Geospatial Data: a Revolution in how we understand the accessibility of Healthcare Services

Mrs X was eight months pregnant when she died. There are many reasons for her death, and any one could have tipped the balance. Health education. Family planning advice. Better access to antenatal and facility-based care. It is a familiar story, and one that must still be told*. 

The fact is, that even in today’s era of Sustainable Development, 50% of the world’s population live without full access to essential health services. It’s a complex issue. About more than just the availability of health centres and facilities, there are countless variables to consider, including cultural acceptability, affordability and physical accessibility. Focussing on the latter, if the world wants to make universal health coverage a reality, it must build an accurate picture of the situation on the ground. The ‘haves’ and ‘have-nots’ of healthcare access. Experts in health data science and technology, at Bluesquare Hub we believe that geospatial data has the power to unlock this information – and we want to take this chance to explain why.

The limitations of current accessibility models

Traditional measures of physical healthcare access – Euclidean distances and 5km catchment zones – simplify what is, in reality, a far more complicated situation. Evidence shows that service uptake decreases with distance, travel time and other logistical barriers. An expectant mother might live within 5km of her local health centre, but if it’s too far to walk, there is no car, affordable public transport, or the road becomes impassable, then she cannot get there. 

It is a reality compounded by the fact that current geospatial models do not give policy and decision-makers the information they need to effectively improve healthcare accessibility. Produced on a per-project basis, methods are rooted in regional population estimates and siloed datasets that are static and imprecise. The results are paper-based reports that simply cannot account for the variables that define healthcare access as experienced on the ground.  

In this situation, accessibility measures become theoretical. There is little space for local validation of resulting models, with real-time variations of service availability rarely examined. Yet if ambition towards universal health coverage is to be achieved, we must understand and account for reality. Only then will governments and global health actors have the information they need to drive development forward.

Car travek Times to nearest facility vs Car catchment areas for facilities

Combining geospatial modelling and Big Earth Data to better understand healthcare accessibility

Leveraging recent advances in geospatial modelling, the team at Bluesquare Hub is working to build digital tools that allow for the automatic and rapid computation of accessibility metrics from multiple data sources. For example, in recent years we have seen the development of several open-access libraries providing essential, high-quality data. These include, but are not limited to:

  • The high-resolution land cover maps provided by Sentinel mission.
  • Spatial demographic/population data maps developed by WorldPop.
  • Crowd-sourced geographic information from OpenStreetMap

Capturing variables that influence healthcare access in real-time (topography, road networks, population distribution and demographics), together these sources create a newly available set of ‘Big Earth’ data that can be easily read, updated and integrated into modern accessibility models.  

Combining this information with routine health data, BlueSquare Hub joins the Spatial Epidemiology Lab from the University of Brussels and the University of Geneva in new research to ‘productivise’ this process – using machine learning and artificial intelligence to automate near-continuous updates. This combination of advanced geospatial modelling, ‘Big Earth’ and real world data allows users to develop digital accessibility maps that empower them to:  

  • Understand healthcare accessibility down to a local, village level.  
  • Calculate key accessibility metrics in line with local public health priorities.
  • Accurately map facility catchment areas, population access and travel time.
  • Focus on specific population subsets and demographics (e.g. women of childbearing age). 
  • Account for socio-economic variables, including ethnicity, religion and household income. 
  • Tailor input data to account for multiple scenarios, including seasonal changes.
Official villages vs Detected villages in DRC

With pilot models currently focussed on the Democratic Republic of Congo, Niger and Senegal, for the first time in history, policy and decision-makers can have an up-to-date picture of health service access as it happens on the ground. Not only does this process allow for enhanced accessibility mapping, it makes it dynamic – allowing global health actors to track healthcare accessibility in evolving situations and tailor their response accordingly.

