In many rural areas of India where the ratio of physicians to people is low and accessibility to proper health facilities is poor, non-physician Rural Healthcare Providers (RHPs) are the major providers of healthcare to millions. Most RHPs have a high school education, but very basic levels of health training; thus the quality of care they provide may be technically deficient.
RHPs’ quality of care can be enhanced and standardized through the use of disease management guidelines appropriate to their service level.These guidelines offer special relevance in low resource settings where diagnosis cannot be confirmed through laboratory investigations. These guidelines can help improve disease recognition, initial treatment, management, and referral. The format and platform upon which these guidelines appear can determine how well they are understood and used. RHPs often do not follow standardized guidelines of care when given in paper-based form.The use of multiple modalities (voice, text, pictures, video) to impart information has been shown to enhance understanding.
First Care has successfully delivered distance-learning modules to improve the knowledge levels of 21 RHPs in southern Tamil Nadu. However low bandwidth in rural areas makes it cumbersome for RHPs to rapidly retrieve selected portions of the learning modules and deploy that knowledge in their patient interactions. The penetration of mobile phones is pervasive in these rural areas. Solutions delivered on mobile platforms will be a significant value addition to First Care’s ongoing capacity-building strategies. Decision support algorithms and protocols are available (on computers) for professionally trained doctors; however, there is little evidence of the availability of any such tools to non-physician RHPs, who are the first point of contact for health care in rural areas.
This project seeks to develop interactive and structured clinical guidelines for RHPs by adapting and field-testing a technology called ‘GuideView’. GuideView will provide an accessible and user-friendly job aid that will promote best practice and improve performance through reduced errors of diagnosis and treatment. The goal of this application is to increase appropriate referrals and guideline while reducing inappropriate drug use. Another major innovative feature of GuideView is the use of structured rich media that integrates pictures with voice in a meaningful way. A randomized controlled study design will test the clinical guidelines and measure RHPs’ error rates, compliance, accessibility, and health outcomes.
GuideView is designed to provide multi-modal “how-to” advice and instruction for performing simple procedures. It has been tested for use on multiple Windows-based platforms, including Windows cell phones and Personal Digital Assistants.As the J2ME (Java-based) cell phone has become a ubiquitous communications device, even in low-income areas in India and Africa, we propose to develop and field test a GuideView version for Java-enabled mobile phones. This is in addition to a conventional version for Windows PCs, which will use mobile platforms to run the clinical guidance tool.
The immediate beneficiaries of this initiative will be the 21 RHPs linked with First Care and their patients, numbering around 15-20 daily.This can be extended to a total patient load of around 100,000-140,000 per annum.
As a tool, GuideView has been designed to help improve medical care to under-served and needy communities typically located in urban slums or rural villages. Here, reliable electricity and high-bandwidth communications are rarely available. Well-trained physicians and nurses are scarce; community health workers and other non-physician care providers have, at best, very basic training in clinical diagnosis and treatment. The current project accommodates clinic-based RHPs, but this application will create mobile RHPs in other regions who are able to travel to multiple villages every day. Our clinical guidelines will directly impact the quality of care for underprivileged and underserved rural populations.
For these marginalized communities, GuideView can support health services in multiple ways. Encoded referral decisions can assist RHPs to perform accurate triage, correctly referring complex cases to physicians and clinics. Mobile communications will allow the RHP to liaise with remote clinicians via image, audio, and data transfer using GuideView. The remote experts can then assist the RHP in real time.
GCDWS is a national NGO that seeks to improve the health status of rural and indigenous populations and strengthen the capacity of frontline health workers. These goals are achieved through research, training, and service delivery programs. Dr Rajesh Singh, founder of the Christian Hospital of Chamba, established GCDWS in 1993 as a natural corollary to the Hospital. GCDWS exists to provide and promote accessible, preventative health care for poor and needy people residing in remote areas.
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