1Nasrda, Abuja, Nigeria 2Zonal Advance Research Laboratory (Zastal Kashere, Gombe State, Nigeria

The importance of creation of geodatabase and mapping of healthcare facilities in Northeast Nigeria, Gombe state cannot be over emphasis, an adequate and equity access to healthcare facilities in Gombe state, Northeast Nigeria.

Geodatabase; Creation; Mapping; Healthcare; Facilities

The provision of adequate basic health services in developing countries is becoming increasingly difficult by the day (Fanan and Felix, 2014). Rapid population growth, widespread poverty and lack of financial resources for the provision of health facilities/infrastructure are identified as the key factors responsible for the poor health care delivery systems in the developing world (Amer, 2007). In the health sector, much concern has been expressed pertaining to the pattern of distribution of heath care facilities and level of utilization. According to Inyang (1994), distributive equity in healthcare facilities indexes accessibility. In other words, the level of access to health care facilities is a function of the degree of fairness in spatial distribution of the facilities. Accessibility in this context has spatial theme and signifies the ease with which potential healthcare seekers get to the health facilities where healthcare services are delivered.

The provision of health care centres in Nigeria is a concurrent responsibility of the three tiers of government in the country (Abbas et al., 2012). However, because Nigeria operates a mixed economy, private providers of medical health care have a visible role to play in health care delivery.

The federal government’s role is mostly limited to coordinating the affairs of the university teaching hospitals, federal medical centres (tertiary health care) while the state government manages the various general hospitals (secondary health care) and the local government focuses on dispensaries (primary health care) which are regulated by the federal government. Geographic Information System (GIS) is a valuable tool to assist health research planning, monitoring and evaluating health systems. GIS has been used by several scholars to combine different data and generates information required for decision making in health management. In 1854; John Snow demonstrated the utility of mapping disease outbreaks to gain insights as to their cause. Snow, an anaesthesiologist, mapped the highest density of cases that occurred in households, which used the public pump on Broad Street as their water source (Law et al., 1998).

Benachi and Yasui (1999) identified that there was a positive correlation between deprivation of health centres and mortality rate. In their analysis of 2,200 small areas of Spain, they obtained two indices of deprivation and they concluded that, there was excess mortality in deprived areas estimated at 35,000 deaths. Thus, they called for government intervention in the deprived small areas of the country. They also found that there are inequalities in other aspects related to health care, such as, waiting list times, or the access to preventive health services.

Olajuyin et al., (1997) investigated the effect of location on the utilization of healthcare centres in Irewole local government area of Osun State, Nigeria. Data used in this research included population data, list of health facilities and their coordinates, and distance of the settlements to each health centre. They found that health centres were unevenly distributed among the settlements and that the distance was a paramount factor. Okafor et al., (1977) analyzed the spatial distribution and efficiency of health centres in the old Bendel (now Edo and Delta) State. He created a data base of all the health centres in Benin and found that there were discrepancies between the population distribution and the distribution of health centres. Adejuyigbe (1973) used GIS technique to demonstrate the relationship between distance and patronage of health centres in Ife. He noted that attendance at each health centre in Ife region is a function of both type of service available there and the distance from other centres providing similar services. Dzikwi and Abbas (2012) also used GIS to map the spatial distribution of rabies in Kaduna State, Nigeria. They used GIS to analyze record data obtained from the state ministry of agriculture and the archived map of the state to track the spread and management of the disease in the state.

The World Health Organization WHO (2004), describes GIS as “an excellent means of analyzing epidemiological data, revealing trends, dependencies and interrelationships that would be more difficult to discover using traditional tabular approach”. Site selection and distribution of health care centres are important components of an overall health system which has a direct impact on the burden of diseases that affect many countries in the developing world. The creation of health care centres database and mapping helps in showing the spatial distribution and information about location and their physical relations to each other. The purpose of using GIS in site selection and distribution of health care centres is that maps provides an added dimension to data analysis, which helps in visualizing the complex patterns and relationships. The use of GIS for measurement of physical distribution is well established and has been applied in many areas including retail site analysis, transport, emergency services and health care services (Wilkinson et al., 1998).