There will be some hard truths to face. With preliminary work in the Republic of Senegal showing 80% of women living with reduced, or no, access to family planning, current understanding around healthcare access will almost certainly shift. It is important that it does. By improving the way physical healthcare accessibility is defined and measured, we can create new opportunities for a data-driven future. One that allows for the smarter allocation of health resources and has the power and potential to revolutionise access to healthcare.  

*The story of Mrs X was first told by the WHO in 1988 and retold in 2012. Click here for more information.

Leveraging Digital Health Master Plan for COVID-19

For governments to effectively manage the health crisis caused by COVID-19, they must have the ability to make decisions based on reliable and consolidated data.
Today, the data that are key in this decision making – specifically in low- and middle-income countries – are those related to the availability and location of the infrastructure and sanitary facilities necessary to meet the needs of their populations. Identifying the infrastructure facilities will allow governments to allocate the necessary funding to the essential health services.
During a crisis, time is critical. Governments must be able to rely on what has already been accomplished to improve the information system and health surveillance. Those who started this work before the crisis will have a head start. They will already have critical data at their disposal to manage the crisis. This kind of data management and collection should not stop during the crisis. On the contrary, it is one of the crucial elements of health risk management and mitigation.
In the below, based on Bluesquare experience in the DRC and Niger, we describe the approach to leverage Digital Health Master Plan (Carte sanitaire in French) to tackle COVID-19.

Initial and ongoing work to build the Digital Health Master Plan

We have been supporting the DRC and the Niger Ministries of Health in the implementation of an interactive and dynamic health map of public and private health facilities (pharmacies, clinics and health centres).

The results of this work provide routine information, taking into account the health pyramid and population, to the health authorities (the Minister, Technical and Regional Directorates of the Ministry, Health Districts, Projects and Programmes, Partners, external agencies, NGOs, hospitals and health workers). With this information, they can better allocate resources and target underserved regions and populations. 

Bluesquare has specifically focused on identifying databases containing GPS coordinates of health structures, with precise information, such as photos and features that are specific to the DRC and Niger. In Niger, we identified 14 different databases, including the one from the SNIS (HMIS).

We also identified new sources of data to help increase the number of GPS coordinates on the health map, based on existing data. In the DRC, we have identified the following databases: Geolocation of health facilities in the Ebola response, a database from MSF/common geographical repository, a database from the PDSS containing the GPS coordinates of about 500 health facilities in Kinshasa and Kasai.

These multiple data sources, combined with a constant change of data (population estimates from remote sensing, settlement location, names of villages and settlements, health areas, health districts, health  facilities and “découpage communal”), inconsistency between sources (for example, the health layer does not always correspond to the administrative layer) require continuous integration.

Thanks to our visualisation tool, Dataviz, we have set up public portals to visualise the ongoing work on the health map (carte sanitaire) in Niger and the DRC.

Work that facilitates a quick response to COVID-19

In the framework of the COVID-19 response, countries must quickly identify the infrastructures and services they have at their disposal to address the disease and to target funds to acquire the ones still needed. 

In the DRC, where we have been working with the Health Ministry, supporting health information systems and helping the government to create the “carte sanitaire”, we are currently working with the national COVID-19 Task Force to help them tackle the disease.

We are providing support for the geolocalisation of the COVID capacity response (screening devices, in-patient beds, ventilator beds, critical care beds, laboratories, oxygen production units, etc.).

The work that has been done, and which is continuing with the health map (“carte sanitaire”), supports the establishment of an  “état des lieux” of the existing infrastructures and services for a COVID response.  We are putting in place an android app for the “carte sanitaire” update.

We are also investigating other databases that provide integrated information on the COVID Capacity response in order to consolidate data into a single digital database.

This work, while seemingly low-impact, reveals its importance with the COVID-19 pandemic. Ministries of Health and different stakeholders are even more tempted to work with non-centralised databases, gathering data through excel files and sharing them by email, creating different versions of the same database. More than ever, a centralised digital database, to which the different actors can contribute, is critical.

