6th UK and Ireland Implementation Science Research Conference 2023
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PRESENter
Luanna Fernandes
presenter biography
Luanna Fernandes is a Research Coordinator at the Addictions and related Research Group, Sangath, Goa, India. She is an early career researcher interested in scaling up evidence-based treatments for common mental health conditions, particularly depression and trauma. Currently, she is working on the IMPRESS and PEERS projects which are scaling up the Healthy Activity Program of Depression which is being delivered by lay counsellors working in the state public health system. Previously, she has worked as a school counsellor and on the Umeed II project developing a depressing treatment program for people living with HIV at Sangath. She has a Master’s in Psychology.
background
Geographic Information Systems (GIS) have been widely used for planning and monitoring health programs. However, this is not the case for implementation planning in low- and middle-income countries. We aimed to use GIS to understand patterns of accessing primary health services to inform the implementation of the IMPRESS program. About the study:
IMPRESS is a Hybrid Type 2 Implementation Effectiveness Cluster Randomised Controlled Trial. Through IMPRESS we are scaling up an evidence-based psychological treatment for depression through the primary healthcare system in the state of Goa. This is the first-ever state-wide scale-up of depression care in India.
MEthod
1.An administrative map of Goa was uploaded on the Quantum GIS (QGIS) platform.
2.Health centre (n=30) coordinates were collected using Google Maps.
3.To help understand patterns of accessing services, data about the area of residence of health centre attendees were collected through
(1) retrospective (three months: April-June 2022) review of clinic registers, and
(2) a brief questionnaire about area of residence, administered to a convenience sample of primary health centre attendees over one week in November 2022.
results
1. Of the 425 villages in Goa, people from only 17% of villages exclusively attended the health centre from the catchment area to which they belonged.
2. Residents of the remaining 83% of villages accessed multiple health centres which were not in their catchment area.
3. The highest count of health centres attended by people from a single village was 25 facilities.
Our findings suggest that:
1.The proximity of area of residence to the health centre and administrative boundaries of catchment areas did not influence decisions related to health centre utilisation.
2.Decisions to access a particular health centre are based on contextual factors such as location of the facility along a bus route, and availability of specialist services in the health centre.
3.Pre-determined health centre catchment areas which are meant to ensure equitable access to care do not hold true in the real world.
Conclusion
Our findings allowed us to understand patterns of accessing primary healthcare facilities and define clusters for health centres based on actual utilisation of services for the IMPRESS trial.
Key takeaway: GIS technology has the potential to enhance accurate mapping of catchment areas to support optimal implementation of health programs based on contextually relevant data, which may be considered for pre-implementation planning of facility-based health programs.