as sh ow n in T ab le 3.1. T ab le 3 .1 : B a s ic p o p u la t io n s ta t i s t i c s o f the Ga D is t r ic t I 9 6 0 1 9 7 0 1 9 8 4 1 9 9 6 P o p u l a t i o n 3 1 , 3 0 8 5 8 , 6 7 4 1 3 3 , 3 5 8 2 8 0 , 6 5 6 A n n u a l c h a n g e s (% ) 1 . 0 6 5 1 . 0 6 2 6 . 2 Sou rce : Ga D is t r i c t A ssem b ly , 1996. H igh p o p u la t io n d en s i ty in the d is t r ic t is found a long the b o rd e r w i th the A cc ra M e t ro p o l i ta n a rea (F igu re 3 .1) and a long its so u th e rn b o rd e r w here s e t t lem en ts such as B o r t ia n o r and O sh ie can be found . T h is d ep ic t s the e x p an s io n o f the m e t ro p o l i ta n a rea in to th e h i th e r to ru ra l d i s t r ic t s . The r em a in in g p opu la t io n is d i s t r ib u te d even ly o v e r the d i s t r ic t . T ab le 3 .2 show s the d i s t r ib u t io n o f p o p u la t io n am ong the e le v en m a jo r s e t t lem en ts in the d is t r ic t . The r e la t iv e ly la rge s e t t lem en ts 54 University of Ghana http://ugspace.ug.edu.gh are M ad in a , M a l lam , B o r t ia n o r , P okua se , W e ija , D om e , Kw a sh im an , O fa n k o r and A dzen K o toku . The D is t r ic t c ap i ta l , Am asam an is the tw e l f th la rg e s t s e t t l em en t w ith a p o p u la t io n o f 2799 a c co rd in g to 1996 e s t im a te s . T ab le 3 .2 : P o p u la t io n by m a jo r s e t t l em en ts S e t t l e m e n t P o p u l a t i o n 1 9 6 0 1 9 7 0 1 9 8 4 1 9 9 6 1 M a d i n a 7 , 4 8 0 2 8 , 3 6 4 5 9 , 5 6 4 2 M a l l a m 2 , 4 0 7 2 , 5 3 6 4 , 9 4 3 1 0 , 3 8 0 3 B o r t i a n o r 1 , 8 4 0 2 , 0 8 8 3 , 2 9 8 6 , 9 2 6 4 W e i j a 1 , 5 5 1 1 , 9 0 9 2 , 4 6 4 5 , 1 7 4 5 P o k u a s e 1 , 2 0 7 1 , 9 9 0 2 , 5 2 7 5 , 3 0 7 6 D o m e 4 2 0 7 7 2 1 , 9 3 1 4 , 0 5 5 7 K w a s h i m a n 1 , 9 0 6 4 , 0 0 3 8 M i l e 7 1 , 8 7 0 3 , 9 2 7 9 O f a n k o r 5 0 4 9 3 7 1 , 6 4 9 3 , 4 6 3 10 A d z e n K o t o k u 9 6 8 1 , 2 9 0 1 , 6 5 4 3 , 4 7 3 1 1 O s h i e 7 0 1 7 1 5 1 , 4 1 6 2 , 9 7 4 T o t a l ( 1 0 l a r g e s t s e t t l e m e n t s ) 7 , 3 5 8 1 6 , 4 1 1 4 8 , 1 4 2 1 0 0 , 0 5 2 T o t a l ( D i s t r i c t ) 3 1 , 3 0 8 5 8 , 6 7 4 1 3 3 , 3 5 8 2 8 0 , 6 5 6 Sou rce : Ga D is t r ic t A ssem b ly , 1996. L ess th an 80% o f th e p o p u la t io n live in the ru ra l a rea s o f th e d i s t r i c t and d ep end s m a in ly on the su b s is te n c e or sm all sca le a g r i c u l tu r e - r e la te d in com e a c t iv i t i e s . The v ag a r ie s o f the w ea th e r , the m a rg in a l so i l s , the h igh co s t o f a g r ic u l tu r a l p roduce , the lack o f p o s t h a rv e s t h a n d l in g f a c i l i t i e s e tc . m akes in com e leve ls qu i te low. 3 .2 The Ga D is tr ic t A ssem b ly S tru c tu re and P lann in g The Ga D is t r i c t w as c re a ted in 1988 and is the se cond la rg e s t o f th e f ive d is t r ic t s o f the G re a te r A cc ra Reg ion . Some o f the d e c e n t r a l i z e d and sem i d e c e n t r a l i z e d d ep a r tm en ts r e p re s e n te d in the d i s t r i c t in c lu d e E du c a t io n , A g r ic u l tu r e , W orks , P hy s ic a l P lann ing , Soc ia l W e lfa re and C omm un i ty D ev e lo pm en t , N a tu ra l R e sou rc e C o n se rv a t io n , D is a s te r 55 University of Ghana http://ugspace.ug.edu.gh P re v e n t io n , C en t ra l A dm in is t r a t io n , H ea l th , F in an ce , T rad e and In d u s t ry . The c o n s t i tu e n t s o f th e se d ep a r tm en ts are show n in F ig u re 3 .2 . The p o l i t i c a l h ead is th e D is t r ic t C h ie f E xecu t iv e . The D is t r i c t A ssem b ly co n s is t s p r in c ip a l ly o f th e O ff ic e o f th e D is t r i c t A s s em b ly as th e h ig h e s t body . Its e x e cu t iv e fu n c t io n s are p e r fo rm ed by the E x e c u t iv e C omm it te e , w h ich is p re s id ed .over by the C h ie f E x e cu t iv e . Fo r the e f fe c t iv e g ov e rn an ce and so c io -e c o n om ic d e v e lo pm en t , s u b -c omm it te e s on D ev e lo pm en t P la n n in g , Soc ia l S e rv ic e s , W o rk s , F in an c e and A dm in is t r a t io n , J u s t ic e and S e cu r i ty h av e b e en e s ta b l i s h e d as im po r ta n t o rg an s o f the E x e cu t iv e C omm it te e . F ig u re 3 .2 : D is t r ic t A s sem b ly s t ru c tu re D e v e l o p m e n t P l a n n i n g S u b - C o m m O f f ic e o f D is t r i c t A s s em b ly D is t r i c t E x e c u t iv e C o m m it te e D is t r i c t C h ie f E x e c u t iv e S o c i a l S e r v i c e s S u b - C o m m W o r k * S u b - C o m m F i n a n c e A d m i n i s t r a t i o n S u b - C a m m D i s t r i c t C o - o r d i n a l i n g D i r e c t o r D e p u t y D i r e c t o r P l a n n i n g Sc B u d g e t i n g U n i t } B u d g e t i n g J u s t i c e S e c u r i t y S u b - C o m m D e p u t y D i r e c t o r A d m i n i s t r a t i o n T r e a s u r y I n t e r n a l A dm in M u n i c i p a l S e r v i c e s D e c e n t r a l i z e d a n d N o n - d e c e n l r a l i z c d D e p a r tm e n t s Source: Ministry of Local Government and Rural Development, 1996. 56 University of Ghana http://ugspace.ug.edu.gh The D is t r i c t C o -o rd in a t in g D ire c to r (who h ead s the D PCU ) s e rv e s as th e C h ie f D i r e c to r o f the d i s t r ic t and c o -o rd in a te s p la n n in g a c t iv i t i e s o f th e v a r io u s d e p a r tm en ts bo th d e c en t ra l iz e d and n o n -d e c e n t r a l i s e d . N in e te e n d ep a r tm en ts c o n s t i tu te bo th th e d e c e n t r a l i z e d and n o n ­ d e c e n t r a l i z e d e s ta b l i s hm en ts in the d is t r ic t . T he se se rv e as the f u n c t io n a l a g en c ie s o f th e A ssem b ly th ro ugh w h ich the v a r io u s fa c e ts o f d e v e lo pm en t are c a r r ie d out. The c a te g o r ie s o f sp a t ia l d a ta se ts a cq u i r e d and p ro c e s s e d by th e se d ep a r tm en ts h ave b een i l lu s t r a te d in a s ch em e in C h ap te r fou r o f the th e s is . A c c o rd in g to the law th a t e s ta b l i sh ed the D is t r ic t A s s em b l ie s , th e A s s em b l ie s are su ppo sed to be the f i r s t l ine u n i ts o f the n a t io n a l p l a n n in g sy s tem . T h e ir ro le is to p rov id e the ba s ic da ta to go in to the ove r a ll n a t io n a l p lan n in g . Th is p lan n in g is su p po sed to be bo th sho r t te rm and long te rm . The sho r t te rm p la n n in g im p l ie s th e annua l b u d g e t in g w he re the A ssem b ly is exp ec ted to p ro v id e a “ c om po s i te b u d g e t” in c lu d in g in com e and exp en se s fo r all m in is te r ia l d e p a r tm en ts as w e l l as fo r i ts own o ff ice s . In te rm s o f long te rm p l a n n in g the A s sem b ly is e x p ec ted to p rep a re p lan s for the d ev e lo pm en t o f in f r a s t r u c tu r e in i ts d i s t r i c t and th e reby su bm i t its p r io r i t i e s fo r d e v e lo pm en t p ro je c t s to be in c lud ed in the N a t io n a l P lan . It sh o u ld be em ph a s is e d th a t th e m a in ro le o f the lo ca l a u th o r i t i e s is to p ro v id e d a ta and in fo rm a t io n ( in c lu d in g p r io r i t i e s ) . Th is in fo rm a t io n is th en suppo sed to be “ h a rm o n i s e d ” w ith th a t o f o th e r d i s t r ic t s and a d a p te d to re g io n a l and n a t io n a l f ram es at the re g io n a l and e v en tu a l ly at the n a t io n a l leve l w he re the N a t io n a l D ev e lo pm en t P lan n in g C omm is s io n is re sp o n s ib le fo r w o rk in g ou t the N a t io n a l P lan . 3.3 The H ea lth S e c to r In fra s tru c tu re The d i s t r i c t is su b d iv id ed in to f ive h e a l th c a tchm en t a rea s or s u b ­ d i s t r i c t s n am e ly , Am asam an , D an fa , M ad ina , Obom and W eija . T he se su b -d i s t r i c t s are su ppo sed to be se rv ed by the f ive B -L eve l h e a l th 57 University of Ghana http://ugspace.ug.edu.gh f a c i l i t i e s . The v a r io u s le v e ls o f fa c i l i t i e s in G hana are b ased on a th re e - le v e l h ie r a r c h ic a l s t ru c tu re d e s ig n ed by the M in is t ry o f H ea l th (1 978 ) . The n um be r o f g o v e rnm en t , q u a s i -g o v e rnm en t and n o n -g o v e rnm en ta l i n s t i tu t io n s p ro v id in g h e a l th s e rv ic e s in the d is t r ic t is s how n in T ab le 3 .3 . T ab le 3 .3: I n s t i tu t io n s p ro v id in g H ea l th S e rv ic e s by S u b -D is t r i c t in the Ga D is t r i c t S u b - d i s t r i c t M i n i s t r y o f H e a l t h i n s t i t u t i o n s Q u a s i - G o v t . i n s t i t u t i o n N G O b u i l t c l i n i c s T o t a l h e a l t h i n s t i t u t i o n s H e a l t h c e n t r e M C H / F P c l i n i c A M A S A M A N 1 0 0 2 3 D A N F A ] 2 0 1 4 M A D I N A 0 1 1 0 2 O B O M 1 0 0 2 3 W E I J A 1 1 0 1 3 D I S T R I C T T O T A L 4 4 1 6 15 Sou rce . Ga D is t r i c t H ea l th M an ag em en t T eam , 1996. A l to g e th e r th e re are 15 h ea l th in s t i tu t io n s in the d i s t r ic t bu t no t all o f th e se p ro v id e s e rv ic e s c ov e r in g the en t i re d is t r ic t . B a s ic a l ly , it is the M in is t ry o f H ea l th f a c i l i t i e s th a t are p a t ro n is e d by the m a jo r i ty o f the p eop le in th e d is t r ic t . The num be r th e re fo re m akes th em in a d e q u a te to m ee t th e goa ls o f p r im a ry h e a l th care in the d is t r ic t . The on ly q u a s i ­ g o v e rnm en t i n s t i tu t io n lo ca ted in the M ad in a s u b -d i s t r i c t is a s p e c ia l i s e d f a c i l i ty , w h ich ca te rs for m en ta l h e a l th ca se s . A c c o rd in g to the DHMT , in fo rm a t io n on p r iv a te h e a l th f a c i l i t i e s p ro v id in g s e rv ic e s in the d i s t r i c t is in com p le te . They in c lud e the p r iv a te m ed ic a l p r a c t i t io n e r s , m a te rn i ty hom es , t r a d i t io n a l b i r th a t te n d an ts , p h a rm acy shop s , ch em ic a l s e l l e r s ’ s to re s , t r a d i t io n a l m ed ica l h e a le r s and o th e r s (M OH /G h an a H ea l th S e rv ic e , 1998). The m a in su b -d i s t r i c t , n um be r o f c omm un i t ie s th a t c o n s t i tu te the c a tc hm en t a rea for the hea l th fa c i l i t i e s and p ro je c ted p o p u la t io n for 58 University of Ghana http://ugspace.ug.edu.gh 1998 a re p re s e n te d in T ab le 3.4. A cco rd ing to th is p ro je c t io n th e D i s t r i c t ’s p o p u la t io n w as 236088 . B ased on e s t im a te s m ade by the D is t r i c t H ea l th M an ag em en t Team (DHMT) fo l low ing the ro u t in e Table 3.4: Ga District health sub-districts and population projection, 1998 S u b - d i s t r i c t A p p r o x . n o . o f c o m m u n i t i e s in c a t c h m e n t a r e a H e a l t h f a c i l i t i e s 1 9 9 8 p r o j e c t e d p o p u l a t i o n N o . o f o u t r e a c h p o i n t s A m a s a m a n 151 A m a s a m a n H e a l t h C e n t r e , O d u m a n H e a l t h C e n t r e 8 7 4 8 2 4 6 D a n f a 3 1 D a n f a H e a l t h C e n t r e , A b o k o b i M a t e r n a l a n d C h i l d H e a l t h C l i n i c 2 2 8 0 9 2 9 M a d i n a 13 M a d i n a M a t e r n a l a n d C h i l d H e a l t h C l i n i c / F P 4 3 2 2 2 14 O b o m 101 O b o m R u r a l H e a l t h C e n t r e , K w a m e a n u m M a t e r n a l a n d C h i l d H e a l t h C l i n i c 4 3 0 4 5 9 0 W e i j a 2 4 C D H , C o m m u n i c a b l e D i s e a s e s H o s p i t a l , W e i j a P u b l i c H e a l t h N u r s i n g D e m o n s t r a t i o n C l i n i c , M a l a m , A m a n f r o H e a l t h C e n t r e 3 9 5 3 0 1 8 GA District Health Management Team, 1996. im m un is a t io n e x e rc i s e s done , the to ta l p o p u la t io n has b e en pu t at 2 9 0 ,000 . T h is e s t im a te is b a sed on in c re a sed in f r a s t ru c tu ra l d e v e lo pm en t in the D is t r ic t and the su rge in m ig ra t io n f rom bo th the c i ty c en t re s and the ad jo in in g h in te r la n d s to the D is t r ic t (M OH /G h an a H ea l th S e rv ic e , 1998). The c row d ing o f the c i ty o f A cc ra c o up led w i th th e h igh co s t o f ren ta l a c comm oda t io n has led a c o n s id e ra b le n um be r o f w o rk e rs to cho se to l iv e ou ts id e the c i ty and commu te to w o rk in s te ad . For e x am p le , c omm un i t ie s such as O fanko r , P o ku a se , D om e , F ise , M ed ie and Am asam an the d is t r ic t c ap i ta l i t s e l f h ave la rge c o n c e n t r a t io n s o f r e s id e n ts who do b u s in e s s in the A cc ra m e t ro p o l i s and the n e a rby tow n sh ip o f N saw am in the A kw ap im Sou th D is t r ic t . T he re 59 University of Ghana http://ugspace.ug.edu.gh is a lso th e p h en om enon o f land a c q u is i t io n in the d i s t r i c t by m any r e s id e n t s f rom the A cc ra m e t ro po l i s as a way o f g e t t in g aw ay f rom the c o n g e s te d co re a rea o f A ccra . S ince it is l ik e ly th a t th is r i s e in p o p u la t io n w il l c o n t in u e to be a fe a tu re o f the d i s t r i c t ’s d e v e lo pm en t , it is im p o r ta n t to see how th is im p ing e s on a v a i la b le h e a l th f a c i l i t i e s or th e h e a l th s e c to r in g ene ra l . G eog raph ic a l a c c e s s ib i l i ty to th e MOH f a c i l i t i e s w as th e re fo re in v e s t ig a te d and r e su l ts p r e s e n te d in C h ap te r f iv e o f the th e s is . 3 .4 San i ta t io n fa c i l i t i e s The Ga D is t r ic t is p r e d om in an t ly ru ra l bu t has a s u b s ta n t ia l p ro p o r t io n o f i ts p o p u la t io n r e s id in g in the u rban a rea s , e sp e c ia l ly a long a re a s th a t f r in g e th e A cc ra M e t ro p o l i ta n A rea . It is th e re fo re comm on to f ind d i f f e r e n t c a te g o r ie s o f s a n i ta t io n f a c i l i t i e s and p ra c t ic e s in the d is t r ic t . The s a n i t a t io n f a c to r has b ecom e re lev an t s in ce it c o n t r ib u te s to d e te rm in in g the h e a l th s ta tu s o f the p o pu la t io n . It has b e en show n th a t im p ro v em en ts in h e a l th canno t be a ch iev ed w i th o u t a lo ok at the e n v i ro nm en ta l f a c to r s in c lu d in g where p eop le l ive and the v a r ie ty o f l i fe s ty le s o f the p eop le (S cho l te rn & de L eppe r , 1991). H e a l th and e n v i ro nm en t h ave th e re fo re b ecom e in t r ic a te ly l inked . Fo r e x am p le , a c o n s id e r a b le n um b e r o f c omm un ic ab le d is e a se s w ere a s so c ia te d w i th the s a n i t a t io n s i tu a t io n in some o f the c omm un i t ie s . The c a te g o r ie s and d i s t r ib u t io n o f the ty p e s o f s an i ta t io n in the d is t r ic t a re i l lu s t r a te d and d is c u s s e d in C hap te r f ive o f the th e s is . 3.5 H ou seh o ld w a te r supp ly H ou seho ld w a te r supp ly in the d i s t r ic t v a r ie s f rom p ip e -b o rn e sy s tem s to w e l ls , pond s , b o reh o le s and r iv e rs or s t ream s . The m a jo r i ty o f the p o p u la t io n s h ow ev e r re ly on s t ream s or r iv e rs as the m a in sou rce o f w a te r supp ly . In some case s the in c id en ce o f sk in d is e a se s and d ia r rh o e a was l in k ed to poo r w a te r supp ly s i tu a t io n . On ly a few a re a s in the d is t r i c t h ave p ip ed or po tab le water . Am asam an , the d i s t r i c t c ap i ta l . 60 University of Ghana http://ugspace.ug.edu.gh r e l ie s on w a te r d e l iv e re d by tank e rs , s to red in c o n c re te ta n k s and d i s p e n s e d to p o o r h o u s eh o ld s in b u ck e ts and o th e r r e c e p ta c le s . S om e t im e s th e se co n c re te tanks are c o nn ec ted to r o o f to p s to h a rv e s t r a inw a te r to su p p lem en t h o u seho ld supp l ie s . In some c omm un i t i e s w a te r so u rc e s in c lud e r iv e rs o r s t re am s and w e l ls . The range o f d r in k in g w a te r f a c i l i t i e s are i l lu s t r a te d and d is c u s s e d in C hap te r f ive o f the th e s is . 3 .6 S o l id w a s te d isp o sa l V a r io u s fo rm s o f so l id w as te d i spo sa l are found in the d i s t r ic t . The c omm on e s t is op en or in d is c r im in a te or c rude dum p in g o f g a rb ag e u su a l ly a ro und h o u s e h o ld s or d e s ig n a ted spo ts w i th in th e c omm un i t ie s . H ou se to h ou se c o l l e c t io n o f h ou seho ld re fu se is done in the u rb an p a r ts o f th e d i s t r ic t . A c h a ra c te r i s t i c o f th e se p ra c t ic e s is th a t m uch o f th e se a re no t c o l le c te d re g u la r ly and thu s p o se d ang e r to the h e a l th o f r e s id e n ts . A la rge s an i ta ry la nd f i l l is f o und in M a l lam v e ry c lo se to r e s id e n t i a l u n i ts . T h is is a m a jo r p ro b lem hav ing im p l ic a t io n s fo r the h e a l th o f r e s id e n ts . The c a teg o r ie s o f so l id w as te d i sp o sa l fo rm s in the d i s t r i c t and the d is e a se s a s so c ia ted w i th th em are i l lu s t r a te d and d i s c u s s e d in C h ap te r f iv e o f the th e s is . 61 University of Ghana http://ugspace.ug.edu.gh CHAPTER FOUR THE DESIGN OF A SCHEME FOR SPATIAL DATA INTEGRATION AND IDENTIFIABLE ELEMENTS OF A PROTOTYPE GIS FOR THE GA DISTRICT 4.0 Introduction GIS practitioners contend that about 80 percent o f all data contain a geographic or spatial component (ESRI, 1997). This means that such category of data has potentials for use in a GIS. Many agencies and departments collect and process data as part o f their functions, or collect data as indirect consequence of their regular functions but do not process such data regularly or collect little data incidental to their regular work but rarely process them (Dias & Poudyal, 1992). The fact remains that substantial proportions of such data have spatial elements, which may be required by other agencies or private individuals for use. Planners and researchers are often confronted with the issue of how to integrate the maze of data that they collect and process from different sources. It is within this context that the issue of geographical interoperability becomes very relevant especially where computers must be required for information processing. There is an increasing need to share various types of resources such as data and services and this is especially true of spatial information. In Ghana, the decentralization policy did not only involve the devolution o f political administration from the central government to the local level but also the planning process. This also called for the creation o f decentralized departments, which carry out the various facets o f development in the districts. Armed with their operational mandates these departments acquire and process different categories o f data either consequent to their functions or rather incidental to their regular work. As part o f the policy, these departments must not only collaborate with each other but also seek to integrate' development plans. Collaboration among the departments to achieve the goal o f holistic plans for the district will certainly call for data integration. This chapter attempts to look at the issue of data integration among the district department for GIS interoperability and proposes the basic elements for a scheme for a prototype GIS for the Ga district. The idea is to demonstrate that for holistic planning and decision making, data from the various decentralized departments need 62 University of Ghana http://ugspace.ug.edu.gh to be integrated as a first step. A practical end to this idea is to integrate sets o f data generated from different sources for health and sanitation sector planning particularly for diseases monitoring. In a similar vein the same principle of data integration is applied within the framework o f layered data concept to analyze spatial accessibility to healthcare services within the district. 4.1 The concept of spatial data integration and interoperability in GIS The process o f unifying existing data sources into a single framework is called database integration (Devogele et al. 1998). It takes as input a set o f databases, herein referred to as schemas and data instances, and produces as output a single unified description of the input schema called the integrated schema. It also unifies the associated mapping information supporting integrated access to existing data instances through the integrated schema (Batini et al. 1986, Parent et al. 1997). Interoperability can be formally defined as the ability of different software applications to freely exchange data and processing resources in real time without the penalty o f information loss (Raper, 1999). Interoperability is attained when compatibility exists among the database formats, software products, spatial conceptions, quality standards, etc. With the rapid advancement in information systems and distributed database paradigms, GIS users realized the need for interoperable geographical information systems, IGIS. IGIS provide the means by which spatially distributed GISs can be connected together in a web in order to transparently exchange data and some remote access to GIS services (Bishr, 1998). For example, spatially distributed databases found lodged within the various decentralized departments could be connected in a local web of cooperating systems to enable data exchange and flexibility o f analysis. Even though interoperability has not yet been achieved in GIS circles, being thought o f as a nightmare for systems developers but a dream for users, the fact that its basic ingredient is data integration from different sources makes it unique for planning applications. It holds great advantages for district level decision-making and planning where data from different departments require to be integrated for what has come to be termed holistic plan development. 63 University of Ghana http://ugspace.ug.edu.gh It has been argued that database integration is the most sophisticated and most powerful approach to data interoperability (Devogele et al. 1998). Simpler alternatives have however been prescribed. The first basic approach, which does not attempt any integration, is to provide users with a global catalogue of accessible information sources, where each source is described by some associated meta-data, including representation mode, scale, last update, and data quality level (Stephan & Vckovski. 1993; Uitermark, 1996). The Alexandria Digital Library project (Frew et al. 1995) is one example of a major effort to build sophisticated tools for such catalogues. A variant to this solution is the use o f dedicated Web browser services to explore GIS data available at different sites (GE02DIS, 1997). The concept o f federated database (FDB) has been proposed (Sheth and Larson, 1990). It aims at scalable integration, combining data integration and site autonomy requirements. They allow each database administrator to define the subset o f the local data, if any, which is to be made available to users o f the federated system. These subsets are integrated into one (or more) virtual DB, called the FDB; virtual here being referred to the fact that only the schema of the FDB is created. Some methodologies for the process of organizing database integration and general GIS database conversion have been discussed (Devogele et al. 1998; Parent & Spaccapietra; Piwowar et al. 1990; Bugayevsky & Snyder, 1995; Demirkesen & Schaffrin, 1996; Fagan & Soehngen 1987; Laurini, 1994; Fl'owerdew, 1992; Raus & Plazanet, 1996). However, what is most relevant to the present study and which focuses attention on an approach to spatial database GIS interoperability implementation, is the global framework proposed by Laurini (1998). 4.2 Practical problems of data and planning in the Ga District A major ingredient o f planning is information (Dias & Poudyal, 1992). The nature of this information need for planning has however changed drastically in recent times due to the fact that planning has become more decentralized and target group oriented. It is also adopting a bottom up approach to respond to the needs of the people. The value of the information however depends upon two factors, the reliability o f the data from which it is derived and the ease with which it can be accessed. As Dias and Pouydal (1992) put it “ the faster we can collect and process the data to provide the 64 University of Ghana http://ugspace.ug.edu.gh information we need the more timely and valid will be the decisions we make . The advent o f planning and policy decision-making at the district level has meant that data had to be produced on regular and timely basis. The main data sets required for this has continued to come from the decentralized, semi decentralized and non-decentralized departments o f the District Assembly. They cover virtually every facet o f the district economy and include agriculture, population, health, education, infrastructural facilities, births and deaths, co-operatives and forestry. Some of these sets o f data are compiled routinely or on ad hoc basis and stored in files or registers manually and summarized for annual report production. Inconsistencies or gaps in data sets are a common phenomenon, which makes it difficult to perform time series analysis. Another major shortcoming is the poor linkages among the departments themselves. No standards for data information sharing or data exchange exists and while some still rely on directives from their headquarters in Accra others have endeavoured to work within mandates laid down for them by their sector ministries. In the end the types of linkages required for holistic plan development become problematic. Notwithstanding these difficulties planning has continued to be conducted with available information and co-ordinated in the office of the District Planning Co-ordinating Unit. The advantage inherent in district level GIS to support planning and decision-making is that, at least the data requirement will not be unwieldy and overly sophisticated. It should be relatively easy to develop methodologies to facilitate the development o f geographical databases and harmonisation to facilitate inter-departmental data communication. 