Computers in Biology and Medicine 37 (2007) 879 – 889

www.intl.elsevierhealth.com/journals/cobm

Creating a GIS application for health services at Jeddah city

Abdulkader A Murad ∗
Department of Urban and Regional Planning, Faculty of Environmental Design, King Abdulaziz University, P.O. Box 80210, Jeddah 21589, Saudi Arabia

Received 3 May 2006; accepted 13 September 2006

Abstract
This paper explores the possibilities of using GIS for private hospitals at Jeddah city, Saudi Arabia. A GIS application is created to cover
three main health planning issues which are distribution of health demand, classification of hospital patients and the definition of hospital
service area. Each one of these issues is covered using several GIS functions including network analysis and overlay analysis. The former is
used to produce drive-time hospital service area and the latter is applied at the selected hospital to calculate the size of its served demand.
GIS has several useful functions and tools that can be used in health planning field. This paper uses some of these functions for one private
hospital. These functions are used to help health planners on evaluating the spatial distribution of hospital demand and for defining hospital
service area. All the produced models can be applied on any private or public hospital in Jeddah city. They can be used to build a spatial
decision support system for hospitals in Jeddah city.
䉷 2006 Elsevier Ltd. All rights reserved.

Keywords: GIS; Hospital demand; Network analysis; Overlay analysis

1. Introduction planning in Saudi Arabia. The former discusses planning issues

Health care facilities at any region can be divided into two
main types that are known as primary health centers and hos-
pitals. The former provides basic health care services and the
latter provides services for specialist health treatment. Health
authorities have always aimed to provide health care for all res-
idents using a fair access policy that is characterized as provid-
ing the right service at the right time in the right place [1]. There
are several issues (challenges) that make such health policy dif-
ficult to be implemented. One of these issues is related to the
relationship between distance to health services and the need
for health care. The use of health services influenced also by
other factors including financial status, time constrains, social
inconveniences and the psychological stress of journey to the
health services [2]. In order to explore these issues, Geograph-
ical Information Systems (GIS) are used by health planners
at several studies (e.g. [3–7]). These studies have concluded
that GIS is a useful technology for analyzing and manipulating
health data. Murad [7,8] are two useful studies explaining the
possibilities and the benefits of using GIS in health care facility
∗ Tel.: +966 504623744; fax: +966 26952756.
E-mail address: amurad25@hotmail.com.
that are related to one local health center at Makkah city and the
latter covers public (general) hospitals and uses GIS network
analysis technique for modeling health supply at Jeddah city.
The presented paper covers some of health care planning issues
that are not explored for Jeddah city which include defining
the location, and types of health demand and using GIS for
manipulating and analyzing the collected demand data.
There are several types of geographical analysis that can
be made in health care studies. These include analysis of the
spatial distribution of health care facilities, analysis of factors
affecting the occurrence and outcome of diseases and analy-
sis of variation in health treatment and outcome for planning
the development of health services [9]. All of these types of
analysis can be covered using several GIS tools and analytical
functions. The aim of this paper is to create a GIS application
that covers some of health issues related to hospitals at Jed-
dah city, Saudi Arabia. The application is designed to cover
several important factors related to hospital planning including
defining spatial distribution of health demand, classification of
patients and defining hospital service area. In order to build
this application, one major private hospital is selected as a case
study for hospitals in Jeddah city. All the resulted outputs from
the presented study can be implemented on any other private or

