Tag: Healthcare

Can ICTs Improve the Indian Rural Health System?

india-nurse

Despite real progress since 1990, India has not achieved universal health coverage yet.

For instance, the country still has the highest infant death rate in the world. In 2013, 1.3 million children under the age of five died. For many, this was due to preventable causes like birth complications, pneumonia or diarrhea. Tragically, the majority of fatalities occurred in poor rural households.

A shortage of skilled medical staff in rural India

In India, most of the medical facilities are in the cities, where only 27 percent of the population lives. Approximately 716 million people are currently living in rural areas and they only have access to deplorable health centers. Most of the time, they have to travel a long way to get there. When they arrive, nothing assures them that they will find a practitioner to treat them. Rural India is indeed facing a 64 percent shortage of health professionals.

Aware of the situation, successive Indian governments have been working on this issue. In particular, they have hired women as health workers in remote villages. Today, they are the backbone of the public health system in the countryside. However, most of them are semi-literate and have an insufficient basic training.

A lofty young couple to tackle the Indian rural healthcare issue

They took the leap in 2013 and their dream seemed impossible to achieve. After all, Abhinav and Shrutika Girdhar had no healthcare experience. All they had were years of frustration with the rural medical system.

Shrukita grew up in Mumbai, but her grandparents live in a village of 2,000 people. Whenever they get sick, they have no choice but consult the local health workers. They are only two and they have poor medical skills. Often they cannot cure treatable problems, and often times, this leads to the patient’s death.

Such a situation worried Shrukita, so she opened up to her husband. As the son of two doctors and an entrepreneur at heart, Abhinav was willing to take action. Together they agreed they would focus on improving the training of health workers.

That’s how they left their well-paid jobs and started Bodhi Health Education.

An accessible, personalized training program for health workers

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In India, road conditions are usually poor, so it was unrealistic to organize the training sessions in the villages. On the other hand, mobile coverage is good and there are over 900 million cell phone users. Plus, Shrukita being an IT engineer, they opted for an e-learning solution that could easily be delivered through Android-based devices.

That way, they would tackle the challenge of training uneducated people. Most health workers have limited formal education and it is hard for them to learn medical topics. That’s why the Girdhars and their team of medical specialists developed an adapted curriculum. They made sure to explain every concept and procedures using pictures and videos. Additionally, they deliver the lessons in Hindi and India’s regional languages. That way, the learning is simple, interactive, and engaging.

Furthermore, the Bodhi curriculum relies on a personalized educational approach. After a lesson, the learner has to answer practical questions; after a module, she must then take a quiz exam. The results are sent to the trainers who can assess the learning process. It allows them to tailor the program to the health worker’s pace and progress.

Reluctant medical authorities

At first, Shrutika and Abhinav had to overcome resistance to e-learning. The medical authorities were doubtful about using technology to train community health workers. Despite this rebuff, the young entrepreneurs persisted. In less than two years, they developed 100 training modules. The Bodhi curriculum now covers topics like maternal and child care, immunization as well as tuberculosis.

Besides, the Girdhars introduced their program to health workers, who all showed great interest. They found it easy to use and were happy for the opportunity to increase their skills and knowledge. They knew it could help them better treat people, but also earn more money.

In view of these results, the Indian medical authorities agreed to give it a try. Bodhi Health Education could develop partnerships with the government, private hospitals and healthcare companies. These organizations provided tablets, computers and smartphones to upload the Bodhi curriculum. Over 1,000 community health workers could at last access the training.

Towards a better healthcare for the ‘bottom of the pyramid’?

For Shrutika and Abhinav, this is only the beginning. In the next five years, they aim to train more than 60,000 rural health workers. They also want to go international and promote their solution in Asia and Africa.

And of course, they will focus on the regions with the worst health indicators to achieve a major impact!

Improving Healthcare Coverage in the Philippines with ACCESS Health International

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ACCESS Health International is a nonprofit think tank and advisory group with health programs in both low and high-income countries. It recently developed the e-AKaP project for targeting high maternal and child mortality rates in the Philippines, and addresses the health issues through a new delivery and training system for community health teams (CHTs).

