Fondation Pierre Fabre

Bringing higher efficiency in public sector healthcare delivery, by re-purposing ICT solutions developed for the private

Main beneficiary country:
India

About the sponsor

World Health Partners

World Health Partners (WHP), established as a not-for-profit organization in 2008, delivers health and reproductive health services within walkable distance to underserved communities, particularly rural poor. It enhances the impact of already available resources, with the innovative use of frugal ICT and deep learning management systems so urgent needs can be addressed without depending on external support. WHP’s programs are currently implemented in India and Kenya and are poised for further expansion. WHP’s approach is to create the entire ecosystem needed for quality healthcare, by developing and deploying ICT tools at every level: patients get quality medical services from remotely connecting urban doctors and low-cost medicines from neighborhood pharmacies whose supplies are digitally managed; networked laboratories upload reports to electronic medical records in the cloud and e-referrals are facilitated by inter-connecting resources. Since the settings in which WHP operates usually have sub-par medical resources compounded with unique social, religious and financial factors, its ICT solutions are sensitized to these contexts to ensure efficient service delivery. WHP avoids vertical programming and follow horizontal approach that deliver a broad range of services and products to create volumes, necessary for reducing cost of delivery. ICT is the lynchpin of bringing various resources together to fashion a viable service delivery structure: rural entrepreneurs invest in WHP’s ICT solutions, specially developed for them, to become the local interface for the patients. City doctors use digital solutions that combine sophisticated algorithms and vital parameters to standardize care. The audio-visual links working in such straitened conditions compensate for the lack of physical proximity between the doctor and the patient. The ICT solutions also enable doctors located anywhere - public sector or private, home or clinic — to obtain vital parameters, such a blood pressure, pulse, temperature, stethoscope sounds of heart and lungs, blood counts, blood glucose levels, foetal sounds and cardiac signals. The ICT system has been stabilized and refined over 220,000 consultations. WHP invests its resources in skilling local entrepreneurs, many of women, and doctors to serve their communities and earn a higher income, both necessary for achieving sustainability. Within the broad range of services, the main focus is to ensure safe motherhood and child survival services. Ante-natal care, immunization and family planning services require follow-up with clients over long spans of time. ICT solutions with special features of automated alerts and computer-aided responses enable efficient implementation within limited resources.

In Kenya, since June 2015, WHP initially established a franchisee network of women entrepreneurs (Sky Centres) in Homa Bay County, who used the ICT platform to connect with city-based doctors to treat minor illnesses. The program transitioned to three nurse-based tele-linked medical centers (Maisha Clinics) for providing gynecological, reproductive and child health services that also required the ICT solutions to be repurposed. Nurses provide a range of services on their own, and use an ICT system to deal with cases beyond their medical capacity with help from city based doctors.

Sector: Organizational: Communities, public authorities, NGOs, associations, foundations, etc.

Country of origin: Kenya

The organisation has:

2
Full-Time Equivalents
6
Employees
2
Volunteers
2
Service providers

Initiative overview

Healthcare themes targeted

  • Mother and child health
  • Primary healthcare
  • Malaria/paludism
  • Infectious diseases
  • Sexual and reproductive health
  • HIV/AIDS

Stage of development:

  • Pilot project/testing/trials

Area where initiative is utilised

  • International (in several countries)

Initiative start date

  • 02/01/2018

Initiative end date

  • 01/31/2019

Financing

Financing method

  • Private (private investors, crowdfunding, philanthropy, etc.)
  • NGO
  • Government agency (i.e AFD, USAID, etc.)

Economic model(s)

  • Revenue generated by the beneficiaries/healthcare facilities

About the initiative

A Kenyan doctor posted at a public health facility spends 4.2 minutes on an average to treat a patient, according to a 2017 study by the Development Economics Research Group of the World Bank. This is vastly inadequate compared to the 15 minutes recommended by the British Medical Association and 21 minutes that an American patient gets with her family physician. The primary reason for this is the limited number of doctors treating large volumes of patients. The problems of staff shortage and dismal infrastructure are compounded further with inefficient work processes.

