Spatial distribution and deployment of community–based distributors implementing integrated community case management (iCCM): Geographic information system (GIS) mapping study in three South Sudan states

AIM: In late 2012 and in conjunction with South Sudan’s Ministry of Health – National Malaria Control Program, PSI (Population Services International) conducted a comprehensive mapping exercise to assess geographical coverage of its integrated community case management (iCCM) program and consider scope for expansion. The operational research was designed to provide evidence and support for low–cost mapping and monitoring systems, demonstrating the use of technology to enhance the quality of programming and to allow for the improved allocation of resources through appropriate and need–based deployment of community–based distributors (CBDs). METHODS: The survey took place over the course of three months and program staff gathered GPS (global positioning system) data, along with demographic data, for over 1200 CBDs and 111 CBD supervisors operating in six counties in South Sudan. Data was collated, cleaned and quality assured, input into an Excel database, and subsequently uploaded to geographic information system (GIS) for spatial analysis and map production. RESULTS: The mapping results showed that over three–quarters of CBDs were deployed within a five kilometer radius of a health facility or another CBD, contrary to program planning and design. Other characteristics of the CBD and CBD supervisor profiles (age, gender, literacy) were more closely matched with other regional programs. CONCLUSIONS: The results of this mapping exercise provided a valuable insight into the contradictions found between a program “deployment plan” and the realities observed during field implementation. It also highlighted an important need for program implementers and national–level strategy makers to consider the natural and community–driven diffusion of CBDs, and take into consideration the strength of the local health facilities when developing a deployment plan.