In the first phase, Bluesquare, in partnership with the Agence Nationale d’Ingénierie Clinique d’Information et d’Informatique de Santé or ANICiiS, is identifying the different existing data flows and databases to have a clear view of the full process (what kind of data exist, how data are gathered, by who, and how often etc..) and inviting the different partners to share any complementary existing databases. When complete, the second phase is to propose a set of tools that take into consideration the actual flow of information, while switching from a decentralised multi-source database to one central tool. 

This information will be made publicly available via the public data visualisation interface: “STOP COVID

To get more information about Bluesquare’s support to COVID-19 response.

Centralizing monitoring and evaluation data for the USAID IHP in DRC

Annotation 0604 (2)The Integrated Health Project in the DRC (IHP USAID) 

The IHP USAID program (in French Programme de Santé Intégré de l’USAID en République Démocratique du Congo (PROSANI USAID) ) aims at strengthening the health system in the Democratic Republic of Congo. It is funded by the US Development Agency (USAID) in close collaboration with the government of the country. The program focuses on maternal and child health, family planning, nutrition, malaria, tuberculosis and HIV.

Bluesquare, as the program’s partner for data management and the development of digital tools, has provided support in three key areas.

  1. Facilitate the data collection and analysis process for the program’s 118 indicators to support the general monitoring and evaluation needs.
  2. Centralize all data collected as part of the program (inventory, household survey, quarterly report, etc.)
  3. Implement dashboards that can be made available to program technical advisors.

DHIS2… and more

Bluesquare has therefore developed the Mesure & Evaluation Platform (M&E Platform) for this program. Similar to a conventional DHIS2 platform, it includes some additional applications to support the specific needs of IHP USAID:

  • D2D: to transfer data in just one click directly from the official Health Management Information System DHIS2 (National HMIS DHIS2) to IHP DHIS2 – especially for all M&E indicators that rely on national data;
  • Iaso: to transfer Etat des Lieux data to IHP DHIS2;
  • Hesabu : to calculate the most complex indicators of the logical framework and store the results in the IHP DHIS2; 
  • DataViz : to present selected data on a public “user-friendly” interface in order to share the program’s results:

Copie de M&E Platform EN

A secure and reliable platform

Access to the M&E Platform is ID and password protected. These can be provided upon request by the M&E team. Each user is assigned one (or more) role(s) based on what they will need to work on in the platform. This approach helps to limit the risk of errors that could cause problems later when using the tool.

In the case of this platform,  4 roles have been defined that can be combined by need and by geographic areas in order to further limit the risk of error (for example: encode data for a province difference from your own): Input, Visualization, Analyst, Superuser.

Data extraction for the development of project evaluation indicators

The source of data

A total of  118 indicators are used to assess IHP USAID’s progress. These indicators are calculated based on data from a variety of sources. The more sources there are for the data the richer the insights we can gather from these indicators. The integration includes mainly the data collected by the Ministry of Health (available in the National DHIS2 HMIS) and some additional data from the project (Project Monitoring Report – PMR data). Thanks to the tools described above, Bluesquare was also able to enrich this with additional data from one-off surveys (IHP Household Surveys or data being collected by the Ministry of Health to evaluate the status of the health system at any given time called “Etat des lieux”) as well as other external surveys and disease specific databases. 

Ensure a very large amount of data extraction

Using the D2D tool, Bluesquare will extract these different data and merge them with IHP DHIS2 data.

To provide a sense of the process to manage such complex routine data integration we herewith provide an overview of the transactions and some data security measures put in place to ensure quality data exchanges.

  • Data from the National health information system (HMIS) are imported quarterly from a copy of the DHIS2 SNIS (so as not to endanger the proper functioning of the real DHIS2 HMIS during the data transfer). This also means that the HMIS data is not updated on a daily basis and thus remains “fixed” once imported into the platform which  allows for methodological consistency to be maintained in trends analysis. The HMIS DHIS2 remains an essential data source for day-to-day data analysis and to observe “absolute” figures.
  • Data from the Project Monitoring Report (PMR) are added directly to the M&E Platform via data collection forms available on a monthly, quarterly or annually basis depending on the monitoring needs of the M&E team.
  • Data from État des Lieux (EDL) This data is collected in a tool called IASO, that collects and manages the data in parallel to the DHIS2. 
  • The remaining data (IHP Household survey and other sources) are manually imported into the IHP DHIS2 by the Bluesquare team. 

