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CMW Assisted Mobile based Primary Health Care System for Rural Pakistan.

Connecting female doctors to marginalized women in rural Pakistan to provide affordable health care via CMW Assisted mobile consultation

Photo of Iffat Zafar
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Telemedicine, in one form or another, has been practiced for over thirty years. At the simplest level, a nurse providing clinical advice over the telephone is telemedicine. Today, however, we think of telemedicine applications that employ advanced image as well as audio capabilities. These technologies can range from high resolution still images (e.g., x-rays) to sophisticated interactive teleconferencing systems. Telemedicine now has the potential to make a difference in the lives of many Pakistanis. Telemedicine can improve the delivery of health care in Pakistan by bringing a wider range of services such as radiology, mental health services and dermatology to communities and individuals in underserved urban and rural areas. In remote rural areas, where the distance between a patient and a health professional can be hundreds of miles, telemedicine can provide for a viable method of consultation. In emergency cases, this access can mean the difference between life and death. In particular, in those cases where fast medical response time and specialty care are needed, telemedicine availability can be critical. In addition, telemedicine can also help attract and retain health professionals in rural areas by providing ongoing training and collaboration with other health professionals.

Pakistan, a population of 182 million and one of the fastest economies of the world still struggles to provide basic healthcare to 51% of it total population. 40 million people live below the poverty line out of which 30 million Pakistanis lives in rural areas, and almost 40% of the population lives in poverty. Almost 30 % of of the populations lacks access to every primary health care facilities and falls in the hands of untrained Traditional birthing attendants, faith healers commonly known as “Hakeems” in the low income segments leading to a maternal mortality index of 149, 3rd highest ranking in infant mortality indicators, 44 % of stunted growth in children and 9.6 million facing acute nutritional deprivation.

Ironically this happens in a country that has one of the best doctors in the world. However, is the current health care work force enough to cater to needs of 182 million people?? Sadly NO. There are only 160,000 doctors in Pakistan today with the need of doctors in the country being of nearly 600,000. Interestingly nearly 50% (78,037) of this entire force consists of female doctors. Even of the current registered female doctors, stats show that 50 % never reenter the medical force after their medical degree and basic registration. While majority of male doctors leaving the country due to a massive brain drain, 17000 doctors migrating to the US alone, female doctors not working especially in low income presents a huge health gap in the ecosystem that needs to be fixed urgently.

At CIH we aim to connect home-based female physicians (who otherwise would be excluded from the workforce) to undeserved populations in need of quality, affordable health care. Through real time HD video conferencing, home-based, female doctors are connected to patients in undeserved rural areas and urban slums via trusted intermediaries such as community-based nurses, midwives and health promoters who are equipped with tablets and laptops. Our m-health delivery system consists of the following: (i) a high-definition (HD) video-conferencing platform, (ii) Electronic Medical Records (EMR), (iii) an online pharmacy inventory management system, (iv) online patient navigation system including tertiary care referrals and (iv) clinical application of peripheral point-of-care (PoC) diagnostic tools such as Blood pressure sensors, e-oximeter, etc which are easily connectable to tablets/mobiles. Nurses, Community Health Workers (CHWs) and Community Midwives (CMWs) are trained to assist these home-based doctors in the physical assessment of patients using remote, diagnostic, cloud-based extensions attached to our M-Health system. At CIH we aim to empower the entire value-chain of female healthcare providers (midwives, nurses,doctors, etc) to leverage ICT and deliver leading edge healthcare in environments where it was unheard of in the past. We aim to: (i)decrease MNCH mortality by 20 % in our targeted population within 5 years,(ii)increase employment opportunities for female healthcare practitioners [doctors, nurses and health promoters] by 60 % within 3 years, (iii)increase childhood immunization in target communities to >95% and(iv)increase capacity building of female health professionals by providing them access to online Continuing Professional Education (CPE) including peer-to-peer learning, virtual rounds, webinars, mentorship & networking opportunities.

Our idea can be easily applicable to other places in the world as both rural and urban slum populations in emerging markets across Asia, Latin America and SubSaharan Africa are rapidly gaining access to broadband internet which significantly increases the practical applicability and scalability of m-Health delivery models. Health systems across the developing world face similar challenges including a chronic shortage of skilled healthcare workers, poor treatment adherence and patient compliance, lack of timely and actionable disease surveillance, poor drug inventory and supply chain management, rampant use of counterfeit drugs and inadequate focus on diagnostic screening, prevention and early intervention. At any given time, as much as 10% of the health workforce is (voluntarily) not participating in healthcare delivery in both emerging and mature markets due to family obligations such as parenting and senior care. A massive opportunity exists for this ‘excluded’ population to be remotely reintegrated into healthcare delivery systems, leveraging technology.

The seed funding  from Sandoz will be utilized for the field-based validation of the nurse assisted m-health delivery model in 2 urban slum settings in Karachi (1 in Model Colony, 1 in Lyari; combined population: 1.5 Million people) as a technology-enabled approach to increase access to quality health care. The €20K funding will enable us to technologically upgrade existing community-based clinics (operated by partners such as DKT International) by installing m-health systems including remote diagnostic equipment along with additional capacity-building of nurses to connect patients from these communities to our network of home-based providers. The funding will utilized to increase accessibility to quality medical supplies and medications as well as will disseminate health education and promotional activities in the targeted communities.

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Photo of John Ervin
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I think the ides can be scalable if you can develop a training program for your para-professionals such as medical assistants to coordinate the point of care clinical review and assessment. A great example is how the U.S. military uses medics to provide treatment at their troop medical clinics. A lot of the basic care is coordinated by the Army medics. As a medic in the Army, you training is complete in 16 weeks. This training time was extended in the early 2000's to provide more advanced medics in the battlefield environment.

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