4.2.1 Data types acquired and processed and present levels o f inter-departmental collaboration within the District. A survey o f spatial data types acquired and processed by the departments was undertaken for the study. These include data on population, socio-economic activities, health facilities and incidence of diseases, infrastructural facilities including road network, vegetation, agricultural production including livestock, and crop area estimates, environmental degradation and renewable and non-renewable resources. As has been noted all the fifteen departments have their plans co-ordinated by the District Planning Co-ordinating Unit (DPCU). To date, the traditional way o f storing data in files still prevails. In many cases the data are heterogeneous in character and are of 65 University of Ghana http://ugspace.ug.edu.gh different spatial scales. A system that will facilitate easy access to stored and reliable information was very much advocated for by the heads o f the departments surveyed. A review of the channels o f communication o f plans and the structure o f the organograms o f these departments also showed that plans are co-ordinated via the Planning Office to the District Chief Executive for presentation to the Assembly. This could be seen as holding an advantage for the process o f putting together the various islands of information or disparate data sets, which form the basis for a federated database. Federated databases are said to be in place when already existing databases must co-operate or interoperate together (Laurini, 1998). The need for data integration to ensure homogeneity o f information types, avoid duplication of efforts and dissipation of scarce resources was noted to be vital to facilitating the work of the Planning Co-ordinating Unit. Even though, by their mandates, these departments are supposed to have working links with each other, little collaboration was found to exist among them. Each department was found to be an island onto itself seeking ways of collaborating but lack the necessary technologies to accomplish this. It is in the light o f this that this thesis proposes that as a first step to planning, issues of inter-departmental collaboration and data integration need be ascertained. The following sessions show the feasibility of seeking levels o f inter­ departmental data sharing that will lead to a multidatabase development for the district and for that matter GIS interoperability. Interoperability is feasible when uniformity exists among the database formats, spatial conceptions, quality standards, etc. This will call for the design of a framework by the district planners, which prescribes among others the basic areal unit and scale for data collection. 4.3 The scheme for spatial data integration An investigation of the spatial data types acquired and processed by both the decentralized and non-decentralized departments o f the District Assembly was made through a questionnaire administered among the departments and interviews with heads of departments. The study was not concerned with the type o f algorithms required to accomplish database integration and interoperability but was concerned about proposing the type o f approach needed as a first step to data integration and GIS interoperability in the district. The major components of the investigation include the following: 66 University of Ghana http://ugspace.ug.edu.gh • The identification of the department; • Operational activities carried out by the department; • Data type acquired and processed (data specification); • Scales at which the data are compiled; • Existing levels o f inter-departmental linkages and data harmonization; and • Common data sources to be shared based on inter-departmental needs. A proposed scheme for spatial data integration based on fieldwork is presented in Figure 4.1. A first step to the development o f the scheme for spatial data integration was to identify the departments, which generate spatial data, and therefore has potential for GIS implementation. Such departments DD1, DD2...DD15 as shown in the figure could be referred to as local sites where sets o f databases or schema and data instances, DGs are found lodged. It was found that not all departments produce spatial data as a consequence o f their operational mandates. As shown in the scheme, the section F illustrates the summary of the different categories o f functions carried out by the departments listed FI, F2...F15. From this listing, it was possible to obtain information on the spatial data types acquired and processed by the departments. It also constituted the bases for data harmonization to achieve the objective of data integration and exchange among the departments. A second step was to look at the existing systems of inter-departmental collaboration in terms o f common data sharing. It was common to find departments professing inter-departmental linkages, but this could not be found in much practice. Virtually every department indicated not less than two departments with which they interact by way o f data sharing or have common sets of objectives and mandates. However, it is encouraging to see this as a major step towards federated database development. It is possible that as the District Assemblies concept matures, issues about interdepartmental collaboration and information sharing for holistic plan development will become a permanent feature. 67 University of Ghana http://ugspace.ug.edu.gh Figure 4.1: Proposed scheme for district level spatial data integration F u n c tio n s(F) D is tr ic t D e p a r tm en t(DD / local sites) Data collection and analysis Development planning FI District Planning Co-ord ina ting Unit DD1 Medical care F2 Maternal &Child Health Family Planning Immunisation, Disease Control Health Education, N utnhon District Heal th Depar tment DD2 Financial advicc F3 Controll er & Accoun tant Gen. Disbursement o f Funds Department. DD3 District Planning Schemes F4 Settlement Development Control Physical Development advice Town & Count ry Plann ing Dept. DD4 Child care F5 Administration o f justice Community ca*e (Disabled) Depar tment o f Social Welfa re DD5 Agricultural development F6 Crops & Livestock disease control. Crop and (Livestock forecast. Productivity estimates Depar tmen t o f Food & Agr icu lture DD6 Co-ordinate youth activities F7 Nationa l Youth Council DD7 Registration o f Deaths & Births Births & Deaths Registry DD8 Waste management F9 Premises inspection Food Hygiene Enforcement o f sanitation laws. Public Health Education. Disease I Control ; Building sanitation I Depar tmen t o f Environmenta l Heal th DD9 Development, monitoring and quality control o f works programmes and projects FIO Works Department DD10 Averting environmental FI 1 degradation. Control o f tree felling, Nursery development Forest ry Department DD11 Administration and Finance o f Educational Programmes & Projects Manpower training. Monitoring & Evaluation F12 Dis tri ct Directorate o f Education DD12 Adult education, Self help Projects encouragement. Promotion o f Income generation projects F13 Depar tmen t o f Communi ty Deve lopment DD13 Depar tment o f Co-operatives DD14Registration/Inventory o f Co-operative Societies FI 4 Assist in humanitarian services Fire fighting. Education on fire prevention Train fire volunteer squads F 15 DD1 5 O the r sources: Donor agencies and NGOs DD16 Source: Based on field work, 1998. D ata G en e ra te d (DG) Population Statistics DGI Infrastructural facilities (Social amenities) DG2 Diseases Trend DG3 Nutritional status DG4 Socio-economic data DG5 Base maps DG6 Crop area estimates DG7 Crop and Livestock/ Fisheries production estimates DG8 Farm & Household data DG9 Drinking water sources DR10 Educational facilities D G ll Sanitation forms and facilities DGI 2 Markets DG13 Environmental degradation D G I4 Vegetation data DR15 Income generating activities DGI 6 Settlement design DG17 Road network DGI 8 District resources DG19 D ata S o u rc e s (DS) (for the global s chema) DDI: DGI, DG2, DG3, DG4, DG5.DG6, DG7, DG8.DG9 DG10, DGI 1, DG I2, DG13, DGM ,DGI5,DG16,DGJ7 DGI 8,DGI 9 DD2.DG I.DG3. DG4.DG6.DGI0, DG I2, DD3: D D 4 :d g i ,DG2, DG6, DGI7.DG18 DD5: DD6:DG1,DG7,DG8 DG9 0 0 7 :006 .005,0016 DG19 DD8: DG I,DG6, DD9: DG1.DG2.DG3 DG6.DG10, DG12.DG14 DGI 7 D D 10 :D G 2 ,D G 6 , DG I7.DG I8 DD11:dG6. d g k DG15 DD12:dgi DG6. D G ll DD13:dgi DG I6, D G I9 DG5, DG6 DD14:dg i6 DD I 5 :DG2.DG6,DG 15, DG I7, DG 18 DD I6 Collabo ra te wi th all distr ict assembly depa rtment s to m ee t the goals o f deve lopment 68 University of Ghana http://ugspace.ug.edu.gh The last step, which would lead to a global conceptual schema or a federated database development, was to seek the data sets or categories o f data that the various departments or local sites could use. It shows at the first instance what individual departments would require to accomplish their operational mandates. For example, DD1 as a department will require data from sources such as DG1, DG2, DG5, DG6, DG10, DG13, DG16 and DG19. It was noted however, that not all departments had clearly defined spatial data types and their sources to meet their operational needs (e.g. DD3 and DD5). These sources therefore could not be shown in the scheme. Other sources o f data included in the scheme are from donor agencies, both bilateral and multilateral and NGOs. 4.4 The approach to multidatabase design for the district Even though the various departments and their data requirements have been identified, it is important to develop a basic approach to the design of the multi­ database for the district. Multidatabase refers to any kind o f structure that links several databases together. They are relevant in several ways, for instead of centralizing geographic information into a unique database, they serve a more useful purpose when they are federated and stored into different databases or sites. Another aspect is that it can be very interesting also from any computer system to use geographic data stored in other computers. The multidatabase design process involves starting from the local schemata in order to synthesize them to build the global schemata. The main difficulties with this process is that the databases can have different structures; that is to say the same data name can refer to different things and so on. For example, the settlement of Obom in the Ga district is referred to in other records as Obon and Oboum. This creates problems when executing spatial joins. The need for a multidatabase development and interoperability therefore calls for agreements or consensus among departments on issues such as: • Who are the potential users; • What are the output products requirements; • A definition o f spatial data categories, • Establishment of required levels of accuracy; and • An evaluation o f data sources/quality (ASPRS, 1988). 69 University of Ghana http://ugspace.ug.edu.gh This consensus can be sought at the district level or at national level to allow for homogeneity. In designing a multidatabase, two main cases have been cited (Laurini, 1998); either one has to build a distributed system from scratch (top-down), or one has to federate different existing databases (bottom-up). Figure 4.2: The top-down and bottom-up schema designs D ecom po s i t i o n o f schem a ta a cco rd ing to seve ra l local d a tabase s S c h em a in teg ra t ion o f seve ra l ex is t ing da tabase s A fte r Laurin i , 1998 4.4.1 The top-down approach In this approach, one is starting from a global schema encompassing all data aspects of the systems. The global schema is then split into different local schemata due to some placement strategy. By placement strategy, we mean that rules have been designed and must be followed in order to place adequately data fragments. In this approach, generally speaking, same network, DBMS, operating systems and hardware are used, so giving a homogeneous distributed system. The study favours this top- down approach for several reasons. In the first place the global schema could be brought about by the present efforts at plan synthesis or integration by the District 70 University of Ghana http://ugspace.ug.edu.gh Planning Co-ordinating Unit (DPCU). As shown in the scheme, (illustrated in Figure 4.1), the DPCU, (DD1), has the responsibility of synthesizing all the data sources DG1, DG2....DG19, or building what is referred to as the distributed database. The use scalograms have already formed a substantial base for spatial data and resource inventory by the DPCU. As it were, the district has been divided into areal units called electoral areas, which form the basis for representation at the assembly, and also as basic units for development planning and allocation of resources. It will be relatively easier therefore for the district departments or local sites to use these areal units as the bases for spatial data inventory. By so doing a global schema design could be brought about much more easily under a general consensus. 4.4.2 The bottom-up approach The bottom-up approach or local-to-global approach is much more complex. The problem here is starting from different existing databases, to create a federation taking the maximum in common. Due to the variety of hardware operating systems, data representation capabilities, it is often difficult to federate different databases (Laurini 1998). It must be noted that this scheme has not involved a prescription for the type o f hardware and software configuration needed to achieve multidatabase design. The study is concerned with a first step approach to data integration and interoperability which some authors have often referred to as a dream of spatial data users but a nightmare for system developers (Laurini, 1998). It is sufficient to state however that given the decentralized system of government and planning, the districts constitute homogeneous and manageable units for which the same network, DBMS, operating systems and hardware could be prescribed. 4.5 Proposed elements for prototype GIS in the district The preceding sections have been an attempt to underline the basic requirements for database integration and GIS interoperability in the district. It shows the relevance of multidatabase development and the type of approach needed to attain this in order to enhance the planning and decision-making process. The proceeding sections describe the elements for a prototype GIS that could be implemented in the district and which could be. replicated in other districts. The main components of the scheme are based on spatial data types acquired and used by the decentralized departments. The objective is to show data sources, methods and tools for obtaining the various 71 University of Ghana http://ugspace.ug.edu.gh categories o f data - environmental or socio-economic and cultural and the software components o f the prototype. Figure 4.3: The elements o f a prototype district GIS showing the main data sources, data categories and software components DATA SOURCES 1. District Planning Co-ordinating Unit, 2. District Health Department, 3. Controller & Accountant Gen. Department. 4. Town & Country Planning Department., 5. Department o f Social Welfare, 6.Department o f Food and Agriculture, 7. National Youth Council, 8. Births and Deaths Registry, 9.Department o f Environmental Health, 10.Works Department, 11. Forestry Department, 12. District Directorate o f Education, 13.Department o f Community Development, 14.Department o f Co-operatives, 15. Fire Service, 16. Others - including Donor Agencies and NGOs. Remote Sensing G round base surveys Sate l l i te im ages , aer ia l pho tog raph s , and o the r rf>cnrHincr trK tr iim pn te J Base maps, Questionnaire, interviews, Compass, GPS, etc. Ground truthing Environmental Data Socio-Economic & Cultural Data Data input/entry Geographical Information System Spatial and Attribute database Climate Vegetation Soils Relief Geology Drainage O t h e r f ie ld observations “ 1“ . Population Education Agriculture/land use/production Health and sanitation Industry Trade Transport Tourism Other field observations Geographic Database Topology, position, attributes Data transformation Data display/Output and reporting Tables Query input Figures Charts, Graphs J Software components of the GIS (after Borrough, 1987) 72 University of Ghana http://ugspace.ug.edu.gh Figure 4.3, is a model o f the basic elements of the proposed prototype district GIS. The salient elements of the model are: • the data sources, • the categories of data available in the district for planning, • the means by which the data sets are captured, • the software components o f the GIS and • the GIS and its products. 4.5.1 Sources and categories o f data The study identified fifteen district departments whose activities generate spatial data - environmental, socio-economic and cultural. These departments use very diverse data sets, especially diverse in content and in the scale o f coverage. Much o f the data are collected and based on individual community level. The advantage inherent in this scale of coverage is that it lends itself more easily to data harmonization for the purpose of generating any new information. Chapter five of the thesis uses this community level data gathering to generate various data sets for the analysis o f health and sanitation issues in the district. So far the geo-coding scheme used was based on population census o f 1984. All other attribute data used in the thesis were related to the population and settlements data, which was the common key field. Even though the study did not come across instances where remote sensing methods have been employed in data gathering in any of the departments, the technology is here mentioned as an important source: of: data for any meaningful district level primary data generation. Meijer & Kuipers. (1992) mentioned that remote sensing data is relevant when there is the need for environmental information system. Ground base survey methods including questionnaires, interviews, the use o f the GPS, and radiometers have also been mentioned as other means o f obtaining data. These could be applied to both environmental data and socio-economic and cultural data. As shown in Figure 4.3 a large array o f data is available for use in any planning and decision making venture within the district. These range from climatic data to tourism data, which can be constituted into a spatial and attribute database. 73 University of Ghana http://ugspace.ug.edu.gh 4.5.2 Software components o f the prototype system The software components of the scheme as shown in Figure 4.3 consist o f five basic technical modules (after Borrough, 1986). These basic modules are sub-systems for: (a) Data input and verification; (b) Data storage and database management; (c) Data output and presentation; (d) Data transformation; and (e) Interaction with the user (Query Input). A few o f these modules are mentioned here to establish how they function within the context o f the scheme employed for the prototype outlined. 4.5.2.1 Data input and verification Data input covers all aspects o f transforming the district data captured in the form of existing maps, field observations, and remotely sensed data into compatible digital form. This involves a range of computer tools including the interactive computer screen and mouse, the digitizer, scanners and lists o f data text files or spreadsheet programmes and devices that facilitate the reading of data sets already written on magnetic media such as tapes or CDROMs. In the context o f this study, digital copies o f base map information on the district were obtained. Coverages or layers o f information required for the study such as drainage (rivers and streams network), road network and other socio-economic and cultural features were obtained from Survey Department. Other coverages such as lakes, settlement location, population, and road classification were obtained from the CERSGIS, Legon. The spatial and attribute database established by these data sources served as base or common key fields for all other data sets that were joined to form various themes for the GIS analysis. Verification and editing were simultaneous processes employed for checking data for errors such as possible inaccuracies, omissions and other problems prior to linking the spatial and attribute data. 74 University of Ghana http://ugspace.ug.edu.gh 4.5.2.2 Data storage and database management Organizing data in a GIS is enabled by the Database Management System (DBMS). Theoretically data storage and database management concerns the way in which the data about the position, linkages (topology) and attributes o f such geographical elements as points, lines, and areas representing the various spatial objects are structured and organized, both with respect to the way they must be handled in the computer and how they are perceived by the users o f the system. The creation of digital data sets by manual input already creates the data needed. But this must be stored in forms that will facilitate its management and organization. The DBMS is basically designed to store and manage large amounts of data. Its aim is to make data quickly available for multiple uses and multitude of users whilst still maintaining its integrity to protect the data against deletion and corruption, and to facilitate the addition, removal and updating of data as necessary (Borrough & McDonnel, 1998). An inherent problem of planning in the districts is the lack of properly organized databases. A few departments such as the DHMT maintained some categories o f data for health monitoring. For example, it was possible to find data with such details us sex, age, disease type, community of patients etc. These are however all found in analogue forms and held in files and books. Respondents to a questionnaire on GIS use and relevance admitted the advantages inherent in the application o f the technology especially for DBM in the departments. Several advantages are there to be gained. Frank (1998), for example, has indicated that a well functioning DBMS could provide the following: (a) Allow storage and retrieval o f data and data selection based on one or more attributes or relations. (b) Standardize access to data, and separate data storage and retrieval from the use of data in application programmes to maintain independence in those programmes. (c) Provide an interface between database and application programme based on a logical description of the data without requiring details of the physical storage. (d) Make access functions in applications independent of the physical storage structure so that programmes are not affected by changes in storage media. (e) Allow several users to access the data simultaneously. 75 University of Ghana http://ugspace.ug.edu.gh (f) Protect the database from indiscriminate and illegal changes. (g) Provide sound rules for data consistency which will be enforced automatically. These rules are an excellent way of removing errors and inconsistencies from the database. A major advancement in GIS software development is the concept o f relational database (Scholten & de Lepper, 1994). It is a standard tool, which facilitates data manipulation and analysis. This involves the linking together o f different datasets by the use of common key fields - in what is known as spatial join (ESRI, 1996). What this means for any district GIS is the advantages it offers for joining different datasets from the various departments as long as there is a common field or address to match. For example, the data sets on diseases, sanitation practices, household water supply sources and forms of solid waste disposal were all joined as attributes to a common key field - settlements and population data. 4.5.2.3 Data output and presentation Data output is the operation,of presenting, the results o f data manipulation in a form that is comprehensible to the user or in a form that allows data transfer to another computer system. The output o f the data, the way it is displayed and results o f analysis reported is an essential component o f the GIS. Data may be presented as maps, tables, charts and figures in a variety o f ways ranging from the image on the computer monitor through hard-copy output from the printer or plotter to information recorded on diskettes, CDROMS or magnetic media in digital form. In recent, times, capabilities for producing aesthetically pleasing graphical output have increased. In ArcView layout, details such as map legend, title, orientation indicator, a scale or scale bar, neatline, as well as colour, symbology, shaded patterns and texts among others are features that can be added readily as part o f the process of map composition. 4.5.2.4 Data transformation Data transformation embraces two classes of operation. These are: (a) the transformations needed to remove errors from the data or to bring them up to date or to match them to other data sets, and 76 University of Ghana http://ugspace.ug.edu.gh (b) the large array o f analysis methods that can be applied to the data in order to achieve answers to the questions asked of the GIS. Borrough & McDonnel (1998) have listed some basic requirements for a typical GIS. These do not only provide new insights to existing problems that the GIS is set to solve but also lead to the creation of new sets o f information or data which could be added to existing databases thereby increasing the size and value of the database. In this way the district GIS should be able to provide answers to such requests as, (a) the locations of settlements with population within a given range, (b) the distribution of settlements with certain categories o f facilities, e.g. types of household water supply or communities with certain categories o f sanitation practices, (c) the number of occurrences of disease M within distance D o f settlement B, (d) the size o f regions most vulnerable to the strain of disease Q, (e) the attributes of entities located at points Yl, Y2, etc. 4.5.2.5 Interaction with the user (Query Input) One of the most important aspects of GIS application is the interaction with the user or user interface that is, query input. This is absolutely essential for the type of analysis o f data required for spatial planning and decision-making at the district level. This module enables direct interaction between the user and the computer especially where commands are menu driven, or initiated by a response to requests in English- like command language, e.g., the query builder in ArcView. The module allows features in a view or records in a table to be selected by a logical expression based on attribute values. 