0010-4825/$ - see front matter 䉷 2006 Elsevier Ltd. All rights reserved.
doi:10.1016/j.compbiomed.2006.09.006
880 A.A. Murad / Computers in Biology and Medicine 37 (2007) 879 – 889
public hospital at Jeddah city. The selected hospital is regarded
as a model for a high demanded hospital that provides all types
of health services to Jeddah’s residents. The focus of the pre-
sented paper is on the advantages of using GIS in hospital plan-
ning and management. The created application is regarded as
a spatial decision support system for hospitals at Jeddah city.
2. Methods
2.1. Study area
Jeddah is the commercial capital of Saudi Arabia, situated
on the western coast of Saudi Arabia by the Red Sea. The
city has a population of over 2.9 million people that represents
14% of the total population in Saudi Arabia [10]. There are
two main types of health facilities at this city. They are called
public and private health facilities. The former covers health
centers and hospitals owned by the Ministry of Health. There
are 72 health centers and seven hospitals at Jeddah. They are
provided by the Ministry of Health and by other governmen-
tal authorities including the Ministry Interior and the National
Guard [11]. The second main type of health facilities in Jed-
dah is referred to the private health organizations. They pro-
vide 29 hospitals with a total capacity of 2836 beds and also
provide 151 clinics at different parts of the city [11]. Both pri-
vate and public health authorities are faced with different plan-
ning issues that can be handled with GIS techniques. These
issues include defining the spatial location of health demand
and identifying health access and service areas. In order to
discuss the potentials of using GIS with health care facility
planning in general and with hospital facility planning in partic-
ular, the presented study has selected one major private hospi-
tal and applies GIS on it. A number of factors were considered
in selecting this hospital. These include accessibility to health
demand data and the types of health services that are avail-
able at this hospital. In addition, all the planning issues that are
dealt with at this hospital are relevant to the remaining hospi-
tals of Jeddah city. This hospital has a capacity of 300 beds and
120 doctors working at different departments including family
medicine, gynecology and pediatric department. It is located
at the north of the city but expected to serve most parts of
city districts.
2.2. Research issues and analysis techniques
GIS has several techniques and functions that can be used
for health service planning. Each one of these functions can
be applied on different health related issues. For example, the
issue of health accessibility can be modeled in GIS using simple
functions such as buffer function or using spatial analytical
functions such as spatial interaction technique. This study has
selected three major hospital planning issues and uses GIS for
analyzing these issues. The first issue is related to defining
health demand location. GIS has different tools that can be
used for defining any location on the map. One of these tools is
called on-screen digitizing which is used by the presented study
to capture and define health demand location at Jeddah city.
ArcGIS software is used by the presented study to define all
hospital demands location. These data are collected on city dis-
tricts level. Therefore, GIS coverage is digitized at the Arcmap
application, which is one of the main ArcGIS applications, us-
ing polygon-drawing tools that are located at the editor menu.
After creating the required city district polygons, the follow-
ing step was to enter the collected attributes about hospital de-
mand. These include number of patients, age–sex and hospital
utilization types (emergency clinics patients, specialized and
general clinics patients and admitted patients). All of these data
are linked to the demand coverage and used for the second is-
sue of this application which is related to the classification of
health demand.
The third main issue of the presented application is related to
defining hospital service area. This issue is covered using two
main GIS techniques which are network analysis and overlay
analysis. Network analysis is one of the ArcGIS modules that
facilitates the modeling of spatial networks and can be used to
determine the efficient paths and travel sequences. This module
is used in the presented study for determining and calculating
drive time to hospitals at Jeddah city. In general, a network is
a system of interconnected linear features through which re-
sources are transported or communication is achieved. The net-
work data model is an abstract representation of the components
and characteristics of real world network systems [12]. The
key to produce successful network models is in understanding
the relationship between the characteristics of physical network
systems and the representation of those characteristics by the
elements of the network model [12]. Each network coverage
is formed with several elements such as links, nods, stops and
turns. These elements are used together to perform the required
GIS functions. Therefore, before using any of network analy-
sis functions it is necessary that all users should understand the
process of these elements and make sure that the parameters of
these elements are satisfied. One of the important elements that
need to be covered before calculating network travel time is
called the link impedance. It refers to the cost associated with
traversing an entire network link. The presented study has cal-
culated travel time for each arc based on the average driving
speed along each arc and based on the arc length. The resulted
cost is saved as an arc attribute and used during the process of
creating drive-time service area of the selected hospital.
The second main GIS analytical technique that is used within
the hospital service area issue is called overlay analysis. This
technique is used at different studies and for many purposes
[13–15]. Overlay analysis manipulated spatial data organized
in different layers to create combined spatial features accord-
ing to logical condition specified in Boolean Algebra [16].
The logical conditions are specified with operands (data ele-
ments) and operators (relationships among data elements). The
most well used overall functions are called union, intersect and
identity. This study has used the intersect function to analyze
health demand which falls inside the created drive-time hos-
pital service area. This overlay function creates a new output
coverage that has only city districts that falls inside hospital
service area. There are several potential uses for overlay anal-
ysis functions. One of these uses is related to defining health
 A.A. Murad / Computers in Biology and Medicine 37 (2007) 879 – 889 881

