Tag: mHealth

Jaroka is Expanding Healthcare Access in Pakistan with ICT

healthmap

For a nation whose healthcare system is chronically underfunded, Pakistan is all too familiar with disaster. In 2005, a magnitude 7.6 earthquake ravaged the country, killing over 79,000 people. In 2010, heavy monsoon rains triggered massive flooding which destroyed almost 2 million homes, yet Pakistan’s health expenditure that year was just 1% of its GDP. There simply aren’t enough medical personnel in Pakistan to meet demand during times of peace, let alone emergency situations. There are some estimates that up 70% of Pakistanis don’t see a doctor in their entire lifetime.

Jaroka Tele-healthcare

The UM Healthcare Trust, a hospital facility located in rural Mardan, has developed an mHealth system intended to connect rural Pakistanis with the both the daily and disaster healthcare that they need. The system, called Jaroka Tele-healthcare, was developed in tandem with Stanford University. Jaroka directly connects healthcare providers at the Mardan facility to specialists in Pakistan’s urban centers, as well as the United States. This connection allows for specialist review of complex cases without forcing the patient to travel.

Jaroka incorporates an Electronic Medical Record (EMR) into the UM Healthcare Trust system. The EMR allows all medical information, including all records, vital signs, prescriptions, and lab reports to be stored and managed online. These records can be readily accessed when consulting a specialist, or by a healthcare worker in the field.

Lady Health Workers

While there are very few trained doctors and nurses in Pakistan, there are over 110,000 Lady Health Workers (LHWs). LHWs are trained to provide preventative and curative health services to their neighbors, while using their peer status to navigate local customs and languages effectively. Utilizing Jaroka’s SMS enabled features, the LHWs can add new patients to the system, update disease records, search for patients via unique ID’s, retrieve patient history, and access a dictionary of terms. Prior to Jaroka, these capabilities were restricted to the hospital.

Quality care provided by LHWs reduces one of the largest barriers in the Pakistani healthcare system: cost. There is no national health insurance in Pakistan, and 78% of the population pay for their own medical expenses. With over half of Pakistan’s population living under the poverty line, low cost (or free) care provided by LHWs is the only option available. The tools Jaroka provides, used in combination with LHWs peer status, allow them to be efficient intermediaries between the community and the traditional healthcare system.

These intermediaries are even more critical during times of disaster, when the disconnect between hospitals and rural Pakistanis is magnified. One of Jaroka’s key features is a GIS mapping system which allows doctors to track the spread and incidence of diseases in real time. The disease data is received from LHWs in the field who send SMS updates for patients into the Jaroka Electronic Medical Record. From there it is uploaded into a Google Map, allowing real-time tracking. In a disaster scenario, this tool allows doctors to direct resources to areas with the most critical demand.

The Future

The value of Jaroka’s regional disease monitoring capability carries directly over into daily healthcare practice. Pakistan is currently battling a Polio crisis, and ranks fifth in the world for Tuberculosis disease burden. Jaroka provides the UM Health System with the capability to monitor disease trends in the Mardan region, and allocate resources to prevent outbreaks from turning into epidemics.

While Jaroka is currently only deployed in Pakistan’s rural Mardan region, the UM Healthcare Trust is working with the National Rural Development Program to extend mHealth platform throughout the Punjab province. To date, over 200,000 people have received care through Jaroka and the UM Healthcare Trust system.

The UM Healthcare Trust publishes their regional disease trends monthly via Twitter (@Jaroka).

Improving Adolescent Sexual Health in Nepal with m4ASRH

m4ASRH

Child marriage rates in South Asia are the second highest in the world. Despite stiff penalties for marrying under the age of 18, including up to 3 years in prison, this trend holds true for Nepal. A recent survey performed by Nepal’s Ministry of Health and Population showed that 41% of Nepalese women aged 20-24 were married before turning 18. The health impact of childhood marriage is significant. According the World Health Organization, pregnancy and childbirth complications are the second leading cause of death among 15-19 year olds globally.

Additionally, an estimated 26% – 38% of recent births in Nepal are from unintended pregnancies. In this region, women whose pregnancies are unintended are more likely to receive reduced pre and post natal care, resulting in negative health outcomes for both mother and child.

Taboos associated with sex and sexuality remain commonplace across Nepal. According to the Family Planning Association of Nepal, this results in a lack of subject specific teachers to teach sexual health in schools. If educational materials are present, they are often far out of date or in disrepair. Despite the lack of education, Nepalese adolescent pre-marital sex is increasing, creating a population vulnerable to HIV infection.

The Mobile Solution

The Nepali Health Ministry has taken a new approach to providing young people with sexual health and family planning education, launching an mHealth initiative called Mobile for Adolescent Sexual and Reproductive Health (m4ASRH).

The program, which got underway September 18, will reach out to at least 300,000 youth.

The m4ASRH initiative is performing four different types of outreach:

  1. On-Demand Information (Encyclopedia) – Adolescents will have access to an online encyclopedia, where they will be able to find the information and answers that they need, in a safe setting.
  2. Role Model Stories – Stories tailored specifically the adolescents’ age and gender which highlight the actions of role models will be sent. The recipient will have the capability to choose the path of the story and see different outcomes.
  3. Quizzes – To drive engagement and interaction, quizzes based on the content of the on-demand information and role model stories will be sent.
  4. Hotline – m4ASRH will provide adolescents with a hotline where they can talk directly to health care workers, allowing access to expert advice and guidance when needed.

There are several factors at play in Nepal that could help the m4ASRH initiative succeed. Despite being a mountainous country, Nepal boasts high mobile penetration. According to a September 2014 report from the Nepal Telecommunications Authority (available here), over 83% of Nepal’s population are mobile phone users.

Additionally, there is a rising tide of support from within Nepal for family planning awareness. The m4ASRH initiative was launched by Khaga Raj Adhikari, Minister for Health and Population, on Nepal’s first National Family Planning Day in Kathmandu.