4.6 The choice of software Even though it is not the intention of this thesis to prescribe the appropriate software required for the prototype GIS being proposed, it is important to suggest the types that can be handled within the constraints faced by most developing countries. These constraints principally are in the area of expertise and capital. Again the choice of software and data relies on the clear and concise definition of project objectives and goals (Kolars, 1995). Meijer & Kuipers, (1992), proposed what is described as the 77 University of Ghana http://ugspace.ug.edu.gh low-end GIS tools. According to them, several standard PC packages available for socioeconomic fields of interest, have proven to be very useful in western organizations. These packages can also be used in developing countries for prototype purposes in the early phase o f the introduction of larger systems. Others have emphasized the choice of appropriate software taking into consideration issues such as the price o f software and hardware, hardware capacity requirements, technical agent training as well as project goals and objectives (OSS/UNITAR, 1995). 4.7 Conclusion Even though the application of computers and for that matter GIS technology in many agencies and departments in developing countries is still limited, the use o f GIS to meet the needs of planning and decision support is gaining currency. Where information is the key to planning and decision-making then the use of appropriate technologies that will enhance the integration of different data sets held within the various departments should be advocated. The study has indicated the desire o f most departments to integrate their data sets and;allow for GIS interoperability. However, when the decision is taken to adopt GIS, issues such as what data to use, their sources, formats, scale and the type o f approach to integrating them for the purpose of interoperability should be resolved. This chapter has been an attempt at proposing a scheme for spatial data source identification and an approach to the type of multidatabase development to achieve holistic plan development in the district. It has also been an attempt to show the design of the basic elements for a prototype GIS that takes into consideration data types, their sources, tools for acquiring them, the databases that could be established and the software modules for the prototype. District level planning and decision making for holistic plans development requires a technology that will facilitate data integration, multidatabase development and data interoperability. The only medium for achieving this is through a GIS. The study has demonstrated that it is possible to integrate, data sets held by the various departments within the district. It favoured an approach, which involves a split o f the global schema into different local schemata. In the district context these schema refer to the global database supposed to be maintained by the District Coordinating and Planning Unit (global schema) and the local database supposed to be maintained by the district 78 University of Ghana http://ugspace.ug.edu.gh departments (local schema). To allow for homogeneity requires the use of the same network, DBMS, operating systems and hardware. The proceeding chapters are an attempt at using the data integration concept based on disparate data sets held by district departments and others acquired through direct investigations among health institutions, to conduct some health and sanitation sector analysis such as will be required to aid decision-making and planning. These data sets include population distribution, types of sanitation facilities and practices, household water sources, solid waste disposal forms, vector data (road network) and major diseases. The objective is to see through the GIS medium how data federated from various sources using the same spatial scale could be employed to generate new sets o f information for a more informed and reliable decision-making. The choice o f the health and sanitation sector was relevant because o f the challenging problem it poses for the study area as outlined in Chapter 1 o f the thesis. The sector is therefore a test bed for studying the various socio-economic and environmental processes or for analysing the result o f trends or anticipating the possible results o f planning decisions in the district. 79 University of Ghana http://ugspace.ug.edu.gh CHAPTER FIVE AN ANALYSIS OF THE SPATIAL DISTRIBUTION OF ENDEMIC DISEASES, SANITATION FACILITIES, HOUSEHOLD WATER SUPPLY SOURCES AND SOLID WASTE DISPOSAL FORMS IN THE GA DISTRICT USING THE INTEGRATED DATA CONCEPT 5.0 Introduction An increasing recognition is being given to planning in the health sector as a result of the fact that it is the key to achieving the most efficient utilization o f available resources for the improvement of the state o f health of any given population (Popov, 1971). The WHO Expert Committee on Public Health Administration in its fourth report defined health planning in the following terms: “The careful, intelligent interpretation and orderly development of services, in accordance with modem knowledge and experience to meet the health needs of a nation within its resources” (WHO, 1961). During the past 30 years, governments have shown increased interest in health planning as part o f the general economic and social development towards the systematic organisation and rational deployment o f national economic and manpower resources. Without doubt ill health and disability are serious handicap to the development of any economy, and those loses that they can cause can be reduced by measures to safeguard the health of the labour force. Among the important ingredients that have often been cited for the successful accomplishment o f any health planning programme is information. A report by the Institute of Medicine on health planning in the United States indicated that the availability of solid information and good research are essential ingredients in the effectiveness o f any health planning activity (Institute o f Medicine, 1980). Information and particularly how it is packaged is essential for planning and decision-making. The proceeding sections are an attempt at data integration to generate the relevant information for primary health care planning and decision making on major diseases in a district context. The study of diseases and their geographical aspects has become relevant because it contributes to both educational intervention and the planning of health care delivery systems. One of the important instruments for achieving this is through the use of maps (Kabel, 1990). The explanation o f the spatial dynamics of diseases and associated environmental factors has for a long time been done using maps (Scholten 80 University of Ghana http://ugspace.ug.edu.gh & de Lepper, 1991). A classic example often cited is the work of John Snow (1813­ 1858) on cholera. Snow used maps to show the geographical distribution of cholera deaths in an area in London. He was able to demonstrate the association between cholera deaths and contaminated water supplies (Gilbert, 1958). The geographical distributions shown were very striking. One o f the most important issues in public and environmental health concerns the type o f instruments that can be used to device quick, reliable and scientifically valid methods of rapid assessment which in turn, can be utilized in health research and in the planning, monitoring and evaluation of health programmes. As the application of GIS relate to the collection, storage, integration, management, retrieval, analysis and display o f spatial data, it is not suprising that the potential usefulness o f this technology in the area of health research and policy is fast been realized. This chapter demonstrates the relationship between health and some environmental factors in the context of the Ga district, with the aim o f understanding the relationships between the distribution and diffusion o f some endemic diseases and the environment. The concern is not an attempt to link causes and effect but to show the spatial distribution of the diseases and some environmental factors that could help explain the pattern of such distribution. The chapter is aimed at showing the use of layered databases, which integrates different themes with the view to providing indications of those areas on the maps shown in which further research may be useful. The various data layers and their sources demonstrates the multisectoral approach to solving spatial problems. This multisectoral approach lends itself to the systems concept where linked components, here signified by data layers or themes are integrated at different levels to help explain interrelationships between the various phenomena. It is also to strengthen the fact that, it is possible to integrate data from different sources within a given region for planning and decision-making. The study also employed the point in polygon technique of analysis to identify cases of diseases within areas zoned as endemic. Through this, communities that are at risk were noted. 81 University of Ghana http://ugspace.ug.edu.gh Figure 5.1: Household water supply sources •Trokorfcope Dedenjan • Kowksrf ' Dome• Otaten - vra c c rryg Bukor Obeyie • Dantse a * Ablelcima • I Isonfa• Dzamai Mallam Galilea Tetegt Kokrobite Grid Household water supply Pipe Borne • Wells Bore Holes Rivers/Streams IZZi Bore holes/Wells Health centre R a i lw a y Lake R o a d s District Boundary B Kdometers Scakl ) 313,000 81b University of Ghana http://ugspace.ug.edu.gh Figure 5.2: Distribution of solid waste d isposa l forms ■ ssuom •Trokorkope >mpey * Dome• Kowkat f Akutuaku Obeyle Otobt Ozamai ABabaharfl • Gal i tea Kokrobr 0 Kilometers 5 Scale 1: 318,000 Grid + Health centre Solid Waste disposal form Railway • Home collection Lake Sanitary land fill Backyard Disposal Roads _________ District Boundary 81c University of Ghana http://ugspace.ug.edu.gh 5.1 Data types utilized and their sources 5.1.1 Endemic diseases The main focus of the study was on the spatial distribution o f the ten most common endemic diseases reported at the five main health centers in the district. These are malaria, diarrhoea, acute eye infections, ear infections, measles, skin infections, intestinal worms, upper respiratory tract infection, chicken pox and buruli ulcer. Data based on individual cases reported by patients from the various communities were collected for a twelve-month period (between October 1997 and September 1998). These data were obtained from patients’ diagnostic records, which make the data source primary. They were entered into an existing attribute database using settlement names as the common key field. In all, these data sets led to the creation o f ten additional fields in the attribute database. Each of the disease types was converted into a shapefile to become a theme in the table of contents. For the ten diseases listed, ten views were created. The following themes were contained in most o f the maps generated: • the district boundary, • road network, • rail line, • settlements (which were used as points to depict the spatial distribution o f the diseases), • the Weija lake, • major rivers, • environmental factors ( solid waste disposal, sanitation forms and household water sources) and, • delineated or exposure zones (to show areas described as endemic for the particular disease). 5.1.2 Environmental factors D esp i te v a s t im p ro v em en ts in h e a l th g lo b a l ly ove r the p a s t sev e ra l d e c ad e s , e n v i ro nm en ta l fa c to rs rem a in a m a jo r cau se o f s ic k n e s s and dea th in m any r e g io n s o f the w or ld . In the p o o re s t re g io n s , one in f iv e c h i ld r e n do no t l ive to see th e i r f i f th b i r th d ay , la rg e ly b e c au se o f e n v i ro nm en ta l ly r e la te d - and p r e v e n ta b le -d i s e a s e s . Even though little 82 University of Ghana http://ugspace.ug.edu.gh Figure 5.3: Types of sanitation practices / # 1 Akwapim • .suom 1 South D is t r ic t / \ / ^ V ) a n f i , / / B J L lt • / 9*° / • / • Aki^ial • • ; . ^ . G* • * . . . i - I ’ 4 V •Pobtm« 1 X . • ’ “ .-.Am ♦A^ranmSn • \ « . • \ x # • Deder^an Hi ■ ♦ V ' ■ s^^ rnan # • / • / A^okobi/ # #T e m a / M u n ic ip a l / A rea • \ • •* \ • • x • ' \ *•O ✓ \ * X • • % • Adiembra • » • • • Dantse • j\ • • Obeyie '< • • * • *9 . f a . • Dzamatl • 1 \ * %— - Asofaa'-.--.» / V <> T<2f \ \ ♦ \ < # \ % ^\ \ •Galilea \ Bija take/ Weija # . ~ , Mallam* • • • • T' tKaUrrtm '-- -- -- -- -- -- -- -- -- -^ 9 ,' D ° ° \ 6 • a ® ,»« ° ( D tUMBI Scalo 1 8 0 ’ ••MIX 312,000 0 Kifocnetwrs G r id • K V IP /W C /P i t la t r in e S a n ita t io n + H e a lth c e n t r e • W a te r C lo s e ts R a ilw a y V K V IP L a k e • P it L a t r in e s R o a d s P it L a t r in e s /O p e n R a n g e □ D is t r ic t B o u n d a r y 82b University of Ghana http://ugspace.ug.edu.gh research has been conducted on how much environmental factors add to the worlds burden o f ill-health it is becoming increasingly clear th a t h e a lth and i l l - h e a l th are a f fe c te d by a v a r ie ty o f life s ty le and e n v iro nm en ta l fa c to rs in c lu d in g w he re p eo p le liv e (S ch o lte n & de L ep p e r , 1991). A good a s so c ia t io n has b een e s ta b lish e d b e tw een the s p a tia l d y n am ic s o f d is e a s e s and e n v iro nm en ta l fa c to rs and h e re th e w ork o f Jo h n Snow c ite d e a r l ie r is w o rth m en tio n in g . T h is th e s is c o n s id e re d th e b a s ic e n v iro nm en ta l fa c to rs th a t a c co u n t fo r th e le v e ls o f e n d em ic ity o f th e d is e a s e s in d ic a te d . The issu e o f l i fe s ty le as a c au sa l fa c to r w as n o t c o n s id e re d fo r re a so n s o f tim e and scope o f re s e a rc h in v o lv e d . T h is co u ld be a fa c to r to be c o n s id e re d fo r fu tu re re se a rc h . The environmental data constituted the following themes: • Household water supply sources • Refuse or solid waste disposal types • Types o f sanitation practices These sets o f data were obtained from the District Planning Co-ordinating Unit, the District Environmental Health Unit and through supplementary field surveys conducted by the researcher. Under the household water supply sources the following categories were listed: pipe borne system, wells, bore holes and rivers or streams. The objective was to find the category o f household water sources in each community in the district. In many o f the rural areas the dominant source o f household water is rivers or streams. This is shown in Figure 5.1. In Madina, Dome, Gbawe and those areas that fringe the Accra Metropolitan Area, the water source was generally categorized under the pipe borne system. In many o f these areas treated water obviously from the piped system is either found connected directly to homes or purchased in tanks and stored in reservoirs and other receptacles. The categories o f solid waste disposal types listed were home collection and backyard disposal. The spatial distribution of these forms o f waste disposal is illustrated in Figure 5.2. A sanitary landfill was also included as a category since it is a major waste disposal site. Even though sited in the district, it serves as a landfill for refuse from the Accra Metropolitan Area. For the purpose o f the study the dominant form o f solid 83 University of Ghana http://ugspace.ug.edu.gh waste disposal in each community was chosen to be the general. In the rural areas the waste disposal type was not difficult to ascertain. It was either individual household backyard disposal or a system where a few households created a dump for common use. It was concluded in the study that whichever form the backyard waste disposal system took, insofar as it was akin to the unorganized system o f open range disposal, it would be accepted as backyard disposal. In the more urban areas o f the district, the situation varied. The local authorities regulate refuse disposal through the designation o f collection points either at the frontage o f homes or identified spots for household refuse dumping which are collected periodically. Whichever form it took, the general situation was that o f organized collection more akin to the home collection. Sanitation is the term broadly used to include such categories as flush toilets or water closets systems, Kumasi Ventilated Improved Pit (KVIPs), pit latrines or pan latrines and open defecation. In some o f the communities listed, at least, more than one o f these categories o f sanitation is found. Figure 5.3 shows the spatial distribution o f the various types o f sanitation in the district. Each o f the environmental factors and their categories were coded and added as fields to the attribute database for settlements and population. These became themes with their own attribute data tables. Thus as coverages, they were employed as themes for the overlay method o f analysis. The proceeding sections are attempts at modeling the spatial incidence o f endemic diseases in the district and the association between their patterns o f distribution and the three major environmental factors mentioned under 5.1.2 above. 84 University of Ghana http://ugspace.ug.edu.gh Figure 5.5: Malaria incidence (1997/98) 3 0 /3 2000 40 00 60 N 00 80 um ber o f c a se 00 10C s )00 12C)00 14000 Of all the diseases investigated in the district, malaria is the most endemic. As shown in Figure 5.4 above a total o f 11452 cases were reported within the period between October 1997 and September 1998. Malaria alone constituted 53 percent o f all cases o f diseases reported in the district during the period. Figure 5.5 is a cartographic depiction, through the use o f graduated circles, o f the range o f malaria cases reported from each community. Based on the clusters created by the distribution pattern, five zones were delineated as endemic with the disease. These zones are Weija, Madina, Amasaman, Danfa and Obom. For the purpose of analysis, the identify tool, a functionality in ArcView was used as a query builder to investigate individual locations on the map. By activating the malaria theme Figure 5.6: Malaria distribution in the Ga District (1997/98) 85 University of Ghana http://ugspace.ug.edu.gh in the view, the identify tool selects the communities that are found within each zone. In this way all the attribute data on each community shown on the map, including the total number o f reported cases for malaria were obtained. As shown in Figure 5.5, the largest concentration o f malaria is in the Weija and Madina zones. In the case o f Madina, the distribution is concentrated in the Madina township while in the Weija zone it is scattered over eleven communities. A comparative analysis o f the distribution among the five zones is also illustrated in the chart shown in Figure 5.6 where the total number o f cases for the two sub-districts is shown. These two zones alone contribute 60 percent o f the cases o f malaria in the district. They incidentally are the most urban parts o f the district. Through out the district the dominant sanitation form is pit latrine system (Figure 5.3). Backyard disposal method also dominates the forms o f solid waste disposal (Figure 5.2) while the population is mainly reliant on rivers or streams as sources o f household water supply (Figure 5.1). The effects o f these environmentally related factors are not well known for the spread o f malaria in the district. What is known generally is the association o f the disease with insanitary conditions, especially stagnant water bodies. It is observed that zones o f high incidence in the district are those that are located near the Accra Metropolitan Area where insanitary conditions mostly attributed to unwise development are well known. An overlay with the major rivers theme showed no visible relationship between the incidence o f malaria and rivers shown on the map. It is however possible to suggest that the Weija Lake could account for the high incidence o f malaria around Weija and its surrounding areas. As shown in Figure. 5.5, the townships o f Weija, MacCarthy Hill and Mallam are situated nearest to the Weija Lake and this may account for the high cases o f malaria. The Weija Lake side is a hub o f small-scale irrigation activities and this type o f activity has been known to bring about the proliferation o f diseases usually associated with water impoundment projects, malaria being no exception (Kofi, 1990). Pools o f water in the irrigated plots can be favourable vector habitats. The case o f Madina Figure 5.7: Malaria distribution in the Weija sub-district (1997/98) 7 0 0 £ 6 0 0 § 500 * 400 5 300 f 200 J 100 0 < / / / / / / y ' / y ' 86 University of Ghana http://ugspace.ug.edu.gh Figure 5.8: Diarrhoea incidence (1997/98) D an fa /M ad in a (D D ia rrh oea 1 - 13 • 1 4 - 3 0 • 31 - 5 3 • 5 4 - 8 2 • 8 3 - 1 3 3 • 134 • 5 69 R a ilw ay Lake R oad s D ia if l to e a E n d em ic A rea G a D ts tn c t B o u n d a ry 86b University of Ghana http://ugspace.ug.edu.gh could be explained away by the usual insanitary conditions associated with urban areas, where choked gutters and stagnant water bodies among others are a common The pattern o f distribution o f malaria illustrated in Figure 5.7 raises question o f primary healthcare and the need for policies to tackle the diseases at source particularly those that address preventive actions to reduce environmental threats to health. The value o f GIS as a tool for supporting policy decisions has been demonstrated to be worthwhile in this direction. As shown, any plan to control malaria in the district could be emphasized in the Madina and Weija areas. 5.2.2 Spatial incidence o f Diarrhoea Diarrhoea is associated with poor sanitation and contaminated food and drink and is widely recognized as a major cause o f morbidity and mortality in Sub-Saharan Africa (Kirkwood, 1991). It ranks third among the commonest diseases in the Ga District (Figure 5.4). A total o f 3073 cases were reported at the five health centres in the district between October 1997 and September 1998. The spatial distribution of diarrhoea is shown in Figure 5.8. Three zones were delineated as endemic with the disease. These, as shown on the map are Danfa/Madina, Amasaman (which extends to O bom ) and Weija. As is observed the largest incidence o f the disease is found in the Amasaman sub-district. This is Figure 5.9: Diarrhoea cases in the Ga District (1997/98) followed by Madina. A bar chart representation o f the distribution pattern in the sub­ districts is shown in Figure 5.9. 87 University of Ghana http://ugspace.ug.edu.gh Figure 5.11: Diarrhhoea and types of sanitation practices (1997/98) / Amasama _ T Akwa j / Tema «\ / Municipal \ / Area • YjS Danfa/Madm \ • • * \ • •X • X s • * * * • . . • * * . * ^P , v y N s. \ ® \ V • v \ \ \ U ^7 lv i «"•*- , + / . ^ ^ / • •/ / • / / mra \ \ * G o' . ' v * * 0 8 Kilometers Scale 1: 340,000 Sanitation • 83 - 133 ■ Water Closets • 1 3 4 -5 6 9 . KVIP . Pit Latrines Railway Pit Latrines/Open Range I I Lake ■ KVIP/WC/Pit latrine Roads Diarrhoea [ I Diarrhoea Endemic Area • 1 -1 3 [ = □ District Boundary • 1 4 -3 0 • 31 -5 3 • 5 4 -0 2 87b University of Ghana http://ugspace.ug.edu.gh Figure 5.12: Diarrhoea and household water supply sources Household w a te r supply • 6 3 -133 Pipe Borne • 134 - 569 * Wells * Bare Holes IIIIi Railway 0 Rh/ers/StrearTE Roads 9 Bore holes/Wells i i Lake D ia rrh oea i i Diarrhoea Endemic Area • 1 - 13 C T 1 Drstrict Boundary • 1 4 -3 0 • 31 -5 3 • 5 4 -8 2 87c University of Ghana http://ugspace.ug.edu.gh Within the Madina and Amasaman subdistricts the following areas have the highest concentration o f the disease: Zongo, Nkwantanang and Madina Town, Pokuase, Medie and Kotoku. Figure 5.10 shows the top six communities and diarrhoea cases Figure 5.10: Top diarrhoea cases in the Madina and Amasaman sub-districts (1997/98) reported. Kotoku in the Amasaman sub-district recorded the highest number o f cases. An analysis o f the link between diarrhoea incidence in the district and such environmental factors as types o f sanitation, household water supply and solid waste disposal form was done using the overlay method and illustrated in the sections that follow. 