WHO (2004) specified criteria for health care planning for third world countries and indicated that each service area should cover a 4km catchment area with a population of 60,000.00 for primary health care in order to have adequate and equity of access to health centres. In line with WHO (1997), this study therefore aimed to map the spatial distribution of health care centres, create a general health facility geodatabase as well as recommend new health center’s where it is necessary in North Eastern Nigeria using GIS technique.

This study looks at mapping health facilities in North Eastern Nigeria using Gombe state as a case study. Gombe state is one of the six states of the region came into being in 1996 having eleven local government areas and covering 20,265 Km² of land. Located in the Northeastern part of Nigeria between latitude 9°33ʹ and 11°19ʹ north of the equator; and longitude 10°28ʹ and 11°52ʹ East of the Greenwich Meridian (Figure 1). The state falls within the Sudan savannah and having a sub-tropical climate with unique dry season (November-March with humidity of less than 10% in December and January); and the rainy season (April-October) with an average rainfall of 923 mm average annual rainfall. The highest humidity (97%) is in August during the rainy season and the lowest (10%) is during the dry harmattan time in December and January. The temperature ranges between the minimum of 16 ℃ (in December/January) and maximum of 40 ℃ (in March/April); and 25.4 ℃ average annual temperature.

Both primary and secondary data was employed in this work, Collected and recorded health facility data forwarded to data management team where all the captured data keyed in to Excel sheet and saved in .csv format. The data management continuous by creating Health Facility Geodatabase file, which in it state, LGA and ward boundaries as well as settlement and health facility feature classes were created and edited in ArcGIS application. Health facilities coordinates obtained by field survey were transforms to points map portraying their distribution within the study area. To attain quality assurance the created feature classes and their attribute tables were cross check so as to detect errors and identify inconsistency. Health facility point map was further classified and portrayed in terms of level, ownership and service priority of the facility.

Spatial search operation was carried out to test the generated database by looking for certain attributes within the neighborhood which were systematically defined. This gave rise to querying the database towards answering generic question such as what and how much of what is where. ‘Select By Attributes’ tool in ArcMap used to select features that match the selection criteria from the created geodatabase using SQL query expression; the following querying operation were performed.

1.“LGA” = ‘Yamaltu/Deba’ AND “TYPE_2” = ‘Primary Health Center’ 2. “LGA” = ‘Akko’ AND “OWNERSHIP” = ‘Public’ AND (“WARD” = ‘Pindiga’ OR “WARD” = ‘Tumu’ OR “WARD” = ‘Kashere’)

In order to have adequate and equity of access to health centres, WHO (2004) specified a criterion for health care planning for third world countries and indicated that each service area should cover a 4km catchment area with a population of 60,000 people. Therefore, to define areas covered by this designation, a Euclidean Distance tool was used in generation of distances of all cells with reference to source (health centers) within the study area. Then, Reclassified tool employed for the delineation of those cells (areas) falls within the 4 km radius from the health centers as well as those that did not satisfy the criterion. In order to identify where to site new additional health facility, the delineated raster dataset was then converted to KML file format and imported into Google Earth environment where a systematic searching of all settlements outside the 4 km radius from the existing facilities where identified and their positional information retrieved and recorded.

The study identified the health facilities (HF) on the field, collected their attributes and created a geodatabase for both the public and private health centres across primary, secondary and tertiary facility levels within Gombe state. The summary of the collected data was shown in Table 1; also the complete data was portrayed in appendix I. Table 1 shows the overview of the gathered and recorded health facility data, which indicates that there are 669 health centers across eleven LGAs in Gombe state, the captured health facilities are further classified base on their service levels and ownership. As the table shows, out of the 669 facilities, 616 belong to primary level, which correspond to 92.08% of the total facility count. Secondary health facilities have 52 count equivalent to 7.77%; while tertiary facility level have only one count and is proportional to 0.15% of the overall facilities. Furthermore, of the 616 primary facility level, 92.37% of them (i.e. 569 facilities) are public owned and the remaining 47 (7.63%) are owned by private health providers. At the secondary health facility level, 53.85% (i.e. about 28) of the 52 health facilities are public owned while the rest 24 (48.08%) are privately owned. There is only one tertiary health facility in Gombe state and is public owned.

