Sasko Martinovski 1* Abstract. 1. Introduction. Review paper UDC 007:004]:528}:613/614

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1 Review paper UDC 007:004]:528}:613/614 DEVELOPING SYSTEMS FOR STRATEGIC PLANNING IN THE HEALTH AND NUTRITION SECTOR BY USING THE GEOGRAPHIC INFORMATION SYSTEM AND ITS APPLICATION IN THE REPUBLIC OF MACEDONIA Sasko Martinovski 1* 1 Faculty of Technological and Technical Sciences - Veles, University St. Kliment Ohridski - Bitola, Dimitar Vlahov bb, 1400 Veles, Macedonia * saskomartin2@gmail.com Abstract The Geographic Information System (GIS) is now an important and necessary component integrated in Planning Support Systems (PSS). Using GIS and PSS in the Health and Nutrition sectors worldwide is booming and very developed, but the development in Macedonia, or the use of these systems, is very low. The scope of research for this paper is to prepare models for the creation of PSS systems using the GIS for the health and nutrition sectors and their application in the Republic of Macedonia. The purpose of this research is to create a model that could be used in the Health and Nutrition sectors in the Republic of Macedonia. This shall improve the strategic planning in the Health sector, and it will be much easier to prevent the spreading of diseases. In this paper, an original concept is applied for building a model via GIS modelling and directions are provided for its use. The model is built on the basis of several principles, and one of the most important is to provide greater visibility and full understanding of the process that is built into the model. The building of a good model to use in the Health and Nutrition sectors would help the country, as well as its citizens, to act preventively through the adoption of effective, timely and correct decisions. Research has shown that the application of GIS, in the building of the model, is a very important and necessary component. Key words: GIS, PSS, Nutrition, Health Sector, Model, Modelling. 1. Introduction Parallel to the development in the field of planning in the nutrition and health sector, and the prevention of diseases, is the development of concepts and designs for systems for planning support, the so called PSS systems (Planning Support System). These systems are a combination of computer-based methods and models that support planning and serve not just as a support system for decision makers, but also provide a variety of tools, models and information through information technologies. PSS consists of a full package of related information technologies (for instance, GIS, spreadsheets, models, databases, etc.), that are being used in various stages of planning ([1], [2]). In these systems, GIS forms an important component, and thus enables geo-processing, graphic display, database and modeling capabilities. They contain a full range of traditional tools, such as: economic and demographic analysis and forecasts, environmental tools, modeling, transport planning, and modeling of land use, health regions and other. Also the development goes towards inclusion of other technologies such as exert systems, assistance for decision support (for instance, multi-criteria decision analysis), hypermedia systems and group of decision support systems. With the advancement of GIS, the importance of PSS increases and GIS applications in the support of planning tend to be a strategic and routine part of these systems ([3], [4], [5]), and are increasingly more important and necessary in urban modeling and visualization. For example, CAD and 3D models generated from GIS or other software as well as AutoCad, are becoming a routine. This section is the fastest growing in the PSS, because of the non-commercial software available on the Internet, such as: Google Earth, Google Map, Microsoft Virtual Earth and others. Many models of existing GIS software are already embedded spatial models, and each style of a model can be incorporated into another model. The management of a database, the visualization, spatial analysis and modeling, are the main reasons for the use of GIS in strategic planning systems and models in the Health and Nutrition Sector. GIS is used for storing various maps and plans, socio-economic data, environ- 196

2 mental data, data on the diet of the population, diseases and so on, as well as for creation of models that can be used for planning and prevention. Planners can extract useful information from the database via spatial queries that are specific to GIS. Mapping, 2D and 3D virtual realities are powerful tools for visualization in GIS. For example, in spatial analysis some maps can be used to investigate the distribution of socio-economic and environmental data, and then display the results, i.e. graphical and analytical display. There are many advantages of using GIS in the Health and Nutrition Sector, which include: Improve mapping - better access and improved maps, creating more efficient thematic maps and reducing the cost of data storage. Greater efficiency in retrieving information. Faster and more comprehensive approach to the types of geographic information, which is important for planning, but also the opportunity to explore a wider range of alternatives. Improving the analysis, especially spatial analysis. Better communication to the public and employees. Improve the quality of services, for instance, faster access to information in the planning process. Modeling and creating models. The many examples of the application of GIS in the creation of models in general and urban planning, which is in any way connected with the space, suggest that the application of GIS in urban planning is implied, the application in the economy is always useful and is of great assistance in developing a business model, but it is important to say that GIS can be applied in medicine, in the Health and Nutrition Sector. Here are a few examples: the use of GIS in the analysis of the human body, using public health in the field of epidemiology - tracking the sources of disease by making plans and scenarios for their spread and prevention, information and correlations for health and nutrition of the population in certain regions and areas, maps for each health indicator, creating so-called health regions, thematic maps, which include topics such as obesity, asthma, mortality rate and others. 