5.2.2.1. Diarrhoea and sanitation forms When overlaid with sanitation types theme, diarrhoea distribution shows predominantly in areas where the use o f pit latrines is commonest (Figure 5.11). Throughout the district, about five hundred and nineteen communities use pit latrines. These constitute about 60% o f the population. In the Amasaman zone, apart from pit latrines, open defecation is found to occur in a few communities notably, Pokuase, Kotoku and Amasaman Township. The implication o f these sanitation practices on health and for that matter diarrhoea incidence are quite obvious especially when diarrhoea is generally known to be associated with poor sanitation and contaminated foods and drinks. Benneh et al. (1993) have shown in a study o f environmental problems in the Greater Accra Metropolitan Area (GAMA) that most households obtain food from open markets where very often the food is displayed openly on 88 University of Ghana http://ugspace.ug.edu.gh i^gure 5.14: Diarrhoea and solid waste disposal forms G> 16 Kilometers Scale 1:340,0000 0 88b University of Ghana http://ugspace.ug.edu.gh tables and on bare ground in very poor sanitary environments. The prevalence o f disease vectors such as houseflies at these markets, as well as the presence o f pests such as cockroaches and rodents in the storage locations, suggest a potentially high level o f contamination. According to the study such contamination poses particular risks for meat, fish and for fruit and vegetables eaten raw. In the Madina and Weija zones, water closets are used in few locations such as Kwabenya, Haatso, Madina, Mallam MacCarthy Hill and Gbawe. This does not prevent diarrhoea however, for there are other forms o f sanitation that may account for its incidence especially when one considers the high cases in Zongo, Madina Town and Nkwantanang. 5.2.2.2 Diarrhoea and household water supply sources Of the five categories o f household water supply sources in the district, rivers and streams constitute the most dominant. Figure 5.12 shows the distribution o f diarrhoea cases vis a vis household water supply sources in the district and as is shown in Figure 5.13, over seventy-five percent o f the communities in the district have this category as their main form o f water supply. Figure 5.13: Communities and sources of household water supply in the Ga District Streams V\fells Household water source In the Amasaman and Obom zone, rivers or streams are the main source o f household water supply for about 102 communities. Piped systems are found in forty communities including Madina, Pantang, Dome, Amasaman, Weija and MacCarthy Hill. It is noted that in some o f the communities mentioned above, potable or piped water is supplied to households in tanks by vendors because piped water is not found 8 9 University of Ghana http://ugspace.ug.edu.gh running on regular basis. Many households are also not connected and have had to rely on vendors. In Madina, Fise and Amasaman for example it is common to find water being dispensed from concrete tanks erected in some homes for sale to members o f poor households or those who have no supplies or connections to their residences. Others harvest rainwater into these concrete tanks or other receptacles for sale. The probability that these systems could be contaminated is high and likely to be a source of diarrhoeal diseases. The GAMA study had it that some o f these household water are faecaly contaminated (Benneh et al. 1993). The study indicated that samples o f tap water and those from household storage containers had positive counts o f faecal coliform with the latter considerably higher. Faecal contamination, according to the study is likely to be a greater health risk when water supply originates outside o f the immediate household. In both the Amasaman and Madina zones water vending is a common phenomenon. Contaminated water sources for homes are likely to be a source o f spread o f diarrhoea in the district. 5.2.2.3 Diarrhoea and solid waste disposal form s A cartographic depiction o f the diarrhoeal diseases distribution vis a vis forms o f solid waste disposal in the district show backyard disposal as the commonest in the district. In Figure 5.14 backyard waste disposal is found in more than 95 percent o f the communities and as is further illustrated in Figure 5.15, 531 communities dispose of their solid waste through the backyard method. The largest concentration o f this form of waste disposal is found in the Amasaman zone, which also has the highest incidence o f diarrhoea. Home collection system is found in only 3.2 percent o f the Figure 5.15: Forms of solid waste disposal in the Ga District El Home collection ■ Sanitary landfill □ Backyard disposal 531 90 University of Ghana http://ugspace.ug.edu.gh Figure 5.17: Chicken pox Incidence (1997/98) (D Scale 1: 331,000 8 16 Kilometere QHh University of Ghana http://ugspace.ug.edu.gh communities in the district. As noted elsewhere in this thesis, home collection method o f solid waste disposal includes the system where solid waste or garbage is collected from designated spots either at the frontage o f homes or collection points w ith in th e c om m un itie s . T h is sy s tem is fo und in M ad in a , H aa tso , K w ab en y a , T a ifa and D om e. T h e re is a s a n ita ry la n d f i l l at M allam n ea r W eija and th is h as b een know n to be a h a b i ta t o f f l ie s , p e s ts and ro d en ts . In th e W e ija z o n e , as show n in F ig u re 5 .1 6 , th e M allam com m un ity had th e se co n d h ig h e s t re p o r te d c a se s o f d ia r rh o e a d u rin g th e p e r io d b e tw een O c to b e r 1997 and S ep tem b e r 1998 - c om ing a f te r W e ija T ow n sh ip i ts e lf . Figure 5.16: Diarrhoea in Weija sub-district (1997/98) 6 08! so 3 4 0 ° 3 0 .8 20 2 9 22 - 22 1 11 n 22 21 12 r~i n I 16 1 7 ' 9 1 9 16 n n n n n 5.2.3 Spatial incidence o f chicken pox Chicken pox is a viral infection. It is known to be very contagious and 90 percent o f people who are not immune will catch it when they are exposed to someone who has it (American Medical Association, 1997). A total o f 595 cases were reported during the period between October 1997 and September 1998. In Figure 5.17 chicken pox shows predominantly in the Amasaman - Obom and Weija areas than anywhere else in the district. Weija has about thirteen communities with a population o f 34,620 at risk while in the Amasaman zone, over 180 communities with a total population of about 58,947 was at risk. It is noted however that the area with the greatest incidence o f the disease is Weija. As show n in F ig u re 5 .1 8 , to p ca se s o f the d is e a se w ere found in c om m un itie s su ch as G baw e , M acC a rth y H ill, B o r tia n o r and M a llam . 91 University of Ghana http://ugspace.ug.edu.gh Figure 5.18: Chicken pox in Weija (1997/98) / / / / / / ' S s / s / It is difficult to explain the reason for this pattern o f incidence by looking at the map alone. However, it is important to see whether the disease has any association with some environmental factors particularly those listed and discussed with other diseases earlier on mentioned. The association o f chicken pox with the environmental factors is discussed in the preceding sections. Another view is the association o f the Weija health facility with communicable diseases in general. It is noted however that the survey dealt basically with cases from communities within the sub-district only and so the high cases were all based in the district and not from outside. 5.2.3.1 Chicken pox and sanitation In all the zones delineated, the commonest form o f sanitation is the pit latrine system. In Ofankor, Pokuase and Amasaman townships, an average o f nine cases o f chicken pox was reported during the period surveyed. Kojo Ashong, near Obom had thirty- three cases o f the disease. In the Weija area, even though flush toilet system is found in communities such as Mallam, MacCarthy Hill and Gbawe, cases o f small pox incidence were as high as those in other areas in the subdistrict where pit latrines are commonly used. Even though it is possible to suggest that in such communities flush toilets may be in use in only a few homes and therefore not likely to be a source o f the disease, cognisance should be given to the fact that chicken pox, as a viral and contagious disease, is spread more among the populace by direct contact with infested persons rather than the sanitation system used. O f course the disease is also known to be spread indirectly by articles soiled with discharges from the vesicles and mucous secretions (Bradley, 1990). 5.2.3.2 Chicken pox and solid waste disposal Backyard method dominates the form o f solid waste disposal in the two areas delineated. In the Weija zone, a sanitary landfill and backyard dumping system can be 92 University of Ghana http://ugspace.ug.edu.gh Figure 5.20: Incidence of acute eye infections (1997/98) 12 Kilometers Scale 1: 362,000 Acute Eye Infections Railway Lake • 1 - 5 Roads • 6 -1 1 I____I Eye Infections Endem ic Area • • 1 2 -1 9 2 0 -2 8 □ District Boundary • 2 9 -4 4 92b University of Ghana http://ugspace.ug.edu.gh found but apart from these, home collection o f waste is done. Yet chicken pox incidence is as high as anywhere else in the district. 5.2.3.3 Chicken pox and household water supply sources Piped, well and river or stream systems o f household water supply are the types found through out the chicken pox endemic areas. These systems are found intermixed. It is noted however that in the Weija zone, pipe borne water supply Figure 5.19: Top cases of chicken pox in Weija and Amasaman zones ✓ / / & Weija Zone Am asaman Zone system predominate. Again, this does not account for the high cases o f chicken pox in the zone. This also means that other causes o f the disease may be found outside environmental factors. For example, in Figure 5.19 the top four cases o f chicken pox in the communities in the two zones delineated, Weija and Amasaman, show a high incidence in Weija than in Amasaman and yet Weija has relatively better sources o f household water supply, solid waste disposal form and sanitation type. The fact therefore remains that chicken pox is a viral and contagious disease spread rather by human agents through contacts with those infected. For policy-decision this calls for mounting up more educational and immunization programmes in the Weija area. 5.2.4 Spatial incidence o f acute eye infections Eye infections are caused by factors including bacteria in the tear duct or the membranes that line the eyelids or by polluted atmosphere (smog). Some sources have also attributed certain eye infections to highly contagious disease caused by minute parasites especially in districts where poor hygiene and overcrowding occur (Shryock & Hardinge, 1985). A total number o f 673 cases o f eye infections were reported in the district during the period between October 1997 and September 1998, 93 University of Ghana http://ugspace.ug.edu.gh The disease as illustrated in Figure 5.20 occurs predominantly in the Amasaman zone. The chart in Figure 5.21 shows that a total o f 398 cases or 59 percent o f the district total were reported in Amasaman zone alone. Figure 5.21: Acute eye infection in the Ga District (1997/98) ■ I »■ 3 9 8 9 6 1 0 7 |-— 1 M ! * ! r———, A m a s a m a n Mad i n a Dan f a We i j a O b om 5.2.4.1 Acute eye infections and sanitation In the three delineated zones, pit latrine system is the main type o f sanitation. In the Amasaman zone, pit latrines are coupled with open defecation. Acute eye infections show highly in Pokuase, Ayawaso, Ofankor, Amasaman, Doblogonno, Kotoku and Obeyie, all o f which can be described as poor hygiene communities. In each o f these communities as shown in Figure 5.22 not less than sixteen cases were reported during the period. Madina as a zone had a total o f forty-four cases o f the infection but the disease presented itself more in communities such as Nkwantanang, Social Welfare, Ashaley Botwe and Point 5 as shown in Figure 5.23. It is noted that the entire Madina Figure 5 .22: Top cases of acute eye infections in the Amasaman sub-district (1997/98) 30 , 25 5 20 5 15 1 10 20 23 25 18 ✓ / / / 4 ? / 94 University of Ghana http://ugspace.ug.edu.gh Township has been categorized under the flush toilet systems o f sanitation. Communities without adequate water supply however rely on pan latrines and KVIPs. Figure 5.23: Acute eye infections in Madina (1997/98) Field investigations took note o f reported cases o f the practice whereby people defecate into containers and polythene sheets and dump them into public refuse containers. MacCarthy Hill Township in Weija reported eighteen cases o f the disease during the period. Here the sanitation type is generally known to be that o f flush toilet system. 5.2.4.2 Acute eye infection and solid waste disposal Backyard method is the commonest among the forms o f solid waste disposal in the three zones shown for acute eye infection. In Madina, as has been shown, the home collection system or methods akin to it is the commonest. The incidence o f eye infection could be accounted for by the manner these are disposed o f and the health threat they pose. It is common to find sites where refuse has been allowed to pile up for long periods and at the mercy o f flies and rodents. In Weija, the disease show highly in the MacCarthy Hill and Gbawe communities where home collection system is found, Mallam, the site for a sanitary landfill and Kokrobite where backyard dumping is common. 5.2.4.3 Acute eye infections and household water supply Nineteen communities have access to potable or pipe borne water in the three zones delineated. The rest o f the systems are either rivers or streams and wells. Eight communities rely on wells while twenty-three rely on rivers or streams for their water 95 University of Ghana http://ugspace.ug.edu.gh Figure 5.24: Incidence of ear Infections (1997/98) E a r In fe c t io n - 1 -4 • 5 -8 • 9-12 • 13-16 • 17-22 R a i lw a y L a k e R o a d s E a r I n fe c t io n s E n d e m ic A re a [ = □ D is t r ic t B o u n d a r y 8 Kilometers Scale 1: 357,000 95b University of Ghana http://ugspace.ug.edu.gh Figure 5.26: Incidence of upper respiratory tract Infections (1997/98) 95c University of Ghana http://ugspace.ug.edu.gh supply. The health implication o f these systems o f household water supply on the incidence o f eye infections are not well known but it is possible to suggest that polluted water sources could be a source o f bacteria that could result in some o f the categories o f eye infections. 5.2.5 Spatial incidence o f ear infections Ear infections rank ninth among the top ten diseases in the Ga District. Health officials explain the disease as being caused by injuries to the ear, which becomes infected or due to a complication o f an upper respiratory tract infection. It is also the result o f measles (Royle & Walsh, 1993). Sixty-four communities with a total o f 439 cases in the entire district had reported cases o f ear infection. On the basis o f the clusters shown in Figure 5.24, the five endemic areas delineated were Amasaman, Danfa, Madina, Weija and Obom. The highest concentration o f the disease is found in the Amasaman area. Here a total of 274 cases coming from o f 24 communities were reported (Figure 5.25). The disease however showed more in communities like Ayawaso, Obeyeyie, Figure 5.25: Cases of ear infection in the Ga District (1997/98) Amamorley, Pokuase, Asofan and Amasaman where an average o f 17 cases was recorded. In the Madina zone, 23 cases o f ear infections were recorded. The disease was common in communities such as Zongo, Social Welfare, Estate, Ogbojo, and Point 5. The Weija zone recorded the second highest number o f cases o f the disease in the district during the period. Settlements such as Bortianor, Oblogo, Kokrobite and Tuba all recorded an average of fifteen cases. Danfa and Obom zones recorded 48 and 38cases o f the disease respectively. 96 University of Ghana http://ugspace.ug.edu.gh 5.2.5.1 Ear infections and environmental factors The incidence o f ear infection in the Ga District has not been linked to any o f the environmental factors discussed so far. Infections as noted earlier are the result o f injuries to the ear and developments due to measles. It is also due to complications o f upper respiratory tract infection. 5.2.6 Spatial distribution o f upper respiratory tract infections (URTI) Upper respiratory infections have been linked with air filled with smoky fumes and generally dusty environments. It is considered among the top killers o f children in developing countries (World Bank et al, 1998). The disease is second to malaria as the most endemic in the district. A total o f 2512 cases were reported during the study period. On the basis o f the pattern o f distribution shown in Figure 5.26, five zones were delineated as pockets o f concentration o f the disease. The largest spatial concentration is found in the Amasaman and Madina zones where 941 and 929 cases respectively were reported. These two zones account for about 54 percent o f the total number o f upper respiratory infections in the district. As shown in Figure 5.27: Upper respiratory tract infections in the Ga District (1997/98) Figure 5.27 the rest o f the district, namely Weija, Obom and Danfa had 19, 14 and 13 percents o f cases respectively. 5.2.6.1 Upper respiratory tract infections and environmental factors The environmental factor that accounts for the cause o f URTI has been mentioned as mainly air pollution - caused by smoke fumes or dust. In the most endemic areas o f 97 University of Ghana http://ugspace.ug.edu.gh Amasaman and Madina therefore, factors such as refuse disposal forms, general sanitation types and drinking water supply system would not be described as having direct association with the disease. In the two zones for example the sanitation forms are basically flush toilets, KVIPs, pit latrines and open defecation. These are not known to be the direct cause o f URTI. A study o f the communities with the top case o f the disease shown in Figure 5.28 below indicated sand-winning activities, dust from unpaved roads and other surfaces and uncontrolled use o f unclean household fuels are common and observable phenomena which are potential causes o f the disease. In the Amasaman zone, where sand-winning activities are very prevalent, tipper trucks are a common nuisance as the cruise along dirt roads spreading along much o f the sand and dust they carry. Communities such as Ofankor, Amasaman, Pokuasse, Babanebo and many more lie within the sand-winning routes and this may account for the high incident rate o f the disease. In the Madina zone, the situation for the communities listed in Figure 5.28 is not different. Unpaved roads have always left dust in most o f the communities especially in the Zongo area. Burning garbage points, which result in huge piles o f smoke, are also a common phenomenon. Overcrowding and smoky indoor air - from burning biomas fuels for cooking or heating is found in most o f these communities too. Figure 5.28: Communities with top cases of respiratory tract infections (1997/98) 250 200 150 100 so o — 2 5 2 ---------------------------------------------------------------------------------------------------------------------------------------------- 130 117 105 n n n ✓ M a d in a z o n e < / / / / A m a s a m a n z o n e 5.2.7 Spatial incidence o f skin infections Viruses, bacteria, fungi or mites may cause the many forms o f skin infections. Health officials in the district contend that many cases o f skin infection are the result o f poor hygiene and bad environmental sanitation. Dr. Mensah-Quainoo (1997), the director o f health services in the Ga District described some o f the skin conditions as water- washed diseases. Skin infections are among the four most endemic diseases in the 98 University of Ghana http://ugspace.ug.edu.gh Figure 5.29: Incidence of skin Infections (1997/98) S k in D is e a s e s ■ 1 -1 5 • 1 6 -3 0 • 31 -51 • 5 2 -1 2 7 • 128-291 ................. R a i lw a y I __ L a k e R o a d s S k in D is e a s e s E n d e m ic A re a ( = □ District Boundary 8 Kilometers Scale 1: 382,000 98b University of Ghana http://ugspace.ug.edu.gh district. A total o f 3059 cases were recorded during the period. Figure 5.29 shows the spatial incidence o f skin infections in the district. Five main areas were delineated on the basis o f clusters o f concentration o f the diseases. These zones incidentally coincide with the five health sub-districts. Figure 5.30 illustrates the number o f cases o f skin infections reported and the communities from which they came. The largest cases are found in the Weija zone where a total o f 1131 patients were seen. The second Amasaman, had 961 cases. Figure 5.30: Cases of skin infections in the Ga District (1997/98) Together these two zones account for 68 percent o f the total number cases o f skin infections in the district. Obom and Amasaman sub-districts had 24 and 21 communities respectively being endemic with skin infection diseases. Weija zone, which had the highest number o f cases, had much o f the diseases concentrated in only three communities. These are Gbawe, Mallam and Weija Townships. 5.2.7.1 Skin infections and environmental factors An overlay o f the sanitation theme with the skin infections theme shows the predominance o f pit latrines system in the delineated zones. In the Amasamam zone, the system is coupled with open defecation in some communities. It is argued that these systems o f sanitation are likely to be a source o f viruses and bacteria that could lead to the spread o f skin infections. The situation in the three most endemic areas in the Weija zone and for that matter the entire district is however different. Here the system is that o f flush toilets, which is a relatively better form o f sanitation. This suggests that some other environmental factor may account for the high incidence 99 University of Ghana http://ugspace.ug.edu.gh Figure 5.31: Skin infections and sources of household water supply Akwapm South District Terra Municipal Area Obom Madina University of Ghana http://ugspace.ug.edu.gh Intestinal worms infection ranks fifth among the 10 most endemic diseases in the district. A total o f 738 cases in 54 communities were recorded between October 1997 and September 1998. Like all the diseases aforementioned, intestinal worms infection are endemic in the five delineated zones shown in Figure 5.34. These are Amasaman, Weija, Madina, Danfa and Dedeman. The Dedeman zone was classified as such because o f the unique nature o f the clusters created around that geographical area. The map shows that the largest concentration o f communities with intestinal worm infection is in the Amasaman zone as further illustrated in Figure 5.35. It depicts 15 communities, and the number o f cases which make them top in the district. Here again Amasaman zone has the highest number o f cases. The reason for this pattern o f incidence may be explained by the environmental factors that the zones are characterized with. The relationship between the incidence o f intestinal worms’ infection and environmental factors is discussed in the preceding sections. Figure 5.35: Top cases of intestinal worms infection in the Ga District (1997/98) 30 a 25s 8 20 2 15 0) I 10 Z 5 0 Amasaman Danfa Madina 15 15 w Dedeman & * & Weija 5.2.9.1 Intestinal worms infection and environmental factors The sanitation types mostly associated with the zones delineated are pit latrines, flush toilets and the open defecation. Figure 5.36 is a view with the following themes, sanitation types, intestinal worms and endemic zones. Using the overlay method of analysis it is observed for example in the Amasaman zone (which has the highest number o f communities and cases o f intestinal worm infection) that pit latrines dominate the form o f sanitation. In the communities where this form is coupled with 103 University of Ghana http://ugspace.ug.edu.gh Figure 5 37 Intestinal worms endemic areas and solid waste disposal types 8 Kilometers Scale 1: 340,000 Solid waste disposal Intestinal Worms Infection « Home collection « 1 - 4 Sanitary Land Fill • 5 -1 1 • Backyard Disposal • 12 - 18 Railway • 19 - 27 Roads • 2 8 -6 1 r ~ Lake I I Intestinal Worms Endemic Area I__________I District Boundary 103b University of Ghana http://ugspace.ug.edu.gh open defecation the incidence o f intestinal worm infection is high. This is the case in Ofankor and Pokuase, the highest in the district. In the Danfa and Dedeman zones, pit latrines are the dominant forms o f sanitation. The situation in Weija is not different. Except for communities like MacCarthy Hill and Gbawe, which have water closets system, the rest o f the zone use pit latrines. And yet a community like MacCarthy Hill had the second highest number o f reported cases o f intestinal worm infestation - coming after Galilea. Madina as a zone is generally categorized under flush toilet system. However the high incidence o f intestinal worm infection is due to an aggregation o f cases from such suburbs as Zongo, Nkwantanang and Ogbojo. In many parts o f these communities other methods o f sanitation especially solid waste disposal form could account for the high cases o f infection. 5.2.9.2 Intestinal worms infection and solid waste disposal The backyard method is the dominant solid waste disposal form in the district and particularly in the delineated zones. This form is commonest in Amasaman, Dedeman and Danfa zones. Home collection form is however found in areas like Dome and Haatso in the Amasaman zone. In Madina where the waste disposal form is categorized under the home collection system, intestinal worm infection is high. As was mentioned elsewhere in this chapter the systems o f solid waste disposal in Madina may be varied but they all involve the dumping o f household waste and other garbage at approved points for onward collection by the local sanitation companies. In Weija, backyard dumping is most common. There is however home collection of waste in MacCarthy Hill and Gbawe which have relatively higher cases o f intestinal worm infection in the zone. The fact about the backyard dumping system o f waste disposal is that, it is a potential source of spread of many diseases. In situations where much o f the domestic livestock are allowed to forage such open range refuse dumps and let loose to roam within the communities, the possibilities of these livestock infesting the communities cannot be 104 University of Ghana http://ugspace.ug.edu.gh Figure 5.38: Intestinal worms endemic areas and household water supply sources 8 Kilometers S c a le 1: 340 ,000 Household W ate r Supply Intestinal Worms Infection Pipe Borne • 1 - 4 Wells • 5 - 1 1 Bore Holes • 1 2 - 18 Rh/a ra/Stream s • 1 9 -2 7 Bore he lea/Wells • 2 8 -6 1 Railway Roads Lake n u Intestinal W orm s Endemic Area District Boundary 104b University of Ghana http://ugspace.ug.edu.gh underestimated. There is also the element o f flies and rodents infestation emanating from such dumps. 