When Table 1 look at the local government wise level, Akko LGA have the highest number of health facility centers which is amount to 96 counts, equivalent to 14.35% of the total facilities in Gombe state. Of this number, 85 belong to primary level while 11 facilities belong to secondary level and there is no count for tertiary health facility level in the LGA. Out of the 85 facilities at primary level, 81 are public owned and 4 belong to private health providers. Similarly, of the 11 secondary level facilities, 5 are public owned while 6 are privately owned. Next to Akko LGA in term of health facility number is Billiri LGA where 80 facilities recorded, this is 11.97% of the entire facility in Gombe state. Seventy nine out of these facilities belong to primary health level and the remaining one is of secondary level hence, there is no tertiary health facility in the LGA. Furthermore, 67 out of 79 of those facilities belong to primary level are public owned while 12 are owned by private providers in Billiri LGA. Dukku LGA follows with 66 (9.87%) health facility counts as shown in Table 1, 64 out of these are at primary level while 2 are at secondary level. Of the 64 primary level facilities, 63 are public owned and the remaining 1 is privately owned. And there is one HF each recorded for public and private owned at secondary level. Balanga and Kaltungo LGAs follow with the same health facility numbers each have 64. Balanga have 61 and 4 public and privately owned primary level facilities respectively, while Kaltungo have 52 and 7 public and privately owned primary level facilities respectively. At secondary level, both LGAs have 3 public owned facilities, and Kaltungo have 2 privately owned while Balanga have nothing. Both LGAs have no tertiary health facility

Table 1 also reveals that Yamaltu/Deba LGA follows Balanga and Kaltungo LGAs with 61 health facilities which equal to 9.12% of the total health facilities in Gombe state. Primary level health facility gets 57 counts, secondary level gets 4 and there is no count for tertiary health facility. Upon the primary level HF, 54 are public owned and 3 belong to private health providers, while the 4 secondary level facilities are all public owned. Shongom LGA is the next with 56 HF counts which is 8.37% of the total facilities in Gombe state and all are at primary level in which public and private owned each get 54 and 3 facilities respectively. Fifty three HF were captured in Funakaye LGA which is equivalent to 7.92% of the total facilities in Gombe state. Of the 53 facilities, 49 are at primary level and 4 belong to secondary level, and nothing belongs to tertiary level. Forty four out of 49 primary level facilities are public owned and the remaining 5 are privately owned. Three out of four secondary level facilities are privately owned and one belongs to public owned facility. The number of health facilities in Gombe LGA amount to 50 counts; this is equivalent to 7.47% of the total facilities. Primary, secondary and tertiary facility level each has

31, 18 and 1 facilities respectively. Upon primary level ones, 25 belong to public owned facilities while 6 belong to private health providers. Likewise for secondary level, 6 are public owned and 12 are privately owned facilities. Table 1 also shows that there are 47 (7.03%) health facilities in Kwami LGA. Open which 45 are at primary level and 2 are at secondary level and all are public owned facilities; and there is no any belong to tertiary level. Nafada LGA recorded the lowest health facility number with which recorded 32 counts. All the facilities are public owned ones open which 30 belong to primary level and 2 belong to secondary level, and no tertiary level facility recorded. Figure 2 below shows the distribution of health facility in Gombe state.

Figure 2 shows the distribution of health facility level in Gombe state. There is well distribution of primary level HF in most of the LGAs in the state, with the exception of western Akko and Yamaltu/Deba LGAs, northern and south western Nafada, western Funakaye and northern Kwami LGAs. This was due to the absent or disperse of settlements (or population) at such places. Figure 3 portrays the distribution of health facility ownership in Gombe state; as in figure 2 the public owned facilities are well distributed within the state. While there is skipped in the distribution of privately owned which mainly concentrated in the central (around Gombe LGA), southern (around Billiri LGA) and north eastern (in Funakaye LGA) part of the state. Health facilities Service Level in Gombe sate were also reveals in Table 2.