2. The role of strategic planning systems in the health and nutrition sector in the Republic of Macedonia and GIS modeling 2.1 The role of strategic planning systems in the health and nutrition sector in the Republic of Macedonia After careful consideration of the PSS literature and practice it can be concluded that many of these systems in different countries cover a wide range of application areas for strategic support. Some observations can be drawn from this: First of all, the number of PSS increases worldwide. Certainly, much of the PSS are available as free systems. Secondly, the experience with PSS in actual practice of planning is very limited. In the real world application of many systems seems to be limited to experimental studies, for instance through educational meetings with students or trainings with professional planners. Small number systems are actually at the stage of professional applications. Thirdly, the diversity is apparent in the goals, possibilities, structure and technology of PSS, as well as their appearance. There is an increasing trend of using strategic planning systems to support the health and nutrition systems. Finally, some of them are dedicated to facilitate and/ or enhance participation by the public and/or stakeholders in the planning process. Other PSS have been developed to inform the public about the various planning policies and issues in their region or state, as well as other specific forms of planning support especially in the areas of the health and nutrition sector. From the analysis already done in Macedonia, very few of these are used and systems have been developed to support planning in the health and nutrition sector. The use of strategic planning systems in the field of health and nutrition sector in the Republic of Macedonia should include the following key elements divided into two main parts: Health sector Tracking of sources of disease by making plans and scenarios for their possible spread and prevention. Maps for each health indicator in areas, regions and municipalities. Health regions. Statistics for the Macedonian health related data and maps for health regions and thematic maps, which include topics such as obesity, illness, mortality rate, etc Nutrition Nutrition in schools with school health programs Special programs for supplementary nutrition for women, infants and children, known worldwide as the WIC (Women, Infants, Children), for pregnant women, breastfeeding women, postpartum women, infants up to 1 year up to 5 years old children. Special programs for nutrition of athletes. WIC Stores for healthy nutrition and their management and marketing. Plans for opening various departments for healthy nutrition (Nutri-divisions) in public health and private nutrition agencies in the regions of Macedonia. 197

3 Building of a good PSS model, which would comprise the two main sections described earlier, can be done by modeling using the GIS concept I propose, and using a range of data from various sources such as the health sector, the State statistical office and a large number of surveys. As an example I shall point out one research which can be used in the building of such a good model. and the development of its software, but in stage 5 we can include mathematical - statistical software (the simplest example is the use of Microsoft Excel), then the use of non-gis databases that includes Database Management Systems (DBMS), and finally to develop software for the model, we need a computer integrated development environment (for example, Microsoft Visual Studio). Namely, to determine the correlations between dietary habits and other indicators, a research has been done throughout the Republic of Macedonia by means of a survey called Nutrition affects your health with a sample of 1600 respondents (a similar survey was made in 2011), done by a team of researchers of the Technological - Technical Faculty in Veles, at the University St. Kliment Ohridski - Bitola. In this research spatial data were used such as maps of regions and satellite images, data from the State Statistical Office of Macedonia, data from the Budget of the Republic of Macedonia and data from the survey. Based on these data an analysis was made on the nutrition, physical activity and socio-economic impact on the diet of citizens in order to improve the health of the population in eight regions in Macedonia, during the period from 2011 to 2012 ([6], [7], [8], [9]) and the global goal were the economic and social benefits of Republic of Macedonia. There have been a large number of statistical analyzes such as: Correlation between the dietary habits and income per family member. Correlation between the dietary habits and education. Correlation between the dietary habits and appearance of certain diseases. Many other analyses. All of this can contribute to creating health strategies on health promotion and disease prevention ([6], [8]), and thus a possible double benefit for the country: First, to reduce the cost of treating diseases that would contribute to the economic and social benefit of the state, and secondly a healthier population. Data can also be used in the domain of health care management GIS modeling for the strategic planning systems in the health and nutrition sector in the Republic of Macedonia The stages of modeling to create a planning support system for the nutrition and health sector, which I propose are shown in Figure 1 [10]. The existence of the relationship of the stages of the application of science and scientific disciplines is required in the modeling, but typically this block diagram is dynamic and depends on the area of the models that are created. Also, for the creation of the model and development of software for it, additional software is required. In this context, GIS is implied in the creation of the model Figure 1. GIS modeling stages and their connection with sciences, disciplines and other applications In stage 1, depending on the model, to determine the purpose - interest, and depending on the complexity of the model, the modeling can be applied to the economic science or any of its disciplines, but if it is a model associated with other sciences or other disciplines, then they can be included. In stage 2, it is characteristic that the output is defined first, after that the necessary methodology on obtaining that output and finally, based on the outputs the model input and its sources are defined. It is necessary in this stage is to use scientific methods and methodologies from the health and nutrition sector and then they can be incorporated into the model. 198