demand of a selected service area and which is covered by the
presented study.
3. Results and discussion
3.1. Using GIS on hospitals at Jeddah
Health facilities in general and hospitals in particular are
faced with different challenges related to their locations, their
market service areas and their demand status. This part of the
paper presents a GIS application that is created for one pri-
vate hospital at Jeddah city. The application is designed to be
as a spatial decision support system for health demand of the
selected hospital. There are several studies that cover public
hospital demand including Murad [8] and Roovali and Kiivet
[2]. Using GIS in health care planning studies is well acknowl-
edged by the western European researchers and it is used for
various health care issues at the developed countries. However,
in Saudi Arabia this technology is still not very well explored
by health authorities and researchers. Therefore, the created
application provides a good example for explaining how to use
GIS by health planners and officers in Saudi Arabia and/or in
any other developing country. This application is considered as
a new GIS-based system that covers private hospital demand in
Jeddah city. The created application covers three main demand
related issues which are spatial distribution of health demand,
types and classes of health demand and accessibility of hospital
location.
3.2. Distribution of hospital demand
Almost every hospital has a database about its existing pa-
tient and saves such data in different Management Information
Systems (MIS). These systems are used for finding needed
information about patient number or recording file and for re-
viewing the medical history of every patient. One of the main

Al Mohammadia KAA Airport

Y
#
Express Road

Red Sea
N

W E

S City Center

Y
# Hospital Location

Road
Hospital Demand
0-6
7 - 19
20 - 45
46 - 87
88 - 150
80000 0 8000 Meters

Fig. 1. Distribution of hospital demand.

882 A.A. Murad / Computers in Biology and Medicine 37 (2007) 879 – 889

KAA Airport KAA Airport

Al Nuzha

#
#
Express Road
Express Road

Red Sea
City Center

City Center

# Hospital Location
# Hospital Location
hospitalized Patients Specialized clinic
0-1 N 0- 3
2-7 4-9
8 - 15 10 -21
16 - 24 22 - 33
25 - 33 34 - 53

0 20000 Meters

Fig. 2. Classification of hospitalized and specialized clinic patients.

limitations of MIS is related to the lack of their spatial pre- of using Spatial Information Systems (SIS) with their patients
sentation of these data. Health administrators are used to work data. This result is found at Jeddah city. Many health man-
with MIS but are still not very well aware about the importance agers who were interviewed during the stage of data collection
 A.A. Murad / Computers in Biology and Medicine 37 (2007) 879 – 889 883

KAA Airport
KAA Airport

Al Nuzha Al Nuzha

Y
#
Y
#
Express Road
Express Road

Red Sea
City Center

City Center

Y
# Hospital Location # Hospital Location
Y
Hospitalized Patients Emergency Clinic
0-1 0-3
2-7 4-9
8 - 15 10 - 15
16 - 24 16 - 23
25 - 33 24 - 68
100000 0 10000 20000 Meters

Fig. 3. Classification of hospitalized and emergency clinic patients.

did not realize the benefits of using GIS or SIS at their orga-
nizations. Accordingly, the presented study has created a GIS
application that can be used as a guide for identifying some
of the benefits that health planners will gain from using GIS
at their health organizations. One of the main issues related to
health demand is regarding defining its location within the city.
There are several methods that can be used in GIS for identify-
ing location of any feature. For example, a GIS function called
Geocoding can be used to create points features on a map from
a table having x, y coordinates of any addresses.
884 A.A. Murad / Computers in Biology and Medicine 37 (2007) 879 – 889

KAA Airport
KAA Airport

Al Nuzha

Al Nuzha
Y
#
Express Road
Y
#
Express Road

Red Sea
City Center

City Center

Y
# Hospital Location
N Y
# Hospital Location
Male Patients
Female Patients
0-4
0-2
5 - 11
3-8
12- 21
9 - 21
22 - 32
22 - 34
33 - 53
35 - 64

10000 0 10000 20000 Meters

Fig. 4. Classification of male and female patients.

On-screen digitizing is another GIS function that can be used
for data entry purposes. It uses different draw tools such as
point, line and polygon tools for identifying feature location.
The presented study has used this method (On-Screen digitiz-
ing) for the purpose of identifying hospital demand location.
Based on the collected data, hospital demand is aggregated
into city districts level. Therefore, GIS coverage is created for
showing location of every city district and then the attributes
data of health demand are entered as records in the coverage
table. After building the database of health demand, the next
step was to use GIS for identifying spatial distribution of pa-
tients. This step is achieved using the graduated color func-
tion that subdivides numerical data into a set of classes. There
are five main methods for classifying numerical data in GIS.
These are natural breaks classification, defined interval classifi-
cation, equal interval classification, quantile classification and
standard deviation classification [17]. Each one of these clas-
sification methods can be applied on health demand data for
 A.A. Murad / Computers in Biology and Medicine 37 (2007) 879 – 889 885

Y
#

Express Road

Red Sea
N

W E

S
City Center

Y
# Hospital Location
Served network

Served area

Road
8000 0 8000 Meters

Fig. 5. 15-min drive-time service area.