The statistics of the health facilities base on their service level in Gombe state is reveals in Table 2. Of the 669 health facilities, 165 are health post corresponding to 24.66% of the total HF; this level is the lowest in terms of healthcare service delivery. Open this value, Akko has 25, Balanga 22, Billiri, Kaltungo and Yamaltu/Deba 20 each, Dukku 19, Shongom 12, Gombe 4, Funakaye 1 and Nafada nil. Table 2 also shows that, there are 253 health clinics out of the 669 health facilities corresponding to 37.82% of the total facilities in Gombe state. Akko LGA has the highest number with 42 health clinics, Billiri and Dukku and Shongom each has 31. Funakaye goes with 27, Yamaltu/Deba with 24, Balanga 22 and Kaltungo 21, while Kwami, Gombe and Nafada each have 11, 7 and 6 health clinics respectively. Among the 669 health facilities, 112 belong to health center service level which is the same as 16.74% of the whole facilities in Gombe state. Out of this value (112), Nafada has 23, Kaltungo 14, Balanga and Funakaye each have 13, Kwami possessed 12, Shongom and Yamaltu/Deba each gets 10, while Billiri, Akko and Gombe have 9, 5 and 3 respectively; and nil for Dukku LGA.

The result of the fieldwork (Table 2) also shows that 53 facilities are used as Primary Health Care Center (PHCC) equivalent to 7.92% of the 669 HF in Gombe state. Open this number, Akko LGA

have 11, Gombe 14, Dukku 13, Billiri 9, Balanga and Funakaye each possessed 2, Nafada and Yamaltu/Deba 1 each, and nil each for Kwami and Shongom LGA. There are 13 Cottage Hospital or equivalent in Gombe state which amount to 1.94% of the HF in Gombe state. Among this value, 3 are in Yamaltu/Deba LGA, 2 each for Akko, Balanga, Gombe and Kwami. Also, Kaltungo and Nafada have one each, while Billiri, Dukku, Funakaye and Shongom have none. Similarly, there are 10 General Hospital (GH) which correspond to 1.49% of HF in Gombe State. Open these GHs, 2 are in Akko, one each in Balanga, Billiri, Dukku, Funakaye, Gombe, Kaltungo, Nafada and Yamaltu/Deba; while none exist in Kwami and Shongom LGAs. There are only one Specialist and Teaching Hospital in Gombe state and both located in Gombe LGA; each has 0.15% as its proportion of HF in the state. Private owned Hospital/clinic (PH) sum up to 61 counts which is the same as 9.12% of the facilities in the state. Gombe LGA recorded high with 17 PHs, follows by Billiri with 10, then Akko and Funakaye with 9 each. Likewise, there are 7 PHs in Kaltungo LGA, 3 in Shongom, 2 each in Balanga and Dukku and Yamaltu/Deba, while there is absent of PH in Kwami and Nafada LGAs.

Figure 4 displays the distribution of HF in Gombe state according to their service level. The lower hierarchy of the facilities such as primary health care center, health center, health clinic and health post where well scattered throughout the state. This indicates that primary health facilities are the most physically accessible level of healthcare providing basic healthcare services to the largest proportion of the population which are mostly duel in rural areas. The figure also portrays that there are ten cottage hospitals or equivalent distributed in Gombe state and it further indicates that the facility was not found in Dukku, Funakaye, Kwami and Shongom LGAs. Ten general hospital or equivalents were displays by Figure 4; all the LGAs in Gombe state have at least one except Kwami and Shongom LGAs. The only specialist and general hospital in Gombe state are in Gombe LGA and are represented with black and red circular background respectively and with a yellow plus (+) symbol on each.

Spatial search operation was used to test the created geodatabase by searching for certain attributes within the geodatabase, which must be systematically defined. This gave rise to querying the geodatabase towards answering generic question such as what and how much of what is where. Figure 5 shows the result of HF geodatabase query using “Select By Attributes’’ tool where the distribution of selected facilities retrieved and graphically portrayed.