4 In stage 3 - a conceptual model, the model of the concept is built, and this requires all the sciences and/or their disciplines. Also in the construction of this stage (and in the construction of the model) it is necessary to use GIS. This stage begins with spatial reasoning, and for this geo-information science and GIS software can be used, as that helps with the perception of reality and phenomena that do exist in all parts of their complexity. An important part of this phase is to define strategies on GIS modeling. In modeling on PSS for the nutrition and health sector the more familiar types of GIS models can be used: Binary models These models are used in many cases as follows: Maps overlay with a combination of attributes/variables. A common example of this model is the analysis of localization of elements, (sitting analysis). Spatial query. These models can be used for space tracking of disease sources and making different plans. As an example of using a GIS binary model, a GIS model was created using input data from a survey conducted in 2012 by regions in Macedonia, and according to: use of drinking water and renal diseases. A correlation was made between the type of water used (two types: natural mineral water - purchased and not purchased tap water) and renal diseases (generally those polled declared that they have kidney problems - non- specific) and on the basis of the created GIS model an output was obtained as shown in Figure 2. It is characteristic that in all those regions where the type of water used is purchased mineral water, the percentage of kidney disease is much lower compared to others where tap water is used, and the Polog region has the highest percentage of kidney disease Logical model There are two types of logical models: vector and raster based logical model. Vector-based logical model By overlapping (collection of) both maps we get a third map, and with a logical separation of a section of the map, we get the required area. Raster -based logical model By overlapping (spatial collection), we get a third network based on logical relation. These models can be used for spatial allocation of nutria-agencies and healthy food stores Index model Standardized spatial values are added to each layer An index value is used, calculated from composite maps or several networks to produce a ranked map There is a vector based index-model and a raster based index-model. Indexing steps are: 1. Assign the weight to each variable. 2. Assign and standardize the result for each class of variables. 3. Calculation of the index value. 4. Ranking the index value for each polygon and cell These models can be used to define the health regions Regression models Refers to the dependent variable from # of independent variables in the equation, and it is used to predict or estimate. By using the operations for overlapping maps in GIS, all independent variables required for analysis are combined. There are two types of regression: 1. Linear regression Dependent and independent variables are numeric variables. 2. Logistic regression The dependent variable is a binary variable, and the independent variables are categorical or numerical. Figure 2. Graphic output from the GIS model (ESRI software was used) for the Republic of Macedonia by regions, obtained on the basis of input data from a survey on the use of drinking water in correlation with renal diseases. These models can be used to define the health regions and thematic maps. 199

5 2.2.5 Process models Integrates existing knowledge about the processes in the real world, presented in a set of relations and equations for the quantification of processes. Usually these models are raster - based. Simple processes can be prepared through these models in GIS, and for the complex and dynamic analyses other software can be used. In stage 4 - logical model, on the basis of the previous stages the logical model is created. The idea is that all stages should be defined by the entities that are related, like a relational model, as presented in the E-R diagram. This relational model will help with the implementation of the understanding of the planning process into the planning support system. I suggest a very good concept for incorporating the process of understanding, which will help a lot in using the system and which should be applied to other systems. Stage 5 - a physical model is created based on the conceptual and logical model. For its preparation a computer integrated development environment is required, which must be integrated with GIS, but if needed, to be integrated with other software and DBMS. Stage 6 - Verification of the prepared model, meaning its testing, analyzing the output results as future plans, and comparison with some predefined parameters, benchmarks, etc. Accordingly, depending on the verification, feedback is triggered to stage 3, with directions to change a part of the defined concept, which entails changes in stage 3, stage 4 and stage 5. If for some reason you cannot get the planned outputs, the feedback link is to stage 1, by changing the goals and interests, and later by implementing changes in other stages. From the planning support systems that are applicable in practice and are well known in the literature, such as: TRANUS [11], DRAM / EMPAL, the projects PROPO- LIS, SPARTACUS and many others, it can be concluded that they are very complex, and some even overload the planning process. For example, a consequence of having too many choices could be similar to having a virus inserted into the expression process and the creation of intuitive design. Based on the above observation, I will give the following observation: planning support systems should be simple, transparent in the