Health goals in the Philippines

The Philippines has struggled to attain the decreased maternal and child mortality rates outlined by its Millennium Development Goals. The government’s solution has been to use CHTs as the main tool for expanding healthcare coverage for Filipino citizens. Over 100,000 CHTs, comprised of midwives, nurses, and volunteers, have been deployed to develop individual household health goals in each community and to target poor and vulnerable populations.

However, CHTs have faced setbacks because of the slow process of aggregating data, high cost of forms and materials, and an inefficient reporting system. Similarly, mothers in the Philippines do not have high access to healthcare information, which could mitigate health risks for both mothers and children.

The e-AKap solution

e-AKaP targets two root causes of MMR and children mortality in the Philippines:

  1. low training and skills for CHTs
  2. low access to healthcare information for mothers

ACCESS Health International’s solution draws on both innovation and technology. The e-AKaP project provides and trains CHTs to use mobile tablets to access the Filipino web and the application iCHT. iCHT provides access to forms and aggregates and processes health data, cutting down on time-consuming paperwork and providing quick access to information for CHTs.

The tablets provided to the CHTs are 7-inch tablet PCs with cloud-based admin panels so that health information could be easily accessed. The forms in the iCHT app are a replica of paper forms previously used by CHTs, so users are accustomed to the format.

iCHT also allows the user to create profiles, health plans, and progress charts for individual households. CHTs can track health progress and provide health information quickly for the households they visit. They can also address health issues for mothers and children on the spot.

The app also allows CHTs to report health information quickly to city and government health offices in the Philippines, which then use the information to track progress towards countrywide health goals.

e-AKaP outcomes

So far, 130 CHTs have been trained and provided with tablets, and ACCESS Health International has presented the app at the Philippine mHealth Forum in April 2014. Because each individual CHT is responsible for about 50 families, ACCESS estimates that its project covers around 5,000 families in the Philippines. A study by the University of the Philippines Economic Foundation found that the iCHT app reduced spending costs associated with paper forms and also reduced time spent on related activities.

The project has been successful at providing CHTs with the tools to balance their heavy obligations and providing mothers and children with quick and reliable health information. Each family covered by the e-AKaP project now has a specific health plan to mitigate and prevent health risks. CHTs are given the means to target health goals and track their progress through this innovative technology.

Furthermore, e-AKaP provides the government with reliable information to target health goals and create policy that reflects the current situation in the country.

Grace Harter is a recent SAIS graduate

Amader Daktar: Improving Rural Health Care via Telemedicine

mHealth-telemedicine

There is one doctor per 5,000 people in Bangladesh, but doctors are not evenly distributed within the population, which means that for the majority of rural Bangladeshi, doctors are a rarity. So how can rural people have access to quality medical care?

Doctor in a Tab

Enter mPower Social Enterprises and their Amader Daktar “doctor in a tab” solution that aims to improve rural health care and reduce the number of people whose illnesses are aggravated by a lack of, or delay in, proper diagnosis and treatment. The service currently has 200 locations in Bangladesh and has served over 1,200 clients to date.

Amader Daktar is a tablet PCs and a custom-made app that allows rural healthcare practitioners to act as a telemedicine assistant. The tablet allows an rural medical professional to register patients and pass on vital medical information over mobile internet, which can then be viewed on a web portal by a remote doctor.

The doctor can then initiate a video call to talk to the frontline healthcare worker and the patient sitting in any village bazaar (with access to mobile internet). In the best case scenario, the doctor can then create and send a prescription over the internet to the healthcare worker who can then print it out at his end and hand it over to the patient.

In cases where remote consultations are insufficient, the doctor can advise the patient on the next course of action and recommend nearby facilities that can provide the necessary services.

Expansion into Myanmar

mPower Social Enterprises recently won the $10,000 USAID Mobiles for Development Award and will  expand its Amader Daktar service into Myanmar in partnership with mobile network operator, Telenor, in order to reach rural populations where health care services are difficult to access.