5.2.9.3 Intestinal worms infection and household water supply If one o f the modes o f spread o f intestinal worms is through faeces laden with eggs from adult worms, then it is possible for communities, which rely on rivers and streams for household water supply to be at risk. It is in view o f this and other unhygienic ways o f handling household water that much o f the district is at risk of contracting intestinal worm diseases. Figure 5.38 shows that substantial parts o f Amasaman, Danfa and the whole o f Dedeman zones have rivers or streams as their main source o f household water supply. Here too, worms infection is among the highest in the district. In Madina, water supply is mainly through piped system but most often the water does not flow causing the population to purchase and store water in concrete tanks, polytanks and other receptacles. These systems are all liable to contamination. In the Weija zone, pipe borne system o f water supply is commonest and interestingly it is those communities with this system that have the highest number o f intestinal worms infection. A reference to Figure 5.35 shows the communities to be Galilea, MacCarthy Hill and Weija Township. This suggests the fact that other environmental factors including those discussed earlier could contribute to the incidence o f intestinal worms in the communities. 5.2.10 Spatial incidence o f buruli ulcer Buruli ulcer is a mycobacterial infection associated with tropical humid environments. It destroys tissues and causes horrifying lesions to the limbs o f affected persons and seems to be on its way to replacing leprosy as a social scourge (WHO, 1997). According to WHO, buruli ulcer is the third most widespread mycobacterial disease in the world after tuberculosis and leprosy. Buruli ulcer has assumed alarming proportions in the Ga District and even though it has not been recorded among the most endemic diseases in the district in terms of numbers o f cases reported at the various health institutions, its study has become relevant for several reasons. For example, surveillance mounted in 1993 by the 105 University of Ghana http://ugspace.ug.edu.gh Figure 5.39: Incidence of buruli ulcer (1997/98) Scale 1: 345.000 8 16 Kilometers0 Grid + Health centre RailwayBuruli Ulcer • • • • 1 2 -8 9-13 14-20 I I □ Lake Buruli Ulcer Endemic Area Boundary • 21 -43 Main Rivers 105b University of Ghana http://ugspace.ug.edu.gh Regional Health Management Team (RHMT)' ih the Greater Accra Region showed that o f 100 cases o f buruli ulcer cases identified 98 percent came from the Ga District. The disease causes marked debilitation in sufferers and often leads to deformities and disability and may result in complications such as septicaemia (blood poisoning) and death (Mensah-Quainoo, 1997). Mensah-Quainoo (1997) indicated in her work on buruli ulcer in the district that the disease causes high dropout ratio from schools. It leaves in its trail social stigma such as severe deformity including total loss o f arms, crippling, impaired grip and limping. The economic losses due to inactivity and the corresponding stress that this brings to already poor families and communities makes the disease worth researching into. A total o f 378 cases o f the disease from 33 communities were reported during the period between October 1997 and September 1998. Figure 5.39 shows the spatial distribution o f the disease in the entire district. The cases were all in the Amasaman and Obom sub-districts but the majority o f them were from the Amasaman sub­ district and especially along the railway corridor. No cases were reported from anywhere else in the district. Amasaman alone had 94 percent (357) o f cases o f buruli ulcer, thus making it the most endemic sub-district. Within the sub-district itself the cases varied from community to community. The top 4 communities are Ayawaso (43), Kotoku (41), Amasaman (40) and Kodzo Ashong (33) (Figure 5.39 shows). The average number of cases for the entire community is 13. The factors that account for buruli ulcer incidence in the district and especially the pattern o f concentration in the two sub­ districts are discussed in the subsequent sections. Figure 5.40: Buruli ulcer cases in Amasaman sub-district (1997/98) 'ti'rrn ;---------------------------- 106 University of Ghana http://ugspace.ug.edu.gh 5.2.10.1 Buruli ulcer and environmental factors A peculiar feature o f buruli ulcer is that its causative agent is known, but the exact mode o f infection and spread has not yet been established (Mensah-Quainoo, 1997). Since not much has been done to suggest human-to-human spread, much effort has so far been expended on environmental sampling. Some researchers have associated the bacteria with the tall siliceous spear grass (Imperata cylindrica) (Johnson, 1997) and the antelope grass (Echinocloa pyramidalis) which has a cutting edge (Barker, 1973). Johnson also indicated other environmental factors that were discovered to cause the mycobacterium ulcerans. In a study in southeastern Australia, he observed the bacteria to be associated with some swamps and golf course irrigation systems that used a mixture o f ground water and effluence. Dr Kelvin Palmer, a WHO malarialogist on the same observation indicated that there could be an obvious connection between the use o f sewage effluence for irrigation and the occurrence o f the ulcers (Palmer, 1995). He noted that all the ulcers occur on the legs and arms, consistent with transmission by contact, with infected grass or vegetation. According to him further investigation might reveal that it is only those golfers who spend much of their time o ff the fairways looking for lost balls that are infected. An earlier study by Dr. Mensah-Quainoo (1997) in the Ga District also showed some correlation between the incidence of buruli ulcer and riparian environments. Her works involved a study o f 751 patients who suffered the disease during the period between 1987 and 1997. By the use o f the overlay process o f analysis, which involved basically two themes, number o f patients and major rivers, she discovered that many of the cases were found along the valleys o f the Densu, Onyasia, Nsaki, Honi, Adaiso, Dobro and Ntafrafra. Figure 5.41 presents a cartographic view o f the number o f buruli ulcer patients from her study sites and the major river valleys along which they were found. This provides a clue that could call for further investigation into the disease and to facilitate decision making for control measures. The distribution of the disease in Uganda, Zaire and elsewhere correspond to that o f swamps and riparian areas in which the grass Echinocloa pyramidalis (antelope grass) which has a cutting edge is commonly found. Mycobacteria species have been isolated from this vegetation (Barker, \912). 107 University of Ghana http://ugspace.ug.edu.gh Figure 5.41: Buruli ulcer cases and riparian environments 1000 cedis No cost Obom 0 4 2 16 Amasaman 12 4 3 3 Danfa 1 4 3 14 Weija 3 15 1 3 Madina 10 4 0 8 Total 26 31 9 44 Source: Fieldwork, 1998. to re c e iv e tre a tm e n t . A t O bom and D an fa , p a t ie n ts m a in ly w a lk and thus in c u r no co s t by w ay o f t r a n s p o r t fe e s . R ea so n s fo r th is m ay ra n g e from n a tu re o f a c c e ss ro ad s , n e a rn e s s to h e a lth f a c i l i t ie s and th e p rob lem o f la ck o f f in a n c e s . 6.3 Acce s s ib i l i t y and the goal s o f G h a n a ’s PH C s t ra t egy T rad itio n a l c o n c ep ts o f lo c a t io n -a l lo c a t io n m o d e llin g c o n c e p tu a lis e g eo g rap h ic a l a c c e s s ib i l i ty in tw o w ays - p ro x im ity and c o v e ra g e (O ppong & H odg so n , 1994). W hen d e f in ed in te rm s o f p ro x im ity , a c c e s s ib il i ty has a d is ta n c e m in im is a tio n c o n n o ta t io n and m ay be m easu red u s ing th e a v e rag e tra v e l d is ta n c e . A s a lo c a tio n a l g o a l, p ro x im ity t r a n s la te s in to th e s im p le /^ -m ed ian p ro b lem . T h is s e le c ts fa c il i ty lo c a tio n s to m in im ize a v e rag e tra v e l d is ta n c e fo r u se rs . E a r l ie r 116 University of Ghana http://ugspace.ug.edu.gh w o rk s d on e in th is a re a has show n th a t d is ta n c e is a m a jo r d e te rm in a n t o f f a c i l i ty u se (S to ck , 1982 & K ing , 1998). A c c e s s ib il i ty m ay a lso be e x p re s se d u s in g a c o v e ra g e d is ta n c e . S im p ly pu t th is m ean s th a t i f a f a c i l i ty is w ith in th e sp e c if ie d c o v e ra g e d is ta n c e from a p e rso n , it is c o n s id e re d a c c e s s ib le to th e p e rso n and th e p e rso n is sa id to be c o v e red . T ho se p eo p le b eyond th is d is ta n c e a re n o t co v e red . T he m ea su re o f a c c e s s ib il i ty in th is c o n te x t is th e p ro p o r t io n o f p eo p le c o v e re d . A s a lo c a tio n a l g o a l, th is a p p ro a ch t r a n s la te s in to the m ax im a l c o v e r in g lo c a tio n a l p ro b lem (M CLP). Im p rov in g a c c e s s ib i l i ty , by re d u c in g tra v e l d is ta n c e to h e a lth c a re f a c i l i t ie s by its u s e rs has b een fo und to be v e ry fu n d am en ta l to th e goa l o f the g o v e rnm e n t’s PHC s tra te g y . The goa l can a lso be v iew ed in cov e rag e te rm s , i .e . , im p ro v in g th e p ro p o r t io n o f p e o p le w ho are w ith in a s p e c if ie d d is ta n c e o f a h e a lth ca re f a c i l i ty . T he p re s e n t p o lic y sp e c if ie s a d is ta n c e o f 8 -km as th a t w h ich a t le a s t a B - le v e l f a c i l i ty m ust be w ith in re a ch o f ev e ry com m un ity . L o c a t io n -a l lo c a t io n m ode ls e f fe c tiv e ly a d d re s s th e p ro b lem s o f id e n tify in g s p e c if ic a re a s or com m un itie s th a t su rro u n d or a re se rv ed by th e p a r t ic u la r c e n tre or fa c ili ty and th e o p tim um lo c a tio n s fo r new c e n tre s o r f a c i l i t ie s g iv en a set o f o b je c t iv e s r e la te d to a c c e s s ib il i ty . 6.4 Ne two rk ana ly s i s and l o c a t i on - a l l o c a t i on mod e l l i n g Any sy s tem o f in te rc o n n e c te d l in e a r fe a tu re s : se ts o f ro a d s , r a i lw a y s , r iv e rs , p ip e lin e s , te le p h o n e and e le c tr ic l in e s , is a n e tw o rk (E SR I, 1996). A s im p le w ay o f e v a lu a tin g a c c e s s ib i l i ty is by s t r a ig h t- l in e d is tan ce such as we o b ta in w hen g e n e ra tin g b u ffe rs . F o r e x am p le , we can fin d ou t how m any c l ie n ts liv e w ith in 8-km ra d iu s o f a s ite u s in g a s im p le c irc le . H ow ev e r, c o n s id e r in g the fa c t th a t p eo p le tra v e l by ro ad m ost o f w h ich are no t s tra ig h t lin e s bu t in c lu d e c u rv e s , th is m e th od w ill no t re f le c t th e ac tu a l a c c e s s ib i l i ty to th e s ite . Som e re s e a rc h e rs and s tu d en ts o f LAM s have o f te n used E u c lid e an d is ta n c e s in s te a d o f u s ing th e ac tu a l shape and g eom e try o f the ro ad n e tw o rk to r e f le c t 117 University of Ghana http://ugspace.ug.edu.gh a c tu a l a c c e s s ib i l i ty . O ppong & H odg son (1 994 ) fo r e x am p le , in th e ir w o rk in th e Suhum d is t r ic t d id an a n a ly s is in v o lv in g 150 p o p u la t io n c e n tre s o r c om m un itie s as d em and p o in ts fo r 30 h e a lth c a re f a c i l i t ie s . T hey em p lo y ed E u c lid e an d is ta n c e s b ec au se a c c o rd in g to th em , w a lk in g is th e m a in m ode o f tra v e l in Suhum d is tr ic t . The fa c t is th a t no m a tte r the m ode o f tr a n s p o r ta t io n (e x c e p t by a ir) t ra v e ls a re done a lo ng w in d in g p a th s or ro ad s . T hese a re no t found to be s t r a ig h t lin e s . S e rv ic e n e tw o rk s c om pu ted by a N e tw o rk A n a ly s t, fo r e x am p le , c an o v e rcom e th is l im ita t io n by id e n tify in g th e a c c e s s ib le ro ad s w ith in 8 ­ km o f th e s ite v ia th e ro ad n e tw o rk . The th e s is em p lo y ed th e N e tw o rk A n a ly s t fu n c t io n a l i ty in A rcV iew . It is a n e tw o rk a n a ly s is e x te n s io n p ro d u c t d e v e lo p ed by th e E n v iro nm en ta l S y s tem s R e se a rch In s t i tu te (E SR I, 1996). L ik e a ll n e tw o rk a n a ly s is to o ls , it is b a sed on d ig ita l v e c to r m aps and d a tab a se s . T h is re q u ire s th a t th e a re a s u rro u n d in g a c e n tre be re p re se n te d as a n e tw o rk o f l in e a r fe a tu re s . W ith th e N e tw o rk A n a ly s t the a rea su r ro u n d in g a c e n tre o r th e s p e c if ie d lo c a tio n on a n e tw o rk is the se rv ic e a rea . The N e tw o rk A n a ly s t d e te rm in e s th e e x te n t o f th e a re a and d isp la y s it in a v iew . To do th is , you n eed to sp e c ify a s ite lo c a t io n and tra v e l tim e o r d is ta n c e (E SR I, 1996). O nce th e s e rv ic e a re a is e s ta b lish ed , th e A rcV iew th em e on th em e se le c tio n c a p a b i l i t ie s can be u sed to e v a lu a te a c c e s s ib i l i ty o f th e s ite . I t d oes th is f i r s t by co n n ec tin g p o in ts o f equ a l t ra v e l tim e ( re fe r re d to as is o c h ro n e s i f the o b je c tiv e is t im e ) o r equa l d is ta n c e s ( e q u i-d is ta n c e s i f th e o b je c tiv e is d is ta n c e ) from th e re fe re n c e p o in t o r c e n tre . I t a lso f a c i l i ta te s th e c om pu ta tio n o f th e to ta l p o p u la tio n th a t is co v e red and th a t n o t covered . O nce se v e ra l s i te s and tra v e l t im e s o r d is ta n c e s a re s p e c if ie d , the N e tw o rk A n a ly s t g e n e ra te s s e rv ic e a re a s fo r a ll th e s ite s . By so do ing it is p o s s ib le to s e le c t op tim um lo c a tio n s fo r new c e n tre s or s i te s su b je c tiv e ly or by a se t o f o b je c tiv e s re la te d to a c c e s s ib i l i ty , e .g . th e g eog raph ica l lo c a tio n , p o p u la t io n , in f ra s tru c tu re b a se , e tc . 1 1 8 University of Ghana http://ugspace.ug.edu.gh Figure 6.2: Selected sites for service areas and network analysis 8 0 8 Kilometers Scale 1: 326,000 ♦ Grid Settlements Health Facility 0 Health Facility Lake District boundary Roads 1 Railway 118b University of Ghana http://ugspace.ug.edu.gh 6.5 Data r e qu i r em en t s and approach to n e twork ana ly s i s The c u r re n t a n a ly s is is c a r r ie d ou t u s in g d ig ita l m aps p ro c u re d from S u rvey D ep a r tm en t and th e C ER SG IS , L egon . T h e se p ro v id e d th e d ig ita l ro ad n e tw o rk b ase . S u p p lem en ta ry ro ad n e tw o rk d a ta on th e d is t r ic t w as c a p tu re d u s ing th e GPS . O th e r se ts o f d ig ita l d a ta fo r the s tudy in c lu d e p o p u la tio n and lo c a tio n a l in fo rm a tio n fo r each c om m un ity . P o p u la t io n d a ta w ere o b ta in e d from th e 1984 p o p u la t io n c en su s and p ro je c te d fo r 1996 b a sed on 6 .2% annua l g row th ra te fo r th e d is t r ic t w ere m ade and in c lu d ed as a f ie ld in th e a t t r ib u te d a ta b a se . T he p o p u la tio n d a ta o f som e sm a lle r c om m un itie s w ere a g g re g a te d w ith la rg e r c e n tre s c lo se by. 6.6 The n e tw o rk ana ly s i s The th e s is em p lo y ed th e m ax im a l c o v e r in g lo c a tio n a l p ro b lem (M CLP ) w h ich is b a s ic a l ly c o n c e rn ed w ith im p ro v in g th e p ro p o r t io n o f p e o p le who a re w ith in a s p e c if ie d d is ta n c e o f a h e a lth c a re f a c i l i ty . T h is sp e c if ie d d is ta n c e , o th e rw ise c a lle d th e se rv ic e a re a is u sed to d e te rm in e c o v e ra g e . It is u su a lly b u ilt by fo rm in g a re g io n th a t co v e rs the a c c e s s ib le ro ad s . The a s sum p tio n is th a t p a tie n ts do n o t tra v e l b eyond c o n v e n tio n a lly a p p ro v ed d is ta n c e s to re c e iv e h e a lth c a re . As is show n la te r in th e a n a ly s is , s u b s ta n tia l p ro p o r t io n s o f th e d is t r ic t w e re le f t u n co v e red and a p ro c e s s o f s e le c tin g p ro p o sed s ite s to lo c a te new fa c il i t ie s g iv en s p e c if ic s p a tia l o b je c tiv e s w as done . T h is is r e fe r re d to as lo c a tio n m o d e llin g . The a n a ly s is in v o lv e d 550 com m un itie s in th e d is t r ic t as d em and p o in ts and the p o p u la t io n in each com m un ity as th e p ro xy fo r d em and . The p o p u la tio n ran g e b e tw een c om m un itie s w ith tw o p e rso n s (as in A lh a ji Farl fa rm s) and 59564 (as in M ad in a ). The s ite s s e le c te d w ere f iv e ex is tin g MOH fa c i l i t ie s at A m asam an , W e ija , O bom , M ad in a and D anfa . A v iew w ith a lin e or l in e a r th em e w as ch o sen and a c t iv a te d . F igu re 6 .2 show s the v iew w ith th e s e le c te d s ite s o f MOH f a c i l i t ie s and the a c c e s s ib le ro ad s n e tw o rk . 119 University of Ghana http://ugspace.ug.edu.gh Figure 6.3: General areas around established healthcare facilities Grid Established Service Areas • Snet2 Settlements 8.0 km I | m 27391.0 Roads Lake District boundary 119b University of Ghana http://ugspace.ug.edu.gh In b u ild in g th e s e rv ic e a re a s , a tra v e l d is ta n c e from th e f a c i l i t ie s or s ite s to th e s u rro u n d in g a re a s w as se t. An a l te rn a tiv e is to se t th e tra v e l d ire c t io n from th e su rro u n d in g a re a s to th e h e a lth f a c i l i t ie s . E ith e r w ay is a d e q u a te s in c e in th e Ga d is t r ic t t ra v e l is no t r e s tr ic te d to any one d ire c t io n . The g o v e rnm en t sp e c if ie d d is ta n c e o f 8-km w as se t to c re a te two th em es s e rv ic e a re a s (S a re a ) and se rv ic e n e tw o rk s (S n e t) . The se rv ic e a re a is a to o l th a t fa c i l i ta te s th e e v a lu a tio n o f a c c e s s ib i l i ty and th is is u sed to d e te rm in e co v e rag e . The se rv ic e n e tw o rk show s th e ro ad n e tw o rk se le c te d by p rom p tin g sp e c if ie d d is ta n c e s . The n e tw o rk a n a ly s t g en e ra te d g en e ra l a re a s o r a p p ro x im a te p o ly g o n s a round the f iv e s i te s or h e a lth f a c i l i t ie s (F ig u re 6 .3 ) . G iv en th e 8 -km d is ta n c e se t from th e s ite s th e n e tw o rk a n a ly s t r e v e a ls a c o v e ra g e p a tte rn show n in T ab le 6 .5 . T ab le 6 .5 . P o p u la t io n and c om m un itie s w ith in 8 -km tr a v e l l in g d is ta n c e from h e a lth c a re f a c i l i t ie s a lo n g m ain ro ad n e tw o rk S ite P o p u la tio n C om m un itie s Am asam an 40123 113 D an fa 9968 38 Obom 27421 119 W eija 24934 14 M ad ina 62088 12 To ta l 164534 296 Source . N e tw o rk a n a ly s is and se t t lem en ts a t t r ib u te d a ta ta b le . T ab le 6.5 show s th a t h e a lth c a re c o v e rag e is on ly 54% o f th e to ta l num ber o f c om m un itie s in the d is t r ic t (296 ou t o f 550 c om m un itie s ) . In te rm s o f p o p u la tio n , p re se n t c o v e ra g e is 64% (1 64534 ou t o f 258173 fo r the d is tr ic t) . The p o p u la tio n th u s no t co v e red c o n s t i tu te s 34% o f the d is tr ic t . T h is m eans th a t a w ay h as to be fo und to e n su re th a t h e a lth 120 University of Ghana http://ugspace.ug.edu.gh Figure 6.4: Eight-Kilometres buffers around healthcare faclllltles Ghd Railway • Settlements Lake Health Centre 8 km Buffers 0 Health Centre District boundary Roads 1 2 0 b University of Ghana http://ugspace.ug.edu.gh ca re s e rv ic e s re a ch a ll. T h is can be done th ro u g h th e s e le c t io n o f o p tim um lo c a tio n s fo r n ew s ite s . 6 .7 Euc l id e an bu f f e r zones (A l t e rna t i v e Scenar io ) The above is th e r e su lt w hen a c c e s s ib i l i ty or c o v e rag e is c o n s id e re d in te rm s o f a c c e s s ib le ro ad n e tw o rk . The n ex t s tag e o f th e a n a ly s is is to c re a te a sc e n a r io w he re th e n e tw o rk is a ssum ed to be s tr a ig h t l in e s ( c ro w 's f l ig h t) o r E u c lid e a n d is ta n c e s co n n e c tin g th e h e a lth c e n tre s or s ite s . To do th is , 8 -km b u ffe rs w ere g en e ra te d . The re su lt is show n on the m ap in F ig u re 6 .4 . It m u st be n o ted th a t a ro u n d p o in ts , b u f fe rs fo rm c irc u la r a re a s . I t m ean s th e re fo re th a t i f th e m e thod o f tr a v e l w e re by s tra ig h t lin e s o r E u c lid e a n d is ta n c e s , la rg e r a re a s o r p o p u la t io n c e n tre s w ou ld be c o v e re d or w ou ld be c o n s id e re d as h av in g a c c e ss to th e h e a lth c a re f a c i l i t ie s . W id e r a rea c o v e ra g e or s e rv ic e a re a does no t n e c e s s a r ily im p ly re a l a c c e s s ib i l i ty e sp e c ia l ly in s i tu a t io n s w h e re m e thods o f tra v e l a re by long d is ta n c e w a lk in g and d if f ic u l t to t ra v e rs e roads. T ab le 6 .6 . P o p u la t io n and c om m un itie s c o v e red by 8 -km (E u c lid e a n ) b u ffe rs S ite P o p u la tio n N o. o f C om m un itie s Am asam an 47500 140 D an fa 13831 49 Obom 46481 199 W eija 45619 43 M ad ina 66464 29 T o ta l 219895 460 Source: N e tw o rk a n a ly s is and se t t lem en ts a t tr ib u te d a ta ta b le . T ab le 6 .6 show s th a t th e f iv e h e a lth c e n tre s co v e r a to ta l n um be r o f 460 com m un itie s ou t o f th e 550 in th e d is t r ic t . The p o p u la t io n thu s covered is 219895 or 85 p e rc en t. A com p a ra tiv e a n a ly s is o f c o v e ra g e in te rm s o f p o p u la tio n and com m un itie s is p re s e n te d in T ab le 6 .7 . 121 University of Ghana http://ugspace.ug.edu.gh T ab le 6 .7 . P o p u la t io n and com m un itie s co v e red by n e tw o rk and b u f fe r a n a ly s is T ype o f a n a ly s is P o p u la tio n co v e red C om m un itie s c o v e re d N e tw o rk 164534 (64% ) 296 (54% ) B u ffe r 219895 (85% ) 460 (83% ) D iffe re n c e 55361 (21% ) 164 (29% ) The ta b le show s th a t w hen th e n e tw o rk a n a ly s is w as u sed 64% o f th e d is tr ic t p o p u la t io n w as co v e red . On th e o th e r h and a c o v e ra g e ra te o f 85% w as a t ta in e d w hen s tra ig h t- l in e b u f fe rs w ere g e n e ra te d . In th is way an a d d it io n a l p o p u la t io n o f 55361 and 164 c om m un itie s w ere co v e red . T he im p re s s io n is th a t o f a h ig h co v e rag e and as is sh ow n th is does no t g iv e a tru e p ic tu re o f c o v e rag e s in ce t r a v e ls a re no t n e c e s s a r i ly done by s tra ig h t- l in e m ov em en ts in th e G a d is t r ic t . A s ta t is t ic a l a p p ro a ch to d e te rm in in g w h e th e r s ig n if ic a n t d if f e re n c e s e x is ts b e tw een th e tw o m e th od s o f a n a ly s is o f h e a lth c a re c o v e ra g e th e n e tw o rk and th e b u f fe r , in te rm s o f p o p u la tio n and c om m un itie s cove red as show n in T ab le 6 .7 w as m ade u s in g th e c h i- sq u a re . F o r th e p o p u la tio n , th e c a lc u la te d c h i-sq u a re ( x 2) v a lu e w as 0 .0 0 0 5 1 8 0 4 2 . A t 1% lev e l o f s ig n if ic a n c e th e d if fe re n c e b e tw een th e p ro p o r t io n o f p o p u la tio n c o v e red by n e tw o rk and b u ffe r w as n o t s ta t i s t ic a l ly s ig n if ic a n t. H ow ev e r a t 5 p e rc e n t le v e l o f s ig n if ic a n c e th e d if fe re n c e be tw een th e p ro p o r t io n o f p o p u la tio n b e tw een th e n e tw o rk and b u f fe r was s ig n if ic a n t . W hat th is m ean s is th a t th e n e tw o rk c o v e ra g e by v ir tu e o f the l in e a r fe a tu re s or re a c h a b le d is ta n c e it em p lo y s has sm a lle r cove rage as c om pa red to th e e u c lid e a n b u f fe r c o v e ra g e . In te rm s o f com m un itie s c o v e rag e the c a lc u la te d c h i-sq u a re ( x 2) w as 1 .0 1 239E -05 . The re su lts w ere bo th found to be n o n -s ig n if ic a n t at b o th 5 and 1% leve ls . It is fo r th is re a so n th a t one sees th e n e tw o rk a n a ly s is fu n c tio n a li ty , w hich ta k e s in to a c co un t l in e a r f e a tu re s as v e ry v ita l fo r e s t im a tin g th e 122 University of Ghana http://ugspace.ug.edu.gh co v e ra g e o f f a c i l i t ie s ev en th o ugh it m ay h ave its sh o r tc om in g s . I t g e n e ra te s s e rv ic e a re a s e ith e r from s ite s or to s ite s . D if fe re n t s c e n a r io s can be c re a te d u s in g d if fe re n t d is ta n c e s . The tw o ty p e s o f a n a ly s is o u tlin e d above , n am e ly e s t im a tin g h e a lth s e rv ic e s c o v e ra g e em p lo y in g e x is t in g sy s tem s o f ro ad n e tw o rk and e s tim a tin g th e c o v e rag e u s in g s tr a ig h t lin e (E u c lid e an d is ta n c e ) t ra v e ls or b u ffe rs a ll show th a t the s p e c if ie d d is ta n c e o f 8-km does n o t p ro v id e to ta l c o v e ra g e in th e d is tr ic t . P o r tio n s o f th e d is t r ic t rem a in to be co v e red by th e e x is t in g sy s tem o f h e a lth fa c i l i t ie s . T he n ex t s ta g e o f the a n a ly s is d is c u s s e s th e op tim um s ite s fo r new f a c i l i t ie s or a t le a s t o u tre a ch p o in ts r e n d e r in g h e a lth c a re s e rv ic e s to a c h ie v e th e o b je c tiv e o f to ta l c o v e rag e . 