handling, flexible and adaptive, so that normal users can use them for planning, without needing the aid of specialists who built this system. I think this it can be achieved by creating simpler models in the planning process, with one principle it is better to use two simple models rather than a complex one. The planning process requires data, information and knowledge. Among these resources, the importance of geo-referenced information should not be underestimated. In such contexts, it is good to increase the use of GIS in the planning process. In terms of data, the planning process requires good digital data, so that the analysis can produce a good information. The use of planning support systems and GIS has spread much further than urban planning. Thus the following conclusion can freely be made: in the process of planning (urban or otherwise) GIS must be used, and because GIS can be applied or used in all areas of our everyday lives, the development of new models can be developed that are not from an urban area, but are in some way related to the planning of space. From the writings and practice of PSS it can be concluded that very little is done in terms of understanding the planning process itself. Most of the examples show that the focus in the development of PSS is the output, i.e. the quality of the offered solutions. I find that it is very important for planners to understand the process of planning, not just use it as a technique and technology. The proposed concept of modeling is used for each stage of entities and relations, as in the E-R models for the organization of the data. I think that this concept will provide: better organization; simplified modeling at each stage; the modeling system for planning and the general model will be such that allows greater visibility and full understanding of the planning process. From my practice in production and use of various systems, I think that the user s understanding of the system will have a huge impact and role in the development and use of same. Knowledge of how to receive the output from each respective input and the methodology used is of paramount importance for the development and implementation of the system (PSS model or any other system). 3. Conclusions - From the analysis done in Macedonia, my observations are that planning support systems and GIS are not much used in the nutrition and health sector. How can we overcome this? First of all, people need to be educated, the ones who are somehow involved in the planning process, on the methods and concepts for planning and GIS. Subsequently, the development of hardware and software follows an extremely positive trend, the price has decreased, and the Internet has become a source of data and method of communication in the planning process, so that there is more and more free software. These benefits must also be used to invest in the development of PSS, GIS software, hardware and training. - The general conclusion that I have come to, for the needs of developing planning support systems, especially for strategic planning in the nutrition and health 200

6 sector, and is at the same time the motivation of my research: first of all, a good planning support system requires new scientific concepts that should be developed on the basis of several principles: the system should also be conceptualized so that it is easier to use for the planners; next, to use the GIS, not only as a tool for analysis, but for many other uses, for example including data from other databases that are important for planning and building GIS models based on them, and eventually to create 2D or 3D scenarios for specific solutions, but not to overdo it, i.e. it has to have a realistic basis; and third, it is very important for the planning process to be conceptualized so as to give greater visibility to the planning process. I think it can be done, if a relational model is applied as a concept in the creation of PSS by using GIS. [9] Pavlova V., Damjanovski D., Simovska V., Martinovski S. (2011). Research on dietary habits of population of different ages in the region of Veles - Macedonia. 7th International Congress of Food Technologists, Biotechnologists and Nutritionists Proceedings, Opatija, Croatia, pp [10] Martinovski S. (2013). GIS modelling for the strategic urban development planning. Doctoral Dissertation, University St. Kliment Ohridski Bitola, Macedonia, pp [11] Modelistica. Integrated Land Use and Transport Modeling System (TRANUS software). Available at: <URL: 19 June References [1] Batty M. (1995). Planning Support Systems and the New Logic of Computation. Regional Development Dialogue, pp [2] Klosterman R. E. (1997). Planning support systems: A new perspective on computer-aided planning. Journal of Planning Education and Research, 17(1), pp [3] Brail R. K., and Klosterman R. E. (Eds.) (2001). Planning Support Systems: Integrating Geographic Information Systems, Models, and Visualization Tools. Redlands, CA: ESRI Press, pp [4] Geertman S., and Stillwell, J. (Eds.) (2003). Planning Support Systems in Practice. Springer-Verlag, Berlin, Germany, pp [5] Yeh A. G. O., Song X., Niu X., and Li X. (2006). GIS and Planning Support System. Science Press, Beijing, China, pp [6] Martinovski S., Simovskа V., Pavlova V., Nedelkoska N. D., Manceski Dj. (2013). Development and implementation of strategic planning support systems in the urban environment and health sector by applying a geographic information system in the Republic of Macedonia. Journal of Hygienic Engineering and Design, Vol. 2, pp [7] Simovska V., Damjanovski D., Pavlova V., Martinovski S., Nikolovska-Nedelkoska D., Antoska V., Mancevski Gj., Vidin M. (2012). The effect of socio-economic indicators on dietary habits, physical activity levels (PALs) and BMI kg/ m 2 in Macedonian youth. V Congress of Sports Medicine and Sports Sciences Book of papers and Abstracts, Belgrade, Serbia, pp [8] Simovska V., Damjanovski D., Vidin M., Pavloska V., Martinovski S., Vidin M. (2011). Evaluation of dietary habits and physical activity levels monitoring as basis for a new health promotion strategy in Republic of Macedonia. Procedia - Social and Behavioural Sciences [serial online] 2012, 44, pp <URL: and <URL: Accesed 19 June