Impact of security context on mobile clinic activities : a GIS multi criteria evaluation based on an MSF humanitarian mission in Cameroon

Abstract: Humanitarian crises require a quick and effective emergency response to answer the needs of vulnerable populations. Deploying mobile health clinics in the field is an example of an outreach activity that can be undertaken for this purpose. This study is based on a real mission implemented by a medical international aid organization (MSF or Médecins Sans Frontières) in Cameroon during the recent Central African Republic humanitarian crisis (2014). All of the knowledge and information required for the analysis have been collected by field observations, interviews and the experiences of the author of this thesis during a 4-month emergency mission in East Cameroon, working as a mobile clinic manager. The selection of the most suitable mobile clinic sites is a complicated task in such a volatile context. One mobile team can typically cover a number of 8 sites in a two week rotation period (1 site per day, visited every 14 days). Due to a sensitive security and humanitarian situation, a significant number of factors need to be considered before making any decision. This paper shows how GIS can be used to help define the most suitable sites and to what extent the security related factors can affect the final strategy. Using a Multi Criteria Decision Analysis (MCDA), suitable site areas were identified inside the study boundary via two different analyses: (i) with security considerations and (ii) with no security considerations. Through an Analytic Hierarchy Process (AHP), 13 criteria were divided into three distinctive classes (security related factors, human related factors and environmental factors). AHP helped determine the influence and weight of each factor to one another with pairwise comparisons. It has the advantage of structuring the analysis in a simple and comprehensive way for the decision makers. A Weighted Linear Combination (WLC) completed the AHP method to aggregate the factors and classes together according to their respective weights. A final raster map was generated for each analysis and reclassified into 20 ranges of equal intervals based on the suitability value of each cell. Alternatives were ranked according to their suitability range. First, the three highest ranges of values were identified as the most suitable areas given security considerations. They cover 1714 km² (3,7 % of the study area) and include 19 relevant towns for mobile health activities. Second, five of the highest ranges of values were identified as the most suitable areas with no security considerations. They cover 1893 km² (4 % of the study area) and include 18 relevant towns for mobile health activities. Both analyses only share 10 sites which indicates that the security context significantly affects the site selection in a humanitarian context. The first analysis (i) was also compared with the actual activities implemented by MSF in 2014 (without the use of GIS). The comparison shows that 9 of the 12 most pertinent sites selected by the MSF decision makers during the 2014 emergency (most visited sites by the mobile clinics) were also selected with the GIS analysis. The research shows that GIS can be an added value for selecting suitable sites for health mobile activities in a humanitarian context. MCDAs such as AHP proved to be an effective approach to help in the prioritization process and to limit the alternatives for decision makers. Similar analyses can be used in the future and we suggest keeping them simple and well-structured, especially when dealing with emergency crises where influencing factors are subject to very rapid change.