Spatial implications of the tuberculosis DOTS strategy in rural South Africa: a novel application of geographical information system and global positioning system technologies

We used GIS/GPS technology to document and quantify improved access to tuberculosis treatment through a community-based programme in Hlabisa, South Africa. We plotted tuberculosis supervision points used by the district health system in 1991 (programme's first year) and 1996 (programme fully established), and quantified access by using GIS to measure the mean distance from each homestead in the district to hospital, clinics, community health workers (CHW) and volunteer supervisors. While the tuberculosis caseload tripled, the number of community supervision points used increased from 37 in 1991 to 147 in 1996. Adding clinics and then CHWs to the hospital as treatment points reduced the mean distance from homestead to treatment point from 29.6 km to 4.2 km and to 1.9 km, respectively. Adding volunteers further decreased the distance to 800 m. GIS/GPS effectively documents and quantifies the impact of community-based tuberculosis treatment on access to treatment.