“LGA” = ‘Yamaltu/Deba’ AND “TYPE_2” = ‘Primary Health Center’ The above SQL expression asking the application to retrieved all health facilities that are spatially located in Yamaltu/Deba LGA whose service type is primary health centers. The result presented ten selected features both in tabular and graphic forms. The ten selected features were highlighted in cyan and red colours both in the table and map respectively. Another spatial query was performed to retrieve all public owned HF in Pindiga, Tumu and Kashere wards of Akko LGA (see Figure 6).

Prior to identifying and proposing of additional HF sites in Gombe state, a buffer was generated around each facility using the WHO guide line for third world countries which states that each HF service area should cover an area of 4km radius. Figure 7 shows this delineation and extend of the combined (overlapping) service areas in brown clour and the outreach areas in yellow colour. The identified outreach areas are western Akko and Yamaltu/Deba LGAs, northern and south western Nafada, western Funakaye, northern Kwami and some parts of southern Dukku LGA.

In order to locate new sites for the development of HF, the demarcated service area map was then changed to KML file format and opened in Google Earth engine where the outreach areas were zoom-in and systematically detecting any available settlements therein and ‘placemarks’ were placed at each identified location. Coordinates of the identified placemarks were retrieved and recorded. The positions of propose new facility sites were displays on figure 8 and their coordinates given in Table 3.

Figure 8 and Table 3 shows the location of the new health facilities recommended for development in Gombe state. Nafada LGA has the higher number of the proposed HF where four locations identified, while Akko, Dukku, Kwami and Yamaltu/Deba LGAs each have three sites. The outreach areas where no HF is place were farm lands, forest, hills or waterbody, hence there are no settlements and therefore, no facility was proposed.

i. Geodatabase table of the captured HF was generated and its revealed that there are six hundred and sixty nine HFs in Gombe state

ii. Among the identified HFs, six hundred and sixty one are at primary healthcare level, fifty two belong to secondary level and only one is at tertiary level

iii.Five hundred and sixty nine HFs of the primary healthcare level are owned by public health providers while forty seven are privately owned. Of those secondary health facilities, twenty eight belong to public owners and twenty four to private owners. The only tertiary HF is public owned

iv. There is no any privately owned primary and secondary HF in Kwami and Nafada LGAs. In the other hand, there is no private owned secondary HF in Balanga, Billiri, Shongom and Yamaltu/Deba LGAs

v. There is no General Hospital exist in Kwami and Shongom LGAs

vi. Fifty percent of the privately owned HF are duel in Gombe LGA which is the administrative headquarters of the state

vii. The only Specialist and Teaching Hospital are located in Gombe LGA

viii. Sixteen sites were identified for the new HF development within the state; four in Nafada, three each in Akko, Dukku, Kwami and Yamaltu/Deba LGAs.

ix. Different maps showing HF level, ownership, service and combined catchment were produced.

Despite their number, the distribution of health facilities across Gombe state is non-uniform especially in respect of healthcare services. A complete local government (Shongom) lacks any secondary health facility and another (Kwami) lack general hospital. And in general, only few places health facility is not in existence. This study has successfully showcased the capability of GIS as a veritable tool for decision support system for location selection for new health facility. Finally, GIS technology has the potential to transform health surveillance, quick and easy access to large volume of data. GIS is valuable in strengthening the whole process of epidemiological surveillance information management and analyses. Moreover, this system provides analytical support for the planning, programming, and evaluation of activities and interventions in the health sector.

In light of the findings of this research, the following recommendations are made:

Due to the non-uniformity of health facility services in Gombe state, WHO Universal Health Coverage (UHC) strategy if adapted should be responsive to the variation in health facility distribution across the state

Additional investments are needed in some parts of the state to improve access to higher healthcare services by constructions of bridges and rehabilitation of dilapidated roads to make easy access and reduce travel time to those healthcare centers

Local government in collaboration with state government should provide sixteen primary health centers in the identified areas so that to deliver health services to all throughout the state.

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HA Shaba .Geodatabase Creation And Mapping Of Health Facilities In North-Eastern Nigeria. International Journal of Gastroenterology and Hepatology 2023.