DoctHERS-in-the-House: Improving health care for low-income women in Pakistan

Dr Sara Khurram is a young doctor from Karachi. In 2012, she got pregnant, and this led her to quit her residency and stop her medical career.

Sara’s story is common among Pakistani female doctors. While 80 percent of medical school graduates are women, only 25 percent ever practice medicine. Pakistan being a conservative country, many have to stop working once they get married or start having babies. That’s how an estimated 9,000 trained female physicians end up staying at home.

Pakistan’s medical crisis

This home restriction phenomenon puts an additional pressure on Pakistan’s collapsing medical system. With only 0.74 doctors for 1,000 people, active physicians are overwhelmed, and of course, this has a negative impact on the population’s well-being.

Pakistan is still struggling with poliomyelitis as well as with a high rate of stillbirth and tuberculosis cases. Moreover, the examples of malpractice and medical negligence are numerous. In Lahore, for instance, a toddler with a small burn on her hand passed away after a doctor injected her with too much anesthesia. A teenager had his appendix removed when in fact he was suffering from colon cancer. And every day, newborns with jaundice symptoms are misdiagnosed, making them either deaf or brain-damaged.

The main victims of this predicament are the 56 million Pakistani who earn less than three dollars per day. Whenever they get sick, they are left with three choices: get no treatment, go to an insalubrious public hospital, or visit the often unskilled local doctor. For pregnant women living in poverty, the situation is even more dramatic, as many refuse to be examined by a male doctor. Therefore, 95 percent cannot access quality health care; and in the countryside, 1 in 5 mothers dies every day, because she delivers at home, in an unsafe environment.

Bridging the gap between female doctors and female patients

While expecting her baby, Dr Sara Khurram had to spend most of her time on bed rest, and she was doing a lot of thinking. In particular, she thought about her own situation and the current medical crisis.

One day, she came up with a clever idea to circumvent Pakistan’s main socio-cultural barriers: she would open a telemedicine clinic! Thus, female physicians could stay at home, and yet, provide poor women with primary and OB/GYN cares. To lower the risk of misdiagnosis and enhance the human interaction, the young woman decided to rely on Lady Health Workers.

In Pakistan, there are about 90,000 of these community-based women, and they play a key role in preventive health care. Dr Khurram, therefore, thought she could hire some of them and train them further to assist the physicians.During an ante-natal visit, for instance, the nurse would conduct the patient’s examination, and since the entire consultation would be video-conferenced, the doctor would not only supervise her assistant. She would also see in real time what appears on the monitor, and thus, give accurate medical counsel.

At the time, considering opening a virtual clinic was a bold idea. For sure, telemedicine had been spreading across the world for a while. But it was far from having reached Pakistan, and it is well known that many people in the country are wary of ICTs. On the other hand, mobile penetration was already high (85 percent), and Dr Khurram believed mobile and video consultations were workable in most regions.

“On the seventh day, one patient came in”

It did not take long for the young woman to take the leap and give her ‘DoctHERS-in-the-House’ project a try. To test its feasibility and sustainability, she decided to start a pilot in Naya Jeevan‘s health center of Sultanabad, a conservative slum of 250,000 people in Karachi.

In May 2013, everything was ready, and Dr Khurram could open her virtual clinic, the first telemedicine facility in Pakistan. “For six days, she said, not even one patient came in; […] but on the seventh day, one patient came in.” Since then, the clinic has always been full, encouraging the young woman to hire more doctors and replicate her model throughout Pakistan.

It has turned out that video-conferencing is not an obstacle for the female patients. In fact, since DoctHERS-in-the-House started, women have been thrilled by this new type of consultation. For sure, they are happy to pay 50 percent less than they would do for an in-person visit. But what satisfies them the most is the good quality of the care they receive. In Sultanabad only, DoctHERS-in-the-House have provided 500 women with ante- and post-natal care. For 14 percent, they anticipated medical complications and sent their patients to a hospital, where they could get a safe delivery.

And this has certainly saved a few lives!