How the platform will be implemented going forward

The M&E Platform is now being used for ongoing reporting.

To ensure the tools meet the user needs, run smoothly and capture data effectively, the  M&E leads will test the PMR data entry forms on a provincial level. This evaluation of user needs will play a key role in the next iteration of potential improvements to ensure the quality of the data captured for the program monitoring remains consistent.

Additional dashboards will also be developed by the Bluesquare team to help M&E teams capture and visualize the essential information on the definition of indicators.

And the M&E platform itself will continue to be adapted thanks to ongoing dialogue and discussions on the tool, its use and its effectiveness to be sure it continues to meet the needs of the IHP USAID team.

M&E platform EN-rr-1


Dataviz summer update

We have had 6 busy months since January and we have plenty of new features to announce!

New – portal homepage

To provide visitors with a clear introduction and overview of the site, we have added a fully customisable homepage to all portals. You can now present the program objective, data collection process, partners, useful links, publications and more directly on this page.

View a facility’s categorical data

Using the DHIS2 organisation unit groups, we are now able to show the ownership of each facility to one or multiple groups on the map.

When you zoom out of the map, the statistics for that zone appear as you hover over them.

Additional options to visualise your data

In order to respond to the growing diversity of our clients’ needs, we added a few new ways to visualise your data.

Vertical charts

Best used to compare current values of connected indicators.

True / False key indicators visual improvements

Perfect for visualising service availability like water/electricity access or stock out monitoring.


Monitor resources over time with this widely requested chart type option. Define your own color scale for each indicator using color legends set in DHIS2.

Inaccuracies reporting tool

We added this very simple tool that allows someone to easily report issues regarding the data for any facility displayed. It opens a mail with all the facility details and allows the person to explain what and where the issues are.

Improved mobile experience

We noticed an increasing number of users viewing the portals on mobile devices. With this a need to easily report inaccurate information via mobile is growing. So we have focused on improving the user experience for mobile.

Map layers are now grouped and easy to switch

Download a graph as an image

That’s all for now but do not hesitate to reach out with ideas or feedback on your Dataviz instance. We are happy to support your programs with this tool.

The Trypelim project: digital tools to help eliminate Sleeping Sickness

Sleeping Sickness is a parasitic disease transmitted by the tsetse fly. It is lethal in most cases and has been an important cause of death in sub-Saharan Africa over the past century.

Professor Marleen Boelaert and her team from the Institute of Tropical Medicine (ITM) in Antwerp, Belgium, recently launched a new project to reach the global targets for eliminating sleeping sickness. ITM researches new ways to combat the disease and is in charge of an international elimination initiative in DRC, financed by the Belgian Development Cooperation and the Bill & Melinda Gates Foundation. They are working with several partners. One of them is PNLTHA, the National Program against Sleeping Sickness in the DRC.

The project is focused on improved medication and testing, smaller and more effective fly traps and on digital data processing. You can read more about the ITM project here:

Bluesquare has been working with ITM to develop and enhance the existing data processing tools, which includes two main parts:

  1. A mobile application

The mobile application is used on Android tablets to collect data about diagnostic tests that are performed in villages in DRC.


The paper based processes that have been in use, with good results, in the DRC over the years, have the drawbacks of requiring that all the information be gathered physically at a central level and letting spelling errors in names of places slip through. These factors make it more difficult to produce geographically grouped reports.

The mobile application replaces those processes and provides multiple advantages:

  • It enforces improved encoding by for example providing prefilled lists of places and checking that encoded ages are realistic.
  • It allows transfer of data over the internet when connectivity is available, avoiding difficult travel for the PNLTHA teams across the country, and drastically shortening the time to collect data centrally.
  • It can take pictures and videos (through microscopes) of test results. These are taken to  double check the results at health zone, provincial or national level, in order to increase the quality of the testing.