grouping and subdividing data purposes. The presented study
has used the natural breaks method that minimizes the vari-
ance within class and maximizes the variance between classes
[18]. Fig. 1 shows the resulted patient distribution of the se-
lected hospital. One of the main results of this distribution is
that hospital demand comes mainly from the northern city dis-
tricts (which are close to hospital location) and there is very
little demand for this hospital coming from the southern city
districts. Accordingly, it can be said that this hospital is not
performing well at the central and southern city districts. There
are two possible reasons for this low performance result. One is
related to proximity to the hospital location and the other is re-
lated to the income of these low performance areas. This paper
will cover the former in more detail in the following parts of
this study.
3.3. Types of hospital demand
One of the important tasks for any health service planning is
related to having a clear idea about the classification or types
of health demand. This is useful for health planners for the
purpose relating demand types with health supply. For exam-
ple, if the main type of health demand is about pediatric or
diabetic clinics, then the needed supply of these clinics should
match that demand. The presented study has created two types
of hospital demand classification based on health service uti-
lization and based on demand gender. The first type of hospital
demand classification divides patients into three main hospital
utilization groups. These are called general/specialized clinics
patients, emergency clinic patients and hospitalized patients.
Each one of these groups shows a particular type of health
886 A.A. Murad / Computers in Biology and Medicine 37 (2007) 879 – 889

Al Mohammadia

Y
#

Express Road

Red Sea
N

W E

S
City Center

Y
# Hospital Location
Health demand
13
14 - 47
48 - 71
72 - 92
93 - 154
Road

8000 0 8000 Meters

Fig. 6. Distribution of served health demand.

demand. For example, the general and specialized clinic pa-
tient group is related to those patients that use this hospital for
specific health treatment. Meanwhile, the hospitalized patient
group is referred to patients who were admitted for health care
treatment in the same hospital. One of the benefits of using GIS
with health data is related to its ability of showing more than
one attribute data in one view. This tool is known as multiple
data classification method that lets the user to use two renders at
once on a feature layer [18]. It is also called the bi-unique value
render in the ArcInfo object model [18]. Figs. 2 and 3 show
multiple data views for hospital demand and divide such de-
mand based on the predefined hospital utilization groups. One
of the main usages of this output is to define the relationships
between these utilization types, for example, finding areas such
as Alnuzha or Almohammadia located north of the city that have
high-hospitalized patients and also have the same high figures
about general specialized and emergency clinics. Health status
of residents can be measured using different health indices such
as mortality and fertility rates. Because of difficulties in hav-
ing these rates at a micro-scale in Jeddah city, this study has
used the data about hospitalized patients as an index for health
status in Jeddah. Ideally hospitalized rates for any area should
be based on all hospitals located within the city. However, due
to difficulties in having this data for all hospitals (public and
private) in Jeddah the collected data of the selected hospital are
used as an example for defining hospitalization rates in Jeddah
 A.A. Murad / Computers in Biology and Medicine 37 (2007) 879 – 889 887

Al Mohammadia

Y
#

Express Road

Red Sea
N

W E

S
City Center

Y# Hospital Location
% of Market Penetration
0
0-1
1-2
2-4
4-5
Road
8000 0 8000 Meters

Fig. 7. Market penetration of private hospital.