6.8 Op t imum l o ca t i on s for new hea l th care fac i l i t i e s To im p rov e o v e ra ll a c c e s s ib i l i ty to h e a lth s e rv ic e s in th e d is t r ic t re q u ire s p ro v id in g a d d itio n a l f a c i l i t ie s to th e e x is t in g s to ck and in c re a s in g th e sp e c if ie d d is ta n c e to th e fa c i l i t ie s . T he la t te r a l te rn a t iv e may no t be p o p u la r s in ce it g o es to in c re a se th e tr a v e l l in g d is ta n c e in s te ad o f m in im is in g th e to ta l tra v e l d is ta n c e or tim e , a fa c t th a t d e fea ts th e PHC s tra te g y . The f i r s t a l te rn a tiv e w ill be fa v o u re d s in c e it m a in ta in s th e s p e c if ie d t r a v e ll in g d is ta n c e and is a w ay o f im p ro v in g the p ro p o r tio n o f p eo p le w ith o u t a c c e ss . E ven th o u g h som e have c r it ic is e d th is s tr a te g y , c a l l in g it th e add m ore s tra te g y b e c au se o f th e re la tiv e co s t o f re lo c a t io n (O ppong & H odg son , 1994 ), it is a rg u ed th a t in a d is t r ic t w ith a lre a d y few fa c i l i t ie s and la rg e ly th re a te n e d by endem ic d is e a s e s , a s tra te g y th a t im p ro v e s th e p ro p o r t io n o f p e o p le w ith ou t c u rre n t a cce ss is n e c e s sa ry . It is a lso a rg u ed th a t d if f e re n t leve ls o f f a c i l i t ie s m ay be re q u ire d to a n sw e r to s p e c if ic n eed s in sp ec if ic a reas . 6.9 Se l e c t ing s i tes to lo cat e add i t i ona l fac i l i t i e s As show n in the N e tw o rk A n a ly s is , a 64% co v e ra g e ra te w as a c h ie v ed at th e sp e c if ie d 8-km d is ta n c e . T he id ea l s i tu a tio n is fo r th e rem a in in g 123 University of Ghana http://ugspace.ug.edu.gh Figure 6.S: Proposed sites for additional healthcare facilities Grid • Settlements Snet15 8.0 km Proposed Service Area and Centre l i 8km Roads Railway n j Lake □ u District boundary (S> Scale 1: 350,000 8_____________________0 8 Kilometers 123b University of Ghana http://ugspace.ug.edu.gh 46% o f th e d is t r ic t p o p u la tio n to be p ro v id e d w ith f a c i l i t ie s to e n ab le th e d is t r ic t a c h ie v e to ta l co v e rag e . H ow eve r 100% co v e ra g e is n o t a t ta in a b le in v iew o f th e n a tu re o f ro ad n e tw o rk in th e d is t r ic t and th e fa c t th a t re so u rc e c o n s tra in ts w ill no t p e rm it h e a lth c a re to be p ro v id e d at ev e ry n ook and c o rn e r o f th e d is tr ic t . Fo r the a n a ly s is , fo u r s ite s th a t w ere p ro p o sed can be o b se rv e d on th e m ap as n o t c o v e re d by th e 8 -km co v e rag e d is ta n c e . E v en th o u g h sev e ra l o f su ch s ite s can be fo u nd , th e b a s ic c r i te r ia u sed a re p ro x im ity , c e n tr a l i ty , p o p u la tio n a ro u n d th e s ite , and th e e x is t in g le v e l o f in f r a s tru c tu ra l d e v e lo pm en t. T he fo u r lo c a tio n s s e le c te d , n am e ly D an tse ra , A b o k o b i, A b lek um a and O dum p ra la w ere se t by u s in g th e N e tw o rk A n a ly s t A dd L o c a tio n to o l. S e rv ic e a re a s from th e N e tw o rk m enu w ere e s ta b l is h e d u s in g 8-km tr a v e l l in g d is ta n c e . T h is ad d ed tw o them es to th e T ab le o f C o n ten ts - S n e t l5 th a t c o n ta in s th e ro ad n e tw o rk and S a r e a l5 (sh ow n as p ro p o sed s e rv ic e a re a in F ig u re 6 .5 ) w h ich c o n ta in s th e p o ly g o n re p re s e n tin g th e s e rv ic e a re a s . S e rv ice a re a p o ly g o n s c re a te d w ere su p e r im p o sed on th e s e t t lem e n ts them e s e le c te d from th e T ab le o f C o n ten ts in th e v iew to e n ab le us see all the s e t t lem en ts th a t a re fo und w ith in th e p o ly g o n s . W ith th e id en tify to o l th e s e s e t t lem en ts w ere s e le c te d in d iv id u a lly and th e ir p o p u la tio n s n o ted . T h is p ro c e s s is to en ab le p o p u la t io n s a ro u n d each se rv ice a re a to be com pu ted . An a l te rn a tiv e is to u se th e S e le c t B y Them e from th e T hem e m enu w h ich en ab le s a ll s e t t lem en ts w ith in th e se rv ice a re a s to be s e le c te d and h ig h lig h te d in th e A ttr ib u te T ab le . C hoosing S ta t is t ic s from th e F ie ld m enu in th e a t t r ib u te ta b le s ta t i s t ic s abou t a ll th e s e le c te d s e t t lem en ts is p ro v id ed . 124 University of Ghana http://ugspace.ug.edu.gh Figure 6.6: Service areas for existing and proposed healthcare facilities 8 0 8 Kilometers Scale 1: 358,000 ---------- Grid Snet19 i , D istrict boundary * Settlements 8.0 km Lake Health Service area Proposed Service Area Health Service area Proposed Service Area Roads 11 * < <~l f Railway 124b University of Ghana http://ugspace.ug.edu.gh T ab le 6 .8 : P o p u la t io n and com m un itie s c o v e red by p ro p o se d s ite s S ite P o p u la tio n S e rv ic e a re a co v e red N o. o f c om m un itie s D an tse ra 628 7700 35 A bokob i 1028 14311 62 A b lek um a 365 6954 16 O dum p ra la 580 23286 81 T o ta l 2601 52251 194 Sou rce . N e tw o rk a n a ly s is and se t t lem en ts a t t r ib u te d a ta ta b le . T ab le 6 .8 in d ic a te s th a t a to ta l p o p u la t io n o f 52251 in th e n ew s e rv ic e a rea s w as co v e re d . A lso s ig n if ic a n t is th e fa c t th a t 194 c om m un itie s w ere c o v e red . T o g e th e r w ith th e p o p u la t io n o f se rv ic e a re a s c o v e red by the A m asam an , D an fa , M ad in a , O bom and W e ija s ite s (T ab le 6 .5 ) , a c o n s id e ra b le im p ro v em en t in co v e rag e w as o b se rv e d . A to ta l p o p u la tio n o f 2 16785 and 490 c om m un itie s w ill h av e a c c e ss to h e a lth c a re s e rv ic e s (T ab le 6 .9 ). T h is b r in g s th e to ta l c o v e ra g e ra te to 84% fo r th e p o p u la t io n and 89% fo r th e n um be r o f c om m un itie s . T ab le 6 .9 : Im p ro v ed le v e l o f a c c e s s ib i l i ty to h e a lth c a re s e rv ic e s P o p u la tio n co v e red N o . o f c om m un itie s O rig in a l f a c i l i t ie s 164534 296 P ropo sed f a c i l i t ie s 52251 194 To ta l ■ 216785 490 6.10 Achieving total coverage The a n a ly s is h as show n th a t 16% (4 1 1 7 8 ) o f th e e n tire d is t r ic t p o p u la tio n rem a in w ith o u t a c c e ss to h e a lth c a re s e rv ic e s even th o u g h the to ta l n um be r o f h e a lth f a c i l i t ie s w as in c re a se d from th e e x is t in g five to n ine . It a lso show s th a t on ly 11% o f th e c om m un itie s w ill rem ain u n co v e red or w ill be w ith o u t a c c e ss at th e 8 -km sp e c if ie d d is tan ce . A ch iev in g 100 p e rc e n t c o v e rag e fo r th e e n tire d is t r ic t is the idea l bu t under th e p re se n t c irc um s ta n c e s th is has no t b een fe a s ib le . P r in c ip a lly , th is is e x p la in ed by th e g e o g ra p h ic a l sh ap e o f th e d is t r ic t 125 University of Ghana http://ugspace.ug.edu.gh and th e n a tu re o f ro ad n e tw o rk . A lso e v id e n t is the fa c t th a t p o p u la t io n c e n tre s a re u n ev en ly d is tr ib u te d in th e d is t r ic t . I t is th e re fo re n e c e s s a ry th a t as a m a tte r o f p o lic y , em ph a s is be la id on th e p rom o tio n o f o u tre a c h p o in ts fo r th e d e liv e ry o f h e a lth c a re se rv ic e s . The c o n c e p t o f o u tre a c h c e n tre s is no t new to th e d is t r ic t . T hey h av e b een u sed by th e DHMT fo r th e p rom o tio n o f p r im a ry h e a lth c a re . F o r ex am p le , th e re a re 197 o u tre a c h p o in ts fo r im m un is a tio n (M O H /G h an a H ea lth S e rv ic e , 1998) in th e d is tr ic t . In a d d itio n to th e se th e re a re f iv e NGO c lin ic s . Som e o f th e p ro p o sed c e n tre s fo r a d d it io n a l h e a lth f a c i l i t ie s m en tio n e d e a r l ie r a re a lre ad y o u tre a c h p o in ts o f th e m a in B- lev e l f a c i l i t ie s in th e d is tr ic t . F o r ex am p le th e re a lre a d y e x is ts a f a c il i ty at A bokob i u n d e r th e s u p e rv is io n o f D an fa . A b lek um a , w h ich fa lls w ith in th e A m asam an s u b d is t r ic t , co u ld r ig h tly s e rv e as an o u tre ach p o in t fo r A m asam an w h ile th e p ro p o sed s ite o f O d um p ra la cou ld se rv e as th e o u tre a c h p o in t fo r th e O bom H ea lth C en tre . The p ro p o sed s ite o f D an tse ra w as s e le c te d fo r g e o g ra p h ic a l and its r e la tiv e ly h ig h e r p o p u la t io n re a so n s . I t is lo c a te d n o t le s s th an 12 km away from th e n e a re s t h e a lth c a re f a c i l i t ie s . T h is d is ta n c e fa r e x c e ed s the s p e c if ie d 8 -km . A lth o u g h th e re is an NGO c lin ic a t N g le sh i Am anfro , ab ou t 8 -km sou th and n e a r th e sh o re s o f th e W e ija L ak e , it is co n s id e red too fa r aw ay fo r th e p o p u la t io n th a t co u ld be se rv ed by th e D an tse ra f a c i l i ty . D an tse ra has a p o p u la t io n o f 971 w ith in its im m ed ia te e n v iro n s and w ou ld se rv e at la rg e , a p o p u la t io n o f 7700 . This ju s t i f ie s its s e le c tio n fo r th e lo c a tio n o f a t le a s t an A -le v e l fa c ility . 6.11 S t ra tegy o f r e l o ca t in g hea l th care po in ts T ry ing to a s c e r ta in co v e rag e o f e x is t in g h e a lth ca re f a c i l i t ie s b a sed on ex is tin g s tru c tu re o f road n e tw o rk and c o v e rag e from E u c lid e a n d is ta n c e s are ju s t tw o o f the sev e ra l w ays o f a s c e r ta in in g c o v e ra g e using th e n e tw o rk an a ly s t. An a l te rn a t iv e s tra te g y cou ld be to a ttem p t m o d e llin g the cove rage from d if fe re n t p o in t lo c a tio n s on th e m ap and 126 University of Ghana http://ugspace.ug.edu.gh r e c a lc u la t in g th e c o v e rag e . T h is is so i f we w an t to a r r iv e at th e op tim um lo c a tio n s th a t w ill m ax im ize co v e ra g e . It is n o te d h ow ev e r th a t in a r r iv in g a t th e lo c a tio n th a t w ill p ro v id e m ax im um c o v e ra g e , se ts o f o b je c tiv e s re la te d to a c c e s s ib il i ty su ch as g eo g ra p h ic a l lo c a t io n , p o p u la t io n , p re s e n t in f ra s tru c tu re b a se , e tc . n eed to be c o n s id e re d . W hen th is has b een done sev e ra l sc e n a r io s cou ld be tr ie d ou t b e fo re th e a c tu a l r e lo c a tio n is done . T h is m e thod o f s c en a rio c re a tio n is m o re ‘hum an g u id e d ’ and a llow s fo r th e p la n n e r a m o re c a re fu l c h o ic e o f c e n tre s o r lo c a t io n s . 6 .12 . A l t e r n a t i v e a lg o r i thms A n um be r o f a lg o r ithm s ex is t th a t en ab le th e c h o ic e o f one o r m o re new s ite s from a n um be r o f p o s s ib le ( c a n d id a te ) s i te s in su ch a w ay th a t th e m ax im um im pac t in te rm s o f c o v e rag e o r a c c e s s ib i l i ty is reach ed . A n ex am p le is th e ^ -m e d ia n p ro b lem , w h ich s e le c ts f a c i l i ty lo c a tio n s to m in im iz e a v e rag e tra v e l d is ta n c e (T ie tz & B a r t, 1968). T h is can be e x e c u te d in A rc ln fo u s in g th e lo c a tio n fu n c t io n a l i ty . I t is a rgued h ow ev e r th a t th e m ore ‘h um an g u id e d ’ p ro c e s s o f try in g ou t sc en a rio s in A rcV iew u s in g th e n e tw o rk a n a ly s t fu n c t io n a l i ty w ill w o rk ju s t as w ell o r b e tte r , fo r in m any ca se s o th e r fa c to rs o th e r th a n tra v e llin g d is ta n c e s can be tak en in to a c co u n t by th e p la n n e r . 6.13 Conc lu s ion An e v a lu a tio n o f p ro x im ity to h e a lth f a c i l i t ie s in th e Ga d is t r ic t u s in g the m ax im a l c o v e rag e ap p ro a ch in v o lv in g th e N e tw o rk A n a ly s t fu n c tio n a lity show s th a t a c c e s s ib i l i ty co u ld be a s c e r ta in e d w hen th e phy sica l d is ta n c e s or l in e a r f e a tu re s b e tw een th e f a c i l i ty and its s e rv ic e a rea are u sed . T he a n a ly s is sh ow ed th a t from bo th p re d e te rm in e d and p ropo sed c e n tre s , s p e c if ic a re a s o r c om m un itie s th a t su rro u n d o r are se rved by th e p a r t ic u la r c en tre co u ld be id e n tif ie d . The re su lts show th a t in c re a s in g th e n um be r o f f a c i l i t ie s from f iv e to n ine in c re a sed a c c e s s ib il i ty or c o v e ra g e from 64 to 84 p e rc e n t in the d is tr ic t . The se le c tio n o f new c en tre s or p o te n tia l s i te s fo r new 127 University of Ghana http://ugspace.ug.edu.gh f a c i l i t ie s in o rd e r to im p rov e co v e rag e w as d e te rm in ed by th e s e rv ic e a re a s c re a te d w hen th e sp e c if ie d 8-km d is ta n c e s w ere g e n e ra te d . T h is sh ow ed p o p u la t io n s th a t d id n o t h ave a cce ss and ou t o f th e c om m un itie s , c e n tre s w ere s e le c te d g iv en a se t o f o b je c t iv e s r e la te d to a c c e s s ib il i ty . The a n a ly s is h as p ro v ed lo c a t io n -a l lo c a t io n m ode ls u s in g th e N e tw o rk A na ly s t fu n c t io n a l i ty u se fu l to o ls fo r e v a lu a tin g a c c e s s ib i l i ty to h e a lth care f a c i l i t ie s in th e Ga d is tr ic t . G iv en th e p re s e n t s i tu a t io n w here NGO s and o th e r p r iv a te h e a lth c a re f a c i l i t ie s h ave b e en h a p h a z a rd ly s ited w ith o u t due c o n s id e ra t io n to a c c e s s ib i l i ty , th e s e to o ls c o u ld be u se fu l fo r p la n s fo r h e a lth f a c i l i ty lo c a tio n s and in g e n e ra l fo r s t r a te g ic d e c is io n -m ak in g . It a lso em ph a s ise s th e n eed fo r m u lt is e c to ra l a p p ro a ch to th e so lu tio n o f p ro b lem s and ta k e s c o g n is a n c e o f th e in te g ra tiv e n a tu re o f se ts o f d a ta to a c h ie v e th e g o a ls o f s p a tia l p lan n in g . T he m e th o d s and to o ls u sed h ow ev e r are m ere m ean s to an end. T hey a re no t to p ro v id e th e f in a l p re s c r ip t io n or a n sw e r to p rob lem s o f a c c e s s ib i l i ty to h e a lth c a re f a c i l i t ie s in s te a d th ey are m ere to o ls to p ro v id e a d d it io n a l in fo rm a tio n to th e p la n n e r . I t h as b e en sa id th a t sev e ra l c o n s id e ra t io n s com e in to p lay w hen ta k in g p la n n in g d e c is io n s . Som e o f th e se m ay be p o l i t ic a l , p h y s ic a l c o n d it io n s , p o p u la tio n , so c ia l and e co n om ic c o n s id e ra t io n s . T hu s th e se w ill som etim es o v e r r id e m od e ls o f a c c e s s ib i l i ty to h e a lth c a re f a c i l i t ie s . 128 University of Ghana http://ugspace.ug.edu.gh CHAPTER SEVEN SUMMARY AND CONCLUSIONS The aim o f this study has been to ascertain the practical application o f GIS for supporting district level planning and decision-making. The decision to devolve the planning process from overburdened central government is borne out o f the fact that grassroots participation in governance, decision-making and planning will make the process o f development more self-sustaining. It was not only seen as the basic unit of government but it is also suggested to be the best area and manageable unit in terms of data acquisition and processing for local level type o f planning. To this end structures that will facilitate governance, planning and decision-making at the local level were established. Unfortunately the framework for planning failed to emphasize the types o f tools to be employed to enhance the planning and decision-making process. Even though the framework indicated holistic plan development through interdepartmental or sectoral collaboration, it failed to prescribe or suggest the types of techniques or tools to be applied for the integration o f the sets o f information held within the departments or functional agencies. This thesis opines that a way to integrate data is a first step to any meaningful holistic plan development and decision­ making process. The district as a geographical entity comprises o f such components as the population, settlements, functional agencies, socio-economic activities, etc., all o f which generate, acquire or process data. A tool that will integrate the diverse sets o f data pertaining to these sectoral activities will certainly be required to support planning. This tool has been found to be GIS. As Saraf and Choudhury (1998) put it “GIS technique facilitates integrated and conjunctive analysis o f large volumes o f multidisciplinary (multisectoral) data, both spatial and nonspatial within the same georeferencing scheme”. The study has been an attempt to extend the capability o f GIS as a tool for health and sanitation sector analysis through the integration o f data on endemic diseases and environmental factors, which account for their causes. Another important aspect o f the health sector that warranted GIS analysis was geographical accessibility to the existing health care facilities. In a similar vein layered data concept was employed with network analysis functionality to ascertain the health care services coverage in the Ga District. The advantages offered by GIS technology as the study 129 University of Ghana http://ugspace.ug.edu.gh showed in each o f two areas o f application mentioned are twofold. These are the simulation and modeling opportunities offered in the form of maps and the access to permanent attribute databases that have been established and which could be readily- updated whenever necessary for new sets o f information. This is useful for planning since as Selman (1991) put it, it offers the key advantage o f exploring ‘what i f type questions. Thus in the analysis o f diseases in Chapter Five o f the thesis models and assumptions made through the creation o f scenarios involving environmental factors provided useful hints for decision-making and planning in the health sector. The study has demonstrated that as a major step to holistic planning at the district level, sets o f data held by the various departments need to be integrated. A survey o f data types acquired, processed and used by 15 departments in the district showed that substantial proportions are spatial in character, which therefore lend them to GIS application. With the framework for plan integration already established it was possible to develop another framework for data integration. Thus the co-ordinating role o f the District Planning Co-ordinating Unit (DPCU) was seen as useful for the attainment o f this objective. The district as a spatial entity will thus have one database to which all departments have contributed. This will lead to homogeneity o f information types, avoidance o f duplication o f efforts and the dissipation o f scarce resources. Interoperability will thus be facilitated when uniformity among database formats, the spatial conceptions and quality standards are established in such distributed system. The study showed that data integration for GIS interoperability could be achieved at the district level. Steps towards achieving this were outlined based on a questionnaire administered among the district departments. These steps include the identification of the departments which generate spatial data, operational activities or mandates that lead to the generation of the data types, their specification and scales, levels o f inter­ departmental collaboration that could lead to data harmonization and common data sources that could be assessed. The scheme developed showed all the 15 departments, their functions, the types o f data acquired and processed and other sources o f data (collaborating departments) required to accomplish their objectives and plans. It was the belief of this study that achieving a distributed database will be a first step to GIS interoperability among the district departments. 130 University of Ghana http://ugspace.ug.edu.gh In view o f the possibility o f achieving data integration at the district level, the study also found it necessary to show the approach required to accomplish the type of multidatabase designed and which will allow for interoperability. Here the top-down approach proposed by Laurini (1998) was adopted. In the approach, a global schema encompassing all data aspects o f the entire system was the type required to start with. The study indicated that the global schema in the district context conforms to the present framework in which the District Planning Co-ordinating Unit (DPCU) has been in charge o f co-ordinating the district plans and therefore forms the fulcrum for data integration. The functional agencies or the decentralized departments constitute the local sites or local schemata. It has been shown that the district comprises o f electoral areas that constitute the basic units for data inventory. With this basic structure homogeneity in data structure, spatial scales, etc., could be achieved. In proposing a prototype GIS for the district, the study was concerned about the basic elements that could be considered. After considering the basic requirements for database integration and the possibility o f interoperability, it becomes necessary to think o f the elements for the prototype GIS that could be implemented at the district level. The study identified fifteen decentralized and semi decentralized departments in the district as spatial data sources. Such data sets will include data on physical environment and socio-economic and cultural data. Remote sensing, either by satellite imagery, air photos and other recording instruments (radiometers, GPSs, etc.,) and ground base survey methods including interviews and questionnaire are required as the main techniques for obtaining the spatial data sets. These data sets will constitute the geographic databases consisting o f both spatial and attribute elements. This is usually the hob o f the GIS. The other elements o f the prototype are the traditional software modules needed to execute the tasks in the GIS. What the study failed to emphasize however is the set of institutional arrangements and human or personnel elements required for running a GIS. In providing an operational definition o f a GIS some authors have included what they call the orgware (ESRI, 1996) and the liveware (Robinson et al. 1995). The organizational (institutional) and human elements (expertise.) have been found to be crucial for running a GIS. As Ozemoy, Smith and Sicherman (1981) put it GIS is 'an automated set o f functions that provides professionals with advanced capabilities for 131 University of Ghana http://ugspace.ug.edu.gh the storage, retrieval, manipulation and display o f geographically located data . Carter (1989) saw it as ‘an institutional entity, reflecting an organizational structure that integrates technology with a database, expertise and continuing financial support over time’. Simply put an environment is required to place GIS and this is offered by the institutional set up and the expertise to be involved. The study o f diseases and their geographical aspects using the overlay and point in polygon techniques o f analysis was discussed in the study. It was an attempt at extending the data integration concept to the health sector and to see how data from various sectors can be overlaid for new results. It showed the relationship between health and environmental factors in the district and cases o f diseases within specified endemic zones. The distribution of ten most common diseases in the district and the environmental factors that account for their endemicity were discussed. The aim was to indicate areas shown on the maps, which will require both educational intervention and planning o f health care delivery systems. Malaria was the most endemic in the entire district accounting for about 53 percent o f all diseases reported during the period specified. It was commonest in all the five sub­ districts but most concentrated in the Weija zone. The study did not find any relationship between malaria incidence and any o f the environmental factors, mainly household water supply sources, solid waste disposal forms and sanitation and hygiene types. It showed instead that the general unsanitary conditions especially associated with the Accra Metropolitan Area and regions that border it account for malaria spread. It was also concluded that the high cases o f malaria in the Weija, MacCarthy Hill and Mallam communities could be the result o f small scale irrigation activities usually associated with water impoundment projects. It is the view o f this study that any programme aimed at malaria control should emphasize environmental sanitation and control o f vector habitats. Diarrhoea was found to be the third commonest disease reported in the district. The largest cases were from the Amasaman sub-district. All three environmental factors sanitation, household water supply sources and solid waste disposal types were found to be the most likely causes of diarrhoea in the district. Spread by contaminated foods and drinks, the disease could be found to be associated with bad sanitation like the 132 University of Ghana http://ugspace.ug.edu.gh open defecation found in Amasaman, Pokuase and Kotoku. The prevalence o f disease vectors such as houseflies around such unsanitary sites in those communities as well as the presence o f pests like cockroaches and rodents is enough to cause the spread o f diarrhoea. Open dumping of solid waste could also account for the spread o f the disease since the dumpsites serve as habitat for pests including houseflies. This is exemplified by the high cases o f diarrhoea in Mallam where a sanitary landfill is sited. An important factor for the spread o f diarrhoea is household water supply sources. The majority o f the communities in the district rely on rivers or streams as sources of household water supply. Faecal contamination o f rivers and piped water or generally water supplied from outside the immediate household are sources o f diarrhoea. Chicken pox has been described as a viral infection and the study shows that it was more endemic in Weija than anywhere else in the district. Since the disease is known to spread more by direct contact with infested persons or through contact with articles soiled with discharges from the vesicles and mucous secretions, environmental factors were not found to account for its cause and spread. The study concluded that, by way of policy the control o f chicken pox should emphasize education and immunization programmes. Eye infection diseases are caused by factors including bacteria in the tear duct or the membranes that line the eyelids or by polluted atmosphere. It is also attributed to diseases associated with poor hygiene and overcrowded areas. In the light o f these causal factors Amasaman and Madina areas, both identified as having poor sanitation systems have undoubtedly the highest cases o f eye infections. Ear infection was found to rank ninth among the diseases reported in the district. Even though it is not a common disease it must be stated that any policy to control it must emphasis education. Smoky and dusty environments was emphasised as the main cause o f upper respiratory tract infection and it is considered among the top killers o f children in developing countries. The top cases o f the disease were found in the Madina and 133 University of Ghana http://ugspace.ug.edu.gh Amasaman zones where sand winning activities, dust from unpaved roads, and uncontrolled use o f household fuels is common. None o f the traditional environmental factors that the study has employed was found to be associated with upper respiratory tract infection. Many o f the communities are poor and the burning o f garbage openly is a common sight. They are often overcrowded and characterised by smoky indoor air usually from burning fuels for cooking or heating. Skin infection was found in the study to be among the top four diseases in the district. The study did not show any association with any o f the environmental factors used. A review o f the seasons o f the year associated with adequacy or inadequacy of household water supply also did not show any trends towards high incidence o f skin infections. The study proposed a study that would involve data covering a longer period to be able to ascertain the relationship between skin infections and water availability and its non-availability. A study o f the incidence o f measles in the district showed Amasaman, Madina and Weija zones as the most endemic. It was concluded in the study that judging from the mode of transmission o f measles, none o f the environmental factors discussed so far account for the incidence of the disease. Direct contact with infested persons, poor environmental sanitation, indiscriminate spitting and emission o f nasal and throat secretions are more likely to be the cause o f measles in the district. Good environmental and personal hygiene could therefore be emphasised in any policy to mitigate measles. Intestinal worms infection is among the top five diseases in the district and it is associated with poor environmental sanitation especially where the soils are polluted with faeces contaminated with eggs from adult worms. Foods and drinks exposed in very poor sanitary environments are likely source o f contamination with eggs. This is the case for Amasaman zone, where the highest number o f cases occurred and is characterised by the use o f pit latrines and open defecation systems. It was also indicated in the study that the methods o f solid waste disposal especially the backyard dumping form is also a source o f worm infection. 