These advantages are very important and justify the use of digital tools over the traditional paper approach, but the use of a tablet application has its own challenges to overcome.

First, it requires electricity. This has been solved by using solar panels.

Second, it needs to work offline, with the absence of internet connection in most of the DRC. Then when the tablet user reaches a place where internet connectivity is available, it needs to be able to synchronize all the collected data with a central server, securely.

Third, the process must not break the workflow of existing testing teams, and be, whenever possible, as convenient as the paper based processes.The teams  are used to working in parallel with encoders for the patient names, with the testers when collecting blood and finally with the verifiers to proceed to additional tests in case of a first positive diagnostic test. We are tackling these problems by using NFC and Bluetooth synchronization between tablets to avoid multiple encoding at the different stages of the process. The advantage of these technologies is that they do not require internet connectivity to transfer data between devices.

  1. An online dashboard

The dashboard offers many features aimed for use by the PNLTHA members.

First and foremost, it collects all the data about the tests performed in the field, that have been encoded either through the mobile application or through various Microsoft Access files over the years. This makes it a comprehensive electronic record of all recent sleeping sickness cases in the DRC. Our team worked hard to ensure that this data are as clean as possible, allowing us to match cases with the location where they have occurred and been diagnosed, and to ensure that no case is either forgotten or encoded twice. We are also making progress on making links between various tests performed on a given patient.

In the end, the keyword here is traceability: we want to allow users to easily recover any information on a test that has been performed. For example, in which village, by which PNLTHA member and on exactly which date. Dates and GPS coordinates are collected by the tablets during encoding and are used in the dashboard to navigate test information.

Second, it includes tools to track the progress of the testing work in the field, by displaying which tablets have been doing which test, when and where. Statistics about the tests campaign can be viewed online in these tools.

Third, in the very near future, the dashboard will allow us to proceed to quality controls at various levels, by allowing officials of the PNLTHA to see pictures and videos of tests completed in the field and double check the diagnoses that have been performed.  

Fourth, the dashboard offers tools to plan the work of testers in the field, while optimizing the travels of the teams and the epidemiological efficiency. This is crucial in the last steps of elimination of the sickness, where tracking down the last cases requires a level of accuracy that was not really needed in the past, when more broadly cast surveillance networks have done their job efficiently.

All these features are provided while ensuring a fine grained access control where all users of the systems only get access to the parts that are relevant to their work responsibilities. Notably, they only have access to the geographical regions that they are in charge of.

Tools used (for the technology wonks out there):

For the android application, we use Cordova, React, and various libraries for NFC, USB storage (for backup) and external USB camera support. The data is stored in Couchdb, which allows relatively easy replication between devices and the servers.

The online dashboard is written in Python using the Django framework, with the frontend using React, Leaflet for the maps, and d3.js for data visualization.

We are making progress on all aspects of the digital tools for the elimination of the sleeping sickness in the DRC project. Overall, we seem to get a good adoption rate of the tools by the different teams, which is always a major challenge for any digitization project. This is attained through constant feedback loops with people in the field and rapid adaptation of the tools to the needs expressed. Already, hundreds of thousands of tests have been recorded and made available for statistical analysis.

We would like to thank the members of the PNLTHA for their willingness to test the tools and to give feedback and the ITM for trusting us with this important and challenging project.

You can now manage your Dataviz directly in DHIS2

Do you use dataviz to demonstrate your program results? Today we are pleased to announce that you will be able to manage your dataviz directly in DHIS2. Thanks to our new DHIS2 Data Viz app!

Access to the app will allow you to easily make changes to your platform. You can configure all display settings, sections, change their order, …

The app is available directly via the app menu on DHIS2.

For a tour of the app, or if you have trouble finding the app in DHIS2 contact your project manager or our DataViz product owner.