city. Areas with high-hospitalized patients such as Almoham-
madia district should be studied further by health planners to
find out if there are any physical or environmental factors that
produce such high-hospitalized patients.
The second type of hospital demand classification is pro-
duced based on patient gender. Data about male and female
patients were collected and aggregated into city districts level.
Defining health demand gender is one of the important and use-
ful data for health planners. These data can be used by health
planners to identify the required health services for male and
for female patients. For example, Birkin et al. [13] have dis-
cussed a GIS application that uses patients’ ages and sex for
North Humberside at the UK. Fig. 4 presents an output of
multiple data classification for male and female patients in Jed-
dah city. It shows that female patients originated mainly from
the western city districts; meanwhile, male patients are dis-
tributed at different districts with different amounts. This means
that areas that are located close to the hospital location have
more female than male patients. Therefore, health services for
female patients should be provided in this hospital with more
staff and facilities than male health services.
3.4. Hospital service area
There are several methods that can be used for defining health
service area. These methods are used by several health studies.
888 A.A. Murad / Computers in Biology and Medicine 37 (2007) 879 – 889
For example, Roovali and Kilvet [2] have used travel time
method for defining geographical variation in hospital use in
Estonia. Jordan et al. [1] presented another interesting study for
defining health service area in Southwest England using travel
time and straight-line techniques. All of these studies have con-
cluded that distance to health location is the main factor for
identifying health service area. In order to create service area
for the selected hospital, travel time is calculated for all Jeddah
roads and used for producing a 15-min drive-time area. ArcGIS
software is used to select all parts of the city that fall within
the 15-min service area of the selected hospital. The resulted
districts form the main demand parts for the selected hospi-
tal and should be studied and monitored by hospital planners
for the purpose of hospital marketing and utilization. Fig. 5
presents the resulted health service area and its shows that dis-
tricts like Alzahra and Alnahda are the main demand zones
for this hospital. There are several potential uses for the re-
sulted service area. One of these uses is related to calculating
the total amount of health demand. Overlay analysis functions
of GIS software can be applied on any predefined health ser-
vice area to find out the amount of population that lives inside
the resulted service area. In order to use these functions, two
main GIS coverages should be created which are called the in-
put coverage and the overlay coverage. The former shows the
boundaries of census data and the latter represents the area of
interest e.g. service area. Using these functions, portions of
the input coverage that fall inside the overlay coverage will be
saved as new output coverage. All of GIS overlay functions
merge spatial features on separate data layer to create new fea-
tures from the original coverage. The main difference among
these operations is in the way spatial features are selected for
processing [18].
Fig. 6 shows the output of GIS overlay analysis function us-
age with the resulted directive service area. Two main cover-
ages were used to produce this output which are: (1) hospital
demand that shows all hospital patients within Jeddah city and
(2) the 15-min drive-time service area.
These two coverages are overlaid using Intersect function to
produce a third coverage that has patient data for city districts
that fall within the defined hospital service area. It is found that
there are 580 patients who use the selected hospital and live
15 min away from the hospital. These patients represent 60%
of all hospital demand. This indicates that most of health de-
mand to the selected hospital come from the nearest residential
areas around the hospital location. Therefore, the results of the
present study reconfirm that distance to health service is the
main factor for defining and evaluating health accessibility.
One of the other possible usages of the resulted travel time
service area is related to evaluating the share of hospital demand
and the market values of hospital. This is called the market
penetration of health services. The presented study has defined
market penetration rates for the selected hospital by dividing
existing size of patients over number of households living inside
hospital service area and multiplying the result by 100 to get
the needed penetration index. Fig. 7 presents the distribution of
hospital market value that indicates that there is some districts
located inside hospital service area but are not producing high
demand. These are mainly Alsalmah, Albawadi and Alrawdah
districts. Hospital planners and officers should find out why
these close city districts are not producing the desired health
demand to the selected hospital. This can be achieved by a
further marketing study that should study these areas and test
the residents’ views about the selected hospital.
4. Conclusions
This paper discusses a GIS application for hospital facility
planning in Jeddah city. The application covers three main hos-
pital issues that are location of health demand, types of patients
and the extent of hospital service area. Each one of these is-
sues has a direct spatial dimension. Therefore, the use of GIS
for analyzing and manipulating them was of greater value and
benefit. For example, GIS is used to define all hospital de-
mand location and produces an output showing city districts
that are producing remarkable demand to the selected hospital.
This output can be used by health planners to define the real
catchment of health facilities. Classification of health demand
is another important issue covered by the presented application.
Patients are classified based on their usages for the selected
hospital and the results of this classification show city districts
such as Alzahra that have high hospitalization rates. The third
main issue that was covered by the presented application is re-
lated to defining hospital service area. GIS is used to produce
a 15-min drive-time service area for the selected hospital. This
output is used further to define the amount of patients living
inside hospital service area and to test the market share of the
selected hospital.
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Abdulkader A Murad is Associate Professor and Chairman of the De-
partment of Urban and Regional Planning at the Faculty of Environmental
Design, King Abdulaziz University, Jeddah, Saudi Arabia. He also works as a
889
consultant at the High Commission for Development of Makkah Region, Saudi
Arabia. He received his Ph.D. from University of Newcastle Upon Tyne, UK,
in 1998. He started his GIS specialization in 1998 as an Assistant Professor,
and then become an Associate Professor in 2005. He has published several
GIS papers at different international journals. Recently, he has presented
several GIS papers at the Medical University of Varna, Bulgaria, and also
presented a GIS paper at the University of Hong Kong at the GRAFEPHS
2006. His biography is selected by the Publications Board of the Marquis
Who’s Who in the World for the twenty third edition 2006, and for the twenty
fourth edition 2007.