This is the challenge their initiative seeks to address. The problem is all pervasive, from the bottom most unit—termed a ‘dispensary’ staffed by nurses who handle the needs of the most vulnerable rural communities — to higher centres staffed by clinical officers, general practitioners and specialists. None have the management tools that can help them streamline their work nor does a lower level have a pragmatic way to supplement their scarce medical skills with help from higher levels. Inordinate time is spent on routine tasks of maintaining registers and records further limiting the time available for delivering care. Keeping paper records also makes them error-prone, retrieval difficult and undermines inventory management. Performance reports to the higher levels are also filled and sent manually making analysis difficult, especially since they are normally delayed. Since medical skills are deployed in a pyramidal structure within the county, cases that could have been handled at lower levels with a little higher level support end up in reality at the higher levels. This leads to overcrowding and improvident use of scarce resources.

This project provides decision support and tele-consultation tools to providers across the structure, so that lower levels will use ICT tools to provide standardized quality service on their own, or in teleconsultation with medical resources at higher centres. Electronic medical records stored in the internet cloud, a diagnostic and decision support system with updates of ICD-10 lists, inventory management on a utilization basis and metrics for supervisors is an integral part of the suite of solutions. The ICT solutions integrate the utilization of resources over time and space, so an integrated service delivery system is forged, within existing resources using triaging principles. Besides provision of care, the system provides metrics to decision makers for course corrections, and triggers alerts about outbreaks on the basis of pre-determined levels. The teleconsultations functionality improves access to affordable and quality care to the remote and rural areas, by delivering cost-effective health care through live (synchronous) and store-and-forward (asynchronous) teleconsultations. Health management team members will also benefit under the project through easily available data on stock utilization and essential health and morbidity data.

The project brings, with the active support of the county’s ministry of health, higher efficiencies to the resources already invested in the public sector. This necessitates duly aligning and re-adjusting the ICT solutions currently being used in the private sector to the needs, compulsions and habits of the public sector. Once in place, the model addresses the needs of the poorest communities close to their residence and serve as a conduit for referring them to the higher levels.

The project focus on four main attributes of integrated ICT-based solutions:

1. Decision support tools to nurses at rural government health facilities and doctors and clinicians at higher centres, which will provide standardized care efficiently and use tele-consultation features to supplement local skills.

2. Electronic medical records integrated with ICD-10 diagnostic support for referrals and continuum of care.

3. Dashboard of real-time metrics to supervisors auto-analyzed to facilitate quick remedial measures

4. Inventory management, using a bottom-up utilization model.

The entire system is designed to work in low resource settings, and can function even if only 2G connectivity is available. (Better bandwidth improves quality of transmission and images.) The core application for the rural clinics, loaded on a laptop or a tablet, provides algorithms that improve the efficiency and quality of service delivery. Similar tools, more sophisticated in medical terms, are available to doctors and clinical officers available at higher levels. The ICT system accepts a range of off-the-shelf devices on a plug and play basis, which also allows for future additions when more devices become available.

Fields of application:

Health professional training - Telemedicine (remote diagnosis and consultations) - Patient monitoring and medical data

Target audience

  • Healthcare professionals and structures (hospitals, healthcare centres/clinics, health networks)
  • Sick people
  • Pregnant women
  • Children - adolescents (ages 6-18)
  • Young children (0-5 years)

Initiative objectives

  • Decreased mortality
  • Decreased morbidity
  • Improved treatment

Key figures

8000 Number of beneficiaries since launch

800 Number of users per Month

Materials used

  • Cellular (mobile) phone
  • Smartphone
  • Tablet
  • Computer
  • Connected objects

Technologies used

  • Mobile telecommunications (without data connection)
  • Internet
  • Geolocation
  • Mobile app (Android, iOS, Windows Phone, HTML5, etc.)
  • Althea and other IT solutions developed by WHP

Offline use

Yes

Open Source

Yes

Open Data

No

Independent evaluation

No

Partners

Collaborators

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