Continued updates to the design

Thanks to your continued feedback and our user analysis, we have made a few additional updates to the Data Viz layout. Here’s what’s new:

  • Main content placement. Most visitors to the site are interested in the national level results. So we have moved this information to the left for ease of reading.  
  • Health Center attributes. The number of sub-zones, the attributes describing the health centers, the photos and the grouping, were not visible enough. We have added a dedicated space for the attributes describing the health zones and increased the visibility of the photos of the health centers.

We hope you find these changes helpful as you continue to use Data Viz to articulate your program needs to your various partners and stakeholders.

Example of groups display in RCA

Boris Rorsvort
Dataviz Product Owner

Digital Investment Principles – a simple approach to coordinated efforts in global health

While it may not have made waves in international news, there is a new development in digital health that is very exciting for us at Bluesquare: The Digital Investment Principles.

If you have not heard of them yet, they are 10 guidelines that donors can endorse to demonstrate their commitment to working together towards improved collaboration in digital health. Created by leading players – the World Bank, the European Union, USAID, Unicef, WHO, the Bill and Melinda Gates Foundation – these 25 key donors and foundations are making their commitment known.

Principles 1-5 focus on collaboration, sustainable alignment in investments and a commitment for donors to make these investments a priority. The last five provide guidance on where the investments should go: creation and evolution, country capacity and peer-learning to call a few out.

At their center is an urgent call. One that we at Bluesquare have championed for the last 5 years – and that is alignment of investments to the national digital health strategies already in place in each country.

We have worked with Ministries of Health in over 25 countries. Our work has focused on integrated health information systems. Health information systems that support decision making from existing data while finding the most cost-effective ways of collecting additional data. We have seen and experienced the challenges to accomplishing this first hand.

These principles could not come at a better time. While they are simple in nature, they demonstrate how far we have come in the last few years for a meaningful dialogue on the importance of coordinated efforts in digital health in developing countries.

We are eager to continue to be part of the important work in this space.

Bluesquare is happy to release the new ORBF : effectively managing RBF & strategic purchasing on top of your DHIS2 platform(s)

After more than a year of hard work, and months of testing and improvement, we are very pleased to officially release the new ORBF tool to help manage RBF and strategic purchasing on top of DHIS2 platforms.

Since 2012, Bluesquare has been developing and deploying OpenRBF in many countries. OpenRBF was a separate and stand alone software platform. In 2016, we decided to re-build the software, and split it into several modules, while maintaining our focus on technology that would enhance the health financing capability of DHIS2. This led to the development of three software modules that are plugged into DHIS2: DataCollect (an ODK to DHIS2 offline mobile android app), DataViz (a data visualisation interface used for RBF portals), and ORBF, a health financing rule engine.

Over the coming months we will share more on these modules. For today we will focus on ORBF and its great capabilities.

From lab coat to tablet

The first impression you get when you meet Romain is his discreet nature, attention to detail, commitment to quality and a dedication to the work he does. So when we asked him to tell us about himself, it was clear we wanted to understand how he got where he is today.  

While his journey was not linear we immediately notice a central theme: his commitment to understanding complex problems and his desire to make an impact.

Another year for Bluesquare – The same vision, different ways.

Another year for Bluesquare – The same vision, different ways
At Bluesquare, what drives us is the desire to make the world a better place. Our goal is to ensure that every citizen on this planet has access to a minimum package of health services. Unfortunately, we are not there yet. The community surrounding the Tipo health center in the DRC has benefited from barely any substantial Global Health investment over the last years. So, helping Global Health players allocate their resources in a smarter way, so that it goes where it matters most, is where we can continue to make a difference. How will we get there? We believe that technology and data can influence this allocation in two ways : increase efficiency of existing investments through better data insights and financial disintermediation, and make Global Health a more attractive investment for countries and citizens looking to invest in this space.    

But how do we translate this vision into operational priorities? Here is our focus for 2018.