Combining OpenStreetMap mapping and route optimization algorithms to inform the delivery of community health interventions at the last mile

Community health programs are gaining relevance within national health systems and becoming inherently more complex. To ensure that community health programs lead to equitable geographic access to care, the WHO recommends adapting the target population and workload of community health workers (CHWs) according to the local geographic context and population size of the communities they serve. Geographic optimization could be particularly beneficial for those activities that require CHWs to visit households door-to-door for last mile delivery of care. The goal of this study was to demonstrate how geographic optimization can be applied to inform community health programs in rural areas of the developing world. We developed a decision-making tool based on OpenStreetMap mapping and route optimization algorithms in order to inform the micro-planning and implementation of two kinds of community health interventions requiring door-to-door delivery: mass distribution campaigns and proactive community case management (proCCM) programs. We applied the Vehicle Routing Problem with Time Windows (VRPTW) algorithm to optimize the on-foot routes that CHWs take to visit households in their catchment, using a geographic dataset obtained from mapping on OpenStreetMap comprising over 100,000 buildings and 20,000 km of footpaths in the rural district of Ifanadiana, Madagascar. We found that personnel-day requirements ranged from less than 15 to over 60 per CHW catchment for mass distribution campaigns, and from less than 5 to over 20 for proCCM programs, assuming 1 visit per month. To illustrate how these VRPTW algorithms can be used by operational teams, we developed an "e-health" platform to visualize resource requirements, CHW optimal schedules and itineraries according to customizable intervention designs and hypotheses. Further development and scale-up of these tools could help optimize community health programs and other last mile delivery activities, in line with WHO recommendations, linking a new era of big data analytics with the most basic forms of frontline care in resource poor areas.Author summary: Community health programs play a critical role in providing equitable health care, especially in remote and underserved areas. However, these programs are often complex and difficult to implement effectively. This study explores how geographic optimization can improve the delivery of community health interventions, ensuring that community health workers (CHWs) can efficiently reach every household. By integrating OpenStreetMap data into route optimization algorithms, we developed a decision support tool to streamline the planning and execution of door-to-door health services. In the rural district of Ifanadiana, Madagascar, this tool was used to optimize CHW routes for mass distribution campaigns and proactive community case management (proCCM). The results showed that these optimizations could significantly reduce the time and resources required of CHWs. To facilitate its practical application, we created an "e-health" platform that displays resource needs and CHW routes for each activity. This approach promises to improve last mile health care delivery, in alignment with WHO guidelines, and use advanced data analytics to improve frontline health care in resource-limited settings.