134 University of Ghana http://ugspace.ug.edu.gh Communities that rely on rivers or streams for household water supply were also liable to worm infection. For example, it was found that substantial parts o f Amasaman, Danfa and the whole o f Dedeman zones mostly rely on rivers and stream water and these are among communities with the highest recorded cases o f worm infection in the district. Although not ranked among the most endemic diseases in the district buruli ulcer (Mycobacterium ulcerans) was given special attention due to its increasing importance as a social scourge. No where else in the district was the disease found than in the Amasaman and Obom sub-districts with Amasaman alone reporting 94 percent cases. Inconclusive studies of the causes o f the disease have been done. These have pointed to the association o f the bacteria with some vegetation types, sewage effluence, and riverine environments. Analysis carried out to establish the correlation o f buruli ulcer with environmental factors showed few evidences and would therefore require further investigation. For example, a preponderance o f the disease was found in areas with pit latrines and open defecation systems. This was shown in Amasaman, Ayawaso and Kotoku where contamination o f food and water sources were likely to occur more often. Solid waste disposal by open dumping method in these areas could also be a good source o f pollution whenever rain water flowing over such garbage dumps empty their loads into nearby water bodies. The association o f the disease with riparian environments was also established. This showed the disease to be endemic along the major rivers and streams like Nsaki, Ntafrafra and Dobro. Further studies would be required to make conclusive the association of buruli ulcer with the environmental factors discussed. The issue of geographical accessibility to existing health care facilities in the district was considered as an important factor in the business o f planning and policy decision­ making for the health sector. The analysis showed how location-allocation models can be used to achieve health care coverage given specified distances at which services should be within reach o f a given population or group of communities. The analysis also showed the advantages inherent in the overlay concept where different sets o f 135 University of Ghana http://ugspace.ug.edu.gh data themes namely road network, population centres and site locations are integrated to achieve the goals o f health care coverage. It also showed the multisectoral approach to planning within the framework o f systems thinking. The study showed the inadequacy o f the existing five MOH facilities in the district to provide total coverage when the network analysis functionality, which uses accessible road network is employed. On the other hand coverage was increased when Euclidean distance or straight-line buffers which does not base coverage on accessible road network were used. The coverage rate achieved by both methods did not however bring about total coverage for the entire district, which meant that additional sites were proposed for new health facilities. The choice o f these additional sites was based on several factors. Notably these included the relative locations based on the service areas created by the existing system o f health facilities, proximity, centrality, population around the site and the existing level o f infrastructural development. The study showed that in spite o f the additional sites proposed, 100 percent coverage was not attainable. It was indicated that this was the result o f the nature o f the road network and the geographical shape o f the district. The study took note o f the existence o f several other algorithms which are available to enable the choice o f one or more new sites from a number o f possible (candidate) sites in such ways that the maximum impact in terms of coverage or accessibility is reached. It was argued that the more ‘human guided’ process o f trying different scenarios using the network analyst in ArcView appeared to work just well or better since in many cases the final decision for the choice o f any new sites by the planner depends on several other factors apart from travelling distances. Policy implications and suggestions for future research The study has demonstrated that to start with any national plans the district level, understandably is the ideal and most manageable unit for data acquisition and processing. The use o f local areas for planning and programming has been given much credence. Rondinelli et a i , (1989), for example, have stated the advantages inherent in localism. This include the fact that it leads to the improvement in the understanding of local perceptions and needs, reduction in resistance to change, encourages community participation, and allows for easier crossing o f professional 1 3 6 University of Ghana http://ugspace.ug.edu.gh boundaries. The decentralization policy-is therefore in the right direction when one views the fact that for holistic plan development the decentralized departments are already acquiring and processing data. What is left to be done is how to integrate such data sets based on representation mode, scales, standards, updates and data quality levels to allow for interoperability. The present study was based on one district out o f the 110 in the whole country. Future studies may require that more districts are studied in terms o f their departmental data acquisition and processing operations for plan development. This will set the pace for a national consensus and capacity building for spatial data acquisition, processing standards setting, quality levels, etc. By way o f policy it will be important for the district assemblies to be equipped with the basic facilities for prototype GISs that will enhance the execution o f their holistic plans and for more informed decision-making. Questions have often been raised^ about the level at which GIS should be implemented. It is here argued that the district level will be most ideal since the data requirement will not be overly sophisticated and therefore wieldy. Data sets acquired and aggregated at the regional or national levels have the tendency o f loosing their values due to problems associated with data transformation (Tobler, 1979). Such data will not be suitable for district level planning as is the case. The districts are required to produce their own plans and it will be misplaced if data sets required for the plans are rather obtained from the regional or national level. A GIS set up is without doubt an expensive undertaking. What is therefore recommended for a district is a PC with the relevant GIS software for data storage, analysis, manipulation, display and output. The districts would then be required to acquire the relevant digital base data sets (base maps) from institutions, departments or agencies that have GIS facilities. In this way costs would be minimised. At the national level institutions such as the MLGRD and the NDPC could implement iGISs,based on the disparate data sets provided from the districts and the regions. A national framework such as the National Framework for Geospatial Information Management (NAFGIM) is a first step towards the production and exchange o f compatible geographically referenced datasets within the information in Ghana. Programmes of disease control and monitoring in the districts should emphasise knowledge of the spatial incidence o f the diseases and the environmental factors with 137 University of Ghana http://ugspace.ug.edu.gh which they are associated. Here GIS has been demonstrated to play a very useful role as it will facilitate the implementation o f the right type o f policies on environmental education, control o f vector habitats and immunisation exercises. The Ministry o f Health and in particular the DHMTs will find GIS as a useful tool in this direction. Further and more extensive research will be required to study the factors o f spread o f some o f the more dangerous disease like buruli ulcer that this study could not accomplish. For example the association o f the disease with some vegetation types. It is also recommended for the inclusion o f household and other socio-economic or geodemographic data (Beaumont, 1989) for the investigation o f the causes o f disease even though the representation o f such category o f data in GIS environments is still under development (Martin, 1991) and proposal for types o f expert systems required have been made (Rod, 1997). The reason for the non-use o f this category o f data was explained in Chapter two o f the thesis. The use o f GIS as a tool for database development including its integration for district level planning and decision-making and its application for health sector management has been demonstrated in this thesis. 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Liverpool University Press. 148 University of Ghana http://ugspace.ug.edu.gh Watts, M., (1994), Development II: The privatization o f everything? Progress in Human Geography, 18, 371-384. WHO & UNEP, (1988), Urbanisation and its implications fo r child health: Potential fo r Action , p. 50. Geneva. Wiggins, L.L., & French, S. P., (1991), Comparative analysis o f geographical information systems use in American planning agencies. Second International Conference on Computers in Urban Planning and Urban Management 6-8 July 1991, Oxford. W illis , J ., & N u tte r , R .D ., (1 9 9 0 ) , A su rv ey o f sk il l n eed s fo r G IS . A G I Y ea rboo k 1990, pp . 2 9 5 -3 0 3 . L ondon : T ay lo r & F ra n c is . W orld H e a lth O rg a n is a tio n , (1 9 6 1 ) , T e ch n ic a l R ep o rt S e r ie s . N o . 215 ,4 . World Health Organisation, (1997), WHO joins battle against a new emerging disease, Buruli Ulcer. Press release, Geneva, (http://www.who.int/inf-pr-1997). Yoon, S.S., (1995), Geographical information systems: A new tool in the fight against schistosomiasis. The Added Value o f Geographical Systems in Public and Environmental Health, (ed. de Lepper, M.J.C., Scholten, H.J. and Stem, R. M), pp.201-213. London: Kluwer Academic Publishers. 149 University of Ghana http://ugspace.ug.edu.gh COMPOSITION OF DISTRICT DEPARTMENTS APPENDIX I Department Constituents 1. Education, Youth & Sports 1. Education 2. Youth 3. Sports 4 . Ghana Library Board 2. Social Welfare & Community Development 1. Social Welfare 2. Community Development 3. Works 1. Public Work Department 2. Department o f Feeder Roads 3. Rural Housing 4. Physical Planning 1. Department of Town Planning 2. Department of Parks & Gardens 5. Finance 1. Controller & Accountant General 6. Natural Resource Conservation 1. Forestry 2. Games & Wildlife 7. Central Administration 1. General Administration 2. District Planning Co-ordinating Unit 3. Births & Deaths Registry 4 . Information Service Department 5. Statistical Services 8. Trade & Industry 1. Trade 2. Cottage Industry 3. Co-operatives 9. Disaster Prevention 1. Fire Service Department 10. Health 1. Office o f District Medical Officer o f Health 2. Environment Division o f MLG 11. Department of Agriculture 1. Department o f Animal Health & Production. 2 . Department of Fisheries 3. Department of Agricultural Extension Services 4. Department of Crops Services 5. Department of Agricultural Engineering Source: Ministry o f Local Government and Rural Development 150 University of Ghana http://ugspace.ug.edu.gh APPENDIX II QUESTIONNAIRE ON DATA INTEGRATION TO ENHANCE D ISTR ICT LEVEL DEVELOPMENT PLANNING AND POLICY DECISION-MAKING. This q u e s tio n n a ir e is d ir e c te d tow a rd s D is tr ic t A s sem b ly D ep a r tm en ts . It is a im e d a t a s c e r ta in in g the s p a t ia l d a ta /in fo rm a tio n r e q u ir em e n t f o r p la n n in g a n d p o l ic y d e c is io n -m a k in g a t bo th d e p a r tm en ta l a n d d is tr ic t le ve l. The s tu d y w ill le a d to the d e s ig n o f a sch em e f o r s p a t ia l da ta in te g ra tio n a n d e lem en ts f o r p r o to ty p e G eo g ra p h ic a l In fo rm a tio n Sy s tem (G IS ) f o r the D is tr ic t A ssem b lie s . 1. D is tric t: GA DISTRICT 2. Name o f District Department/Unit.................................................................. 3. Year established................. 4. Is this department/unit completely decentralised? Yes / No 5. List the basic functions o f the department/unit. (0 .............................................................................................. (ii) ....................................................................................................................................................................................... ( ii i ) .................................................................................................................................................................................... (iv) ....................................................................................................................................................................... (v) ......................................................................................................................................................................... (vi) ................................................................................................................................................................... (vii ) .................................................................................................................................................................... 6. What is the structure o f the department/unit? (show by an Organisational Chart if any). 7. List the departments/units in the District Assembly that your department relates to by way of data/information sharing? (0 ........................................................... 00 ..................................................... (iii) ....................................................................................................... (iv) ........................................................................................................ (v) .......................................................................................................... (vi) ........................................................................................................ (vii) O thers ................................................................ 8. List the main data/information categories used in the department/unit. w '■........................................(ii)................................................................ (m )..................................................(iv)............................................................... 151 University of Ghana http://ugspace.ug.edu.gh (V ) . . (vii) (ix). .(vi)... .(viii).. Others 9. Which are the other sources o f data/information outside the district? 10. Does the department/unit employ the use of computers? Yes / No 11. If yes, what aspect o f the department’s operations involves the use o f computers? 12. In the absence o f computers, what system o f data/information capture or acquisition, storage, manipulation and analysis is employed in the department? 13.Are you aware o f GIS (Geographical Information Systems) technology? Yes / No. 14. If Yes, does the department/unit plan using it and how soon? 15. In what ways do you think the exchange o f data/information with other departments/units within the District Assembly is/will be beneficial to the work o f the department? 16. What is the nature o f the data that the department/unit contribute towards the district plan (e.g., maps, plans, annual reports, charts, tables, etc.)? 17. From which department(s)/office(s) do you receive directives on the framework for plans, annual reports, etc., produced by the department? 18. List the data requirements for such directives? 19. What problems do you encounter by way o f data acquisition for planning and other uses? 20. How do you solve the problems? 21. In what ways do you think that an automated (computerised) data system for the district will be beneficial to the work of the department? 152 University of Ghana http://ugspace.ug.edu.gh 22. Do you favour a system where the entire district administration is computer networked to enhance information flow and data exchange among the various departments? If yes, can you give reasons? University of Ghana http://ugspace.ug.edu.gh APPENDIX III G E O G R A P H IC A L A C C ESS IB IL ITY TO H EA LTH C A R E FA C IL IT IES IN THE GA D ISTRICT (INFORMATION TO BE PROVIDED BY PATIENTS) 1. Name o f Health Sub-district.......................................................................... 2. Sex: Male Female Age 3. Name o f settlement (place of origin/home) 4. Means o f transport to the Health Centre: I I Tavi I— (c) Walking □(a) TrotrO/ Bus I I (b) xi (d ) Bicycle Q (e) O the rs ...................... 5. Distance traveled to the health centre (km /m iles)..................... 6. Cost o f transportation to and from the Health Centre < t.......................... 7. Surface-type o f road travelled: (a) Gravel Q (b) Bituminous Q ( c ) Asphalt Q (d) Earth (e) Foot path Q (f) O th e rs ........................ 8. How often do you report at the healthcentre in a year? Once Q Two times Q Three times Q Four times 9. Where else do you receive medical attention?......................... 10. How far is that (Q9) healthcare facility from your home?.... Others 154 University of Ghana http://ugspace.ug.edu.gh Norsk gaogr. Tidsskr. Vol. 55, 26-33. Oslo. ISSN 0029-1951 Towards a fram ework for delineating sub-districts for prim ary health care adm inistration in rural Ghana: a case study u sing G IS R IC H A R D Y. K O F IE & LASSE M0LLER-JENSEN Kofie, R. Y. &. Moller-Jenscn, L. 2001. Towards a framework for delineating sub-districts for primary health care administration in rural Ghana: a case study using GIS. Norsk Geog rafts k Tidsskrift-Norwegian Journal o f Geography Vol. 55, 26-33 . Oslo. ISSN 0029-1951. ^ This paper examines the need to carry out primary health care administration, programming and planning beyond the established I iO districts in Ghana. The framework for delim iting the sub-districts is offered by the availability o f digital data, such as the dis­ trict boundary, site location, road network and population. Using the specified travel distance from predetermined sites, network analysis generates approximate polygons around the health centres to create functional areas - the health sub-districts. Additional sites are proposed based on a set o f criteria which includes proximity, centrality, population and existing level o f infrastructural development in an attempt to improve coverage and bring the total utilization o f health facilities closer to 100% in the study area. Keywords: network analysis, primary health care, sub-districts R ichard Y. Kofie, Department o f Geography eft Resource Development, University o f Ghana, P.O. Box LG 59, Legon, Ghana. E- niait: rkoj\e@yahooA om ; Lasse M iller-Jensen, Institute oj Geography, University o f Copenhagen, 0 s le r Voldgade 10, DK-I350, Copenhagen K, Den:nark. E-mail: lmj@geogr.ku.dk Introduction The art o f delim iting reg ions lo carry ou t governm ent bu.'.iness and for ihe effec tive im p lem entation o f p rogramm es has a long history. In Roman tim es, fo r exam ple, censuses were conducted or, a c ity a;id tow n basis fo r the purpose o f collecting taxes. The loca lisa tion o f this system o f tax collection was p robab ly m ean t to m ake it easier, as records o f individuals and their backg rounds would be m ore readily accessible. M oreover, a m ore coheren t comm unity or functional area would m ake identification o f the e lig ib le taxpayer easier. S lates have been dem arcated in to regions, and regions in to districts, comm unes, m unicipalities , w ards, and boroughs. Fo r various reasons, reg ions have been demarcated using such factors as population , cu ltu ra l and ethnic homogeneity , accessib ility to facilities, e tc . In som e cases the dem arcations have been d ic ta ted by the ex igencies of the day o r for political expediency. In Ghana, political adm in istra tion has been devo lved from the central gove-T.ment to basic units o f governm ent, the district assemblies- It is assum ed that b ringing policy decisions reflecting local cond itions c lo ser to the peop le will lead to a fu ller participation in p rogramm es, and that this will in turn bring about im provem ent in the w ell-being o f the people. It also has the advantage o f transferring com petence to the local level iN ordberg 1995). The concep t has been captured in a framework for planning which en jo ins the co ­ ordination ol plans from the various departm ents tow ards the national plan (NDPC 1 995 / For the e ffec tive im plem enta­ tion ol policies and p rogramm es, som e o f these departm ents have delim ited regions into districts for the purpose o f cl recti vely im plem enting their adm in istra tive m andates. One such departm ent is Health. T he d istric t level adm in istra tive machinery is referred to as die D istric t H ealth M anagem ent Teams (DHMTs). In some o f the d istric 's , local in itiatives have been developed to fu rther delim it sub-d istric ts on the basis o f ex isting health care fac ilities - a strategy arguably described as ‘putting the cart before the ho rse ’. T he creation o f sub ­ d istric ts to adm in ister health care has been d ic ta ted by the location o f ex isting facilities. W hile this stra tegy canno t be condem ned outrigh t but ju dg ed as a d ic ta te o f availab le resources, there is the v iew that sim ple and unsoph istica ted d ig ita l m ethods can be used to delim it sub-d istric ts using settlem ents and the ir popu la tion a ttribu tes, d is tric t bound ­ aries and road networks. Justifica tion f o r Localisation The paper em ploys netw ork analysis, a u tility o f A rcV iew G IS (ESR I 1996), to delineate sub-d istric ts in to m anageab le and more coheren t comm unities o r into un its fo r health care programm ing. It is also a step tow ards im proving access to health serv ices and serves as a strategy fo r the be tte r targeting o f health care tow ards local needs. T he study was carried ou t in the G a D istrict o f G hana. It is though t that creating such sub-d istric ts w ill bring several advan tages. For exam ple, it w ill im prove understand ing o f local percep tions and needs, reduce resistance to change, increase m anagem ent capacity , encourage community partic ipation , a llow for eas ie r crossing o f p rofessional boundaries, and im prove access to serv ices (Rondinelli e t al. 1989). Bullen e t al. ( 1 9 9 6 ) indicated that m the UK prim ary health care delivery has been backed by polic ies that favoured localism and community as an organ isational basis for serv ice delivery . The au thors contended that, by basing health care p lann ing on small geograph ical areas, recogn izab le and known to the public, there would be g rea te r pub lic invo lvem en t in, comm itm en t to and understand ing o f the d isposition o f health care resources. Am onoo-Larison e t al. (1984, 14-19) have a lso em pha­ University of Ghana http://ugspace.ug.edu.gh NORSK GEOGRAFISK T ID uS KR lfT 55 (2001) Delineating priim irV health care sub -d is lr ia s in rural Ghana using G IS 27 • Settlements Health Centre © Health Centre Roads □ D stnet boundary Gonten Tema municipal Area Accra fvbtropolitan Area twutu-Efutu-Senya ■IDistnct 8 Kilometers Fig. I. Health sub-dislricis and locution o f major health centres in (he Ga District, Ghana. sised the importance o f decen tra liz ing health c a r e p r o g r a m ­ m ing and adm inistration. They stated , fo r exam ple, that primary health care should be carried ou t a t the community level, because it is the community that know s how the health workers’ know ledge can best be applied. There is therefore the ‘need to ge t to know the community , be trusted by the p eop le in it, and work with local people to p rov ide the services they need .’ They stated furthei that invo lv ing the communities in th t identification o f their needs, p lann ing health programmes, im plem enting and evaluating them , raises the levels o f aw areness o f their health and o ther problems and comm its them to doing som ething abou t the problems. This a l-o im plies that by die lim e they are accepted such programmes are already tailored to the needs of the target group and In in w ith their local traditions. Tradition o f loca lism The practice o f local level planning as a form o f grass-roo ts government and adm inistration in Ghana is not new . It has been a feature o f the country’s developm ent p rogramm es since co lon ia l tim es (M LGRD 1994, 2 -7 ) . N ative au thorities w ere , fo r exam ple, em pow ered to a dm in is ter law and o rde r in their localities w ith lim ited invo lvem ent by the co lon ial governm ent. C ommunities bu ilt a round groups, trad itions and cu ltu res o r around param ountcies and occupations facilita ted the identification o f reg ions fo r the im p lem en ta­ tion o f governm en t p rogramm es and projects. T he de lim ita ­ tion o f enum era tion areas for population censuses also characterized the co lon ia l and post-co lon ial era. It is th e re ­ fore s possib le to find in the census reports reco rds o f details such as the categories o f am enities and facilities , occupation , m igration , housing types and occupancy rates. O ther sectors o f governm ent business are replete w ith exam ples ol local and comm unity -based delim ita tion . E lectoral areas form the basis for represen tation in the d is tric t assem blies. A t presen t, there are 110 agricu ltu ral d istric ts for the im plem entation o f ag ricu ltu ral programm es and the prom otion o f ex tension activ ities. These co incide w ith the 110 basic units o f governm en t o r the D istric t A ssem blies. In a s im ila r vein, there are the educa tion d istric ts referred to as the D istric t D irecto rates o f Education . The health sec to r has institu tiona lized the DHMTs in University of Ghana http://ugspace.ug.edu.gh Table 1. Institutions providing health services by sub-district in the Ga District, Ghana. 28 R. Y. Kofit t£ L. M0ller-Jensen NORSK GEOGRAFISK TIDSSKRIFT 55 (2001) Ministry of Health institutions Sub-distncl Health centre MCH/FP* clinic Quasi-govt, institutions NGO built clinics Amasaman 0 0 2 3 Danfa i 0 1 4 Madina 0 i 0 2 Obom ' 0 0 2 3 Weija ] 0 1 3 Total 4 4 1 6 15 Source: Ga District Health Management Team. * Maternal and Child Health/Family Planning. every district. H owever, the availab ility o f health care services at the sub -d istric t level is o f critical im portance. Health serv ices, even though more expensive to locate, in m any cases are requ ired beyond the estab lished 110 adm inistrative districts. For exam ple, em erging d iseases such as buruli u lcer requ ire additional facilities fo r local treatm ent and monitoring . There is the need to fu rther decentralize health care from the d istric t level to the sub­ district level in order to reduce the responsib ilities o f overcomm itt.id central bureaucracies, and to fac ilita te com ­ munity partic ipation in health care. This w ill help p roduce the relevant inform ation fo r p lann ing and programm ing. In a study o f ex isting health inform ation system s in East Africa, N ordberg (1995) indicated that surveys w ith local community and staff invo lvem ent can generate the data required and stim ulate local initiative. Thus, decen tralization and surveys are related and mutually supportive. The W orld Health O rganisation (W HO ) recognized the re levance o f both intersectoral co llaboration betw een serv ice providers and o f community partic ipation in its ‘G lobal H ealth fo r A ll’ strategy (WHO 1981). This study con tends that rural areas in Ghana do not have a w ell-developed road netw ork system and should therefore have health serv ices at c lose range. It is in the light o f this that this paper proposes a fram ework for delineating sub-districts to enhance health care delivery, especially in the rural areas. Health care po licy The health system in G hana is a com bina tion o f the governm ent health system , private and non-governm en ta l services, and the trad itional health system . P rim ary health care is based on a th ree-tier delivery system designed by the M in istry o f H ealth (M inistry o f H ealth 1978; A djei 1989). These are A -, B- and C -level facilities . A -level fac ilities are located in the communities and are usually staffed w ith m in im ally tra ined health w orkers w ho p rov ide basic curative serv ices. B -level fac ilities are the first re fe rra l leve l fo r the comm unitie s’ health w orkers and are in tended to cover a rad ius o f 8 km . They are usually s taffed w ith a m edical assistan t, a comm unity health nurse/m idw ife , a health inspection assis tan t and a sen io r field techn ician fo r com ­ m unicab le d iseases contro l. C -level facilities are usually the m anagem ent level fo r the en tire system and are based on the distric t hospital. T he m anagem ent team is m ade up o f at least one m edical officer and p rovides m ostly cura tive serv ices including in -patien t care and som e preven tive services. H ealth care delivery in G hana was, until the adven t o f s tructural ad ju stm en t programm es (SAP) in the early 1980s, based on governm ent subsid ies. T he liberalization o f the econom y follow ing SAP brought w ith it the ‘cash and carry ' (user fee) system where patien ts pay as they call. The p roblem associated w ith this policy has been the inab ility o f m ost patients to afford serv ices prov ided at the various health institu tions, leading to the decline in the u tilization o f health services. The resu lt is that the governm en t’s ob jec tive o f achieving basic prim ary health care for 80% o f the popu lation o f the country as fa r back as 1990 has still not been met. A ccessib ility to health resources has becom e increasing ly dependen t upon o n e ’s ab ility to pay. Th is has m ade the health system increasing ly inaccessib le to many ru ral and urban poo r who have therefore resorted to unorthodox health practitioners fo r their health care. A t p resent, the advocacy has been fo r health insurance schem es. T he p rob lem o f econom ic accessib ility has, how ever, not Table 2. Ga District nealth sub-districts and population projection, 1998. Sub-district Approx. no. of communities in catchment area Health facilities 1998 projected population No. o f outreach points Amasaman 151 Amasaman Health Centre, Oduman Health Centre 87,482 46 Danfa 3! Danfa Health Centre, Abokobi Maternal and Child Health Clinic 22.809 29 Madina 13 Madina Maternal and Child Health Clinic/FP 43,222 14 Obom 1C Obom Rural Health Centre, Kwameanum Maternal and Child Health Clinic CDH. Communicable Diseases Hospital, Weija Public Health Nursing 43,0-15 90 Weija 24 Demonstration Clinic, Malam, Amanfio Health Centre 39,530 18 Sciurcc: Ga District Health Management Team. University of Ghana http://ugspace.ug.edu.gh NORSK GEOGRAFISK T1DSSKRIFT 55 (2001) Delineating primary health care sub-districts in rural Ghana using GIS 29 Gonten Obom Amasaman Akwapim South District J^^fofarkope VWzenKotdtBy..' Akwimaij DedemanOdomprajii A^etirpo- Tema Municipal Area A^sbiflao isilmani H tta fc ifra . Accra Metropolitan Area Ewutu-Etutu-Senya District Hauth Facility ibakrom -^Faaf irtianor 2 0 2 4 Kilometers Roadt Fig, 2. Approximate polygons around health centres, Ga District. deterred the governm ent from pursu ing its po licy o f decentralizing health care and carry ing it dow n to the community level. The study area The Ga D istric t is one o f the five d istric ts w hich m ake up the G reater Accra Region and is p redom inan tly ru ral, even though less than 80% o f the population live in the ru ral areas. It is located to the w est and partly to the north o f the Region. It has a total land area o f 859 sq. km . and a popula tion o f c. 300,000 (GDA 1996, 5 -23 ) . The d istric t is d iv ided in to 42 electoral areas. There are about 21 departm ents, decen tra ­ lized, sem i-decentralized and centra lized in the d istric t, each carrying out central governm ent-type activities. For health sector planning and p rogramm ing the d istric t has been subdiv ided into five health catchm ent areas o r sub ­ districts nam ely , Amasaman, Danfa, M adina, O bom and W eija. Each o f these sub-d istric ts is host to a B -level health c are fac ility . T he five fac ilities serve c. 550 communities . F igure 1 show s the sub-d istric ts and the m ain hea lth cen tres a fte r w hich they have b een named. T ab le 1 g ives th e num ber o f governm ent, quasi-govem - m en t and non-governm enta l institu tions p rov id ing health serv ices in the d istric t. T ab le 2 p resen ts the m ain sub-d istric t, the num ber o f comm unities th a t constitu te the catchm en t area fo r the health fac ilities , and the p ro jected popu la tion fo r 1998. A ccord ing to this p ro jec tion the d is tric t’s estim ated popu la tion w as 236 ,088 in 1988. In the ligh t o f estim ates m ade by the D istric t H ealth M anagem en t T eam (DHMT) that w ere b ased on the rou tine imm un isa tion exercises done, the total popu la tion was pu t a t 290,000. Materials and methods T h e G a D i s t r i c t is m a d e u p o f l iv e h e a l th s u b - d i s t r i c t s f o r University of Ghana http://ugspace.ug.edu.gh 30 R. Y, Kojie <£. L. MoUcr-Jensen NORSK GEOGRAFISK TIDSSKRIFT 55 (2001) Gonton Odom piala Akwapim South DistrictTwerebqrj^cJVyarltz i ’■ ,^(°jXrkopo^Adzsij kttto^ u Akwjmaiv, Do'oeman /'U bokobf » I Tema • y f , / Municipal im an / Area '\& ? d z o Astoong AshtMao -v3u*or lHaatso * Dom e./ Abokobiitsera 1 Ablekuma Dzamai ■'Dqfne^braEwutu -E futu-Serya District D an tscra TtitegbiK fuba krom'v': Ablekuma Bortianor .okrobite Road network — - - - 6 0 km Proposed Service Area and Centre Roast | j District boundary Fig. 3. Approximate polygons around proposed sites, Ga District. health programm ing and health care adm in istra tion . These sub-districts are to serve as catchm en t areas fo r the five MOH facilities and w ere de lineated on the oasis o f their nearness to the communities c losest by. Even though the ra tiona le to locate health services near to comm unities and to de lim it the catchm ent boundaries as sm all and m anageab le p rog ram ­ m ing units could be seen as a step in the righ t d irection , the geographical arrangem ent showed a spatial im balance that has m ade accessib ility to som e o f these fac ilities d ifficu lt fo r many communities. Ii is this a rrangem en t that has led to the suggestion that these facilities a re inadequate to m ee t the goals o f prim ary health care in the d istric t (M ensah-Q uainoo 1997, 14). T he study therefore aim ed at finding w ays o f optim izing the location o f the facilities as they are curren tly constituted based on dig ital road netw ork data, in o rde r to identify communities w hich fall w ithin specified travelling distances to the facilities. D ig ita l da ta and coverages A digital bzr.e map o f the district was ob tained from the Rem ote Sensing A pplications U nit o f the U niversity o f Ghana. Th is prov ided the boundary outline and o th e r basic data, such as settlem ents, population , road netw ork and their attributes. T he da ta sets had p roblem s - a s ituation th a t is common to m any areas in A frica w here m aps are generally ou t o f da te and even sets o f m ore recen t ad-hoc m aps are he te rogeneous and o f questionab le au thority . T he d istric t boundary , fo r exam ple, d id no t reflect the s ituation on the ground as m any settlem ents w ere excluded com ple te ly from the d istric t. T rips m ade in the com pany o f som e d istric t Table 3. Population and communities within 8 km distance from health care facilities along main road network. Site Population Communities Amasaman 40,123 113 Danfa 9.968 38 Obom 27,421 119 Weija 24,934 14 Madina 62,088 12 Total 164,534 296 University of Ghana http://ugspace.ug.edu.gh Table 4. Population and communities covered by proposed sites. NORSK GEOGRAFISK TIDSSKRir-'T 55 (2001) D e lin e a tin g p r im a iy Site Population Population of service area No. of communities Dantsera 628 7,700 35 Abokobi 1,028 14,311 62 Ablekuma 365 6,954 16 Odumprala 580 23.286 81 Total 2,601 52,251 194 assembly officials with local know ledge o f the d istrict facilitated the location o f many o f the settlem ents with the aid o f topographic maps and this enabled the boundary to be re-aligned. Supplem entary dig ita l data were obta ined from the Survey D epartm ent o f G hana, w hich con tained topo­ graphic inform ation and, m ore im portantly , the deta iled road network data. In spite o f this, additional road network data had to be generated by the use o f a con tinuously logging 12 XL Garm in GPS. This took stock o f new roads that had been constructed, since the orig inal dig ital data sets w ere based on health care sub-districts in rural Ghana using GIS 31 Table 5. Improved level o f accessibilily lo health care services. Population covered No. o f communities Original facilities 164,534 2% Proposed facilities 52,251 194 Total 216,785 490 analogue maps produced about 25 years ago and which have since not been updated. Popu la tion data The la test census from which all popu la tion in fo rm ation was derived is 16 years old. T he study therefore re lied on p ro jections m ade to 1998 fo r the d istrict. T he annual grow th ra te o f popu lation for the d istric t was 6.2% , w hich is 2 .8% h igher than the national average o f 3.4% . A ll settlem ents in the d istric t w ere covered by the population as a ttribu te data. Gontei Odomprala Obom Aktvapim South District (or»k‘Qfm\n »_ Oomfaa^ ei • vdomprala S*** ilcrbkVkope ^Adzen K oto fy ,,. Akwiman* | , A&oljig •to. Abokobi ■adzat»f MadinaD a n t& e r a Ao iifkum a Accra Metropolitan Area Dantsera We(]z ia fce Road nelwork Ablekuma T T T tm r rm r 8 Kilometer Bortianor rokrobite vVbmo Fig- 4 Sub-districts oi existing and proposed health centres, Ga District. University of Ghana http://ugspace.ug.edu.gh 32 R. Y. Kofie & L. M t-'ler-Jensen NORSK. GEOGRAFISK TIDSSKRIFT 55 (2001) The first step was to specify centres o r sites which represen t the location o f the five health centres around which the serv ice areas o r sub-d istric ts w ere built. These sites w ere Amasam an, O bom , W eija, M adina and D anfa (Fig. 1). To determ ine the ex ten t o f the area around these health centres, a travel distance o f 8 km was used. This is the m aximum d istance w ithin w hich a B -level facility should be accessib le to a community according to the national health policy ^Ministry ot Health 1978). W hat the network analysis did was to connect all communities ly ing 8 km from the specified sites or health centre. In this way, five serv ice areas were generated show ing the real ‘ca tchm en t’ area o f each health centre and the road network to and from the centres. These are shown as polygons. It m ust be noted that the lines connecting the various communities are the ex isting road networks and it is these that are u tilized by the netw ork analysis. Four additional sites w ere selected as cand idate comm u­ nities in an a ttem pt to im prove coverage, given that the five existing B -level facilities and the catchm ent areas they serve were inadequate. A num ber o f m ethods are availab le for finding optim al locations in a road netw ork (e.g. m inim izing total travel time) and fo r com puting the corresponding overall accessib ility . In m any cases, however, the selected sites are unfit for actual use due to a num ber o f factors. The strategy o f this paper has been to focus on a hum an guided approach that m ay be m ore su itab le w ith in the current planning context. U sing the G IS p latform , a num ber o f factors may be exam ined and planners m ay experim ent w ith new location scenarios based on their findings and general know ledge o f '.he physical env ironm ent, accessibility , population, etc. The fou r additional sites suggested here should be considered as one possib le scenario. The basic criteria used to select the communities, which should host /'.-level facilities staffed w ith m inim ally trained health workers provid ing basic curative serv ices, are proxim ity to the nearest B -level facilities, centra lity to the communities that they are supposed to serve, the population o f the catchm ent area, and the ex isting level o f in frastructu ral development o f the selected community . Results Figure 2 shows the areas o r approx im ate po lygons generated around the five sites o r health centres, nam ely Am asam an, Obom, W eija, M adina and Danfa. The road netw ork and the settlements that w ere covered are shown inside the approx­ imate polygons. The total population and num ber o f communities thus covered by these centres are g iven in Table 3. A pproxinuuel’. 54% o f the to tal num ber o f communities or 64% o f the population in the d istric t has access to the health facilities. G iven the crite ria that the maximum travelling distance for access to health care is 8 km, these approximate areas could constitu te functional areas for effective health care delivery. W hen com pared to the original s'jb-district boundaries shown in Fig. 1, it is observed that th'.' new approximate boundaries created are relatively sm tJlei but reflect the true p icture o f accessib ility , since these evolve from a specified distance. In rural areas where the m ain form o f transporta tion is on foot, i t is v ital to adopt a strategy that im proves access to health care fac ilities by m aking them availab le w ithin reasonab le travelling distance o r time. The analysis shows that c. 46% o f the communities and c. 36% o f the population do not have access to the health care facilities. T here is the need , therefore, to iden tify add itional sites that could host new health care fac ilities in o rder to im prove overall accessib ility . This may be frowned at since it requires additional resources, but this paper contends that differen t levels o f facilities may be required to address specific needs in specific areas. Fo r exam ple, the health care facility at A bokobi in the d istric t is an ou tpost o f the health centre at D anfa. In m any o f these communities the facilities are housed in one o r two room s p rov ided by the comm unities o r th rough the assistance o f som e NGOs. F igure 3 show s that fou r sites w ere selected , nam ely D antsera, Abokobi, A blekum a and O domprala . These sites have serv ice areas w ith a popu la tion o f over 52 ,000 and serve 194 communities. T ab le 4 g ives the deta ils o f each site. A long w ith the popula tion o f serv ice areas covered by the Amasam an, Danfa, M adina, O bom and W eija sites (Table 3), a considerab le im provem ent in coverage was m ade. Th is is given in Tab le 5 where a total popu lation o f 216,785 and 490 communities have physical access to health care serv ices. This brings the total coverage ra te to 84% for the popula tion and 89% for the communities. A com bination o f da ta sets o f existing and proposed health centres, and the n ine sub ­ districts created through this superim position , is illustra ted in Fig. 4. Q uite ev ident is the fac t that the sub-d istric t boundaries overlap. The analysis shows that health services are inaccessib le to c. 16% o f the population o f the entire d istrict, no tw ithstand­ ing the increase in the total num ber o f health care facilities from the existing five to nine. It also show s that only 11% o f the communities will rem ain uncovered or w ill be w ithou t access at the 8 km specified travel d istance. It has not been possib le to achieve 100% coverage fo r the en tire d istric t ow ing to the geom etry o f the d istrict, the natu re o f road network, the uneven d istribu tion o f popu la tion centres, and to the hum an phenom enon o f bypassing fac ilities c lo ses t by even w here there is good coverage. Discussion The application o f netw ork analysis to delim it sub-d istric ts has been p rom pted by the view that it is more ob jective and scientific. It aim s a t delim iting the sub-districts for health care p rogramm ing on the basis o f specified travelling distances. T raditional m ethods o f delim iting districts or catchm ent zones have tended to use Euclidean d istances and radii. In this paper, however, the view is that such criteria open real accessib ility to question. First, nowhere w ill people be able to, o r w ish to, w alk along stra ight lines betw een two points for the specified 8 km distance, especially in the rural areas. Second, the determ ination o f catchm ent areas using radius only shows areas that are enclosed w ithin a specified d istance w ithout considering w hether such areas are actually accessib le through any road network. Third , the im pression is University of Ghana http://ugspace.ug.edu.gh NORSK GEOGRAF1SK TIDSSKR1FT 55 (2001) Delineating primary health care sub-districts in rural Ghana using GIS 33 created that large areas have been covered by the facility w hereas in actual fact this m ay not be the case. The additional sites p roposed to improve coverage o f health care serv ices are not necessarily m eant to increase ihe existing system of ia c ililies but are lo com plem ent them as outreach points. Ih e facility al Abokobi, which has been proposed in this paper, is already serv ing as an outstation o f [he D anfa H ealth C entre. A blekum a, w hich falls w ith in the Amasaman sub-d istric t, could rightly serve as an outreach point fo r the Am asam an Health C entre, w hile the proposed site o f O dum prala cou ld serve as the outreach poin t fo r the Obom Healtli Centre. The site of D an tsera was proposed fo r geographical and population reasons. It is located no t less than 12 km aw ay from the nearest health facilities. D antsera has a population o f 971 w ith in its imm ediate env irons and would serve, a t most, a population o f 7,700. W e agree w ith the policy where certain categories o f facilities m anaged by certain categories o f personnel are located a t defined sites in an attempt to im prove health care coverage. Conclusion The increasing use o f G IS fo r health studies and p lann ing is exemplified by the w orks o f Scho lten & de Lepper (1991), Ritchie (1993), K olars (1995), Y oon (1995), C liff & H aggett (1996), and C larke e t al. (1997). Its use by health authorities, and more especially fo r health p lann ing and profiling o f local areas, has been dem onstra ted in recent tim es by Bullen et al. (1996). This study has been concerned with the aspects o f delimiting sub-districts fo r the purpose o f health care programming, especially w ith in a rural context. It is possib le to delim it already ex isting d istric ts into sub-d istric ts w ith the availability o f d igital data fo r effec tive health adm inistra tion . Most localities in G hana have been organ ised around ethnic groups or tribes and already form coheren t spatial units for the implementation o f governm en t p rogramm es. H ealth sub­ districts have been de lim ited on the basis o f the nearest facility, which has m ade accessib ility d ifficu lt fo r som e communities. The use o f GIS to enhance the p rocess o f de lim iting the sub-districts is based on the availab ility o f the fo llow ing basic data sets: local boundary (polygon), settlem ents (.points), population (a ttribu te o f settlem ents) and road network (linear). A G IS in tegrates these da ta sets and facilitates network analysis. T he in teractive query ing o f the database also enables the determ ination o f popu la tion w ith in the approximate polygons o r sub-d istric ts that have been created. The maps composed g ive a visual im pression about the situations on the ground and therefore cou ld help planners, adm in istra to rs and po licy-m akers take more inform ed decisions. AcknowU’