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>View discussions about this entry Country: United Kingdom
Organization: PHASE Worldwide
Focus of activity - Service/process
Year the initiative began (yyyy) - 2007
Positioning in the Mosaic of solutions
Define the innovation - What is the main focus (product, services, etc) of your innovation? Who are the primary beneficiaries? How does it make health and/or health care more affordable, accessible, and simpler to achieve/use? How does it differ from what currently exists in the market? This innovation addresses the problem of the "Information Gap" in what is commonly called the Age of Information Technology.
Health Workers in remote rural health posts are often completely isolated, both professionally and socially, and are therefore often tempted to absent themselves from their post whenever possible. Furthermore, training usually takes place in district centres, out of their work context, and no follow up and in post supervision takes place. For this reason, one of the most difficult to achieve aspects of the health service is ensuring high quality of care and accountability of the health workers. Our intervention will on the one hand enable health workers to comunicate more regularly with their line managers and also their own families, and help them to feel more confident and improve their clinical practice. On the other hand, this new line of communication will also allow better supervision and monitoring of health workers in post, increasing their accountability. In addition, villagers will also be able to use the communication technology for health advice in the absence of health workers, but also for educational and democracy-building purposes. Context for Disruption: - Describe how your innovation is transforming traditional health or related systems in the short and long term. We will be focussing on improving communication between remote rural health posts and the district hospitals, by installing computers and internet lines in both institutions. We already support the concerned health posts with extra personnel, training and equipment.
The primary beneficiaries are the health workers (by acessing more support from line managers) as well as the population of the target communities (by accessing higher levels of health care expertise and better communication facilities). What is innovative about our project is that we are hoping to use telehealth technology to improve primary care, which in Nepal is delivered by health workers with very basic training who are usually not computer literate, have no typing skills, and very little English. We can overcome this problem by using real time audio/video links, which do not require any amount of typing, and by establishing a personal connection of the health workers with their usual line managers. We anticipate that most health workers will also acquire some email skills, so that they can send non-urgent enquiries for response at the convenience of the doctors. Similar projects have been tried in other areas, but usually rely on a higher trained cadre of health workers or have a strong emphasis on data collection, which means a much higher need for training. One project in Nepal is using a local WiFi network for Tele-Education, and is hoping to establish a link to a regional hospital. This approach is probably too expensive to be replicated, and lacks the advantage of personal acquaintance between the participating health workers and doctors. Our approach to also allow villagers access to these computer links (which will be the first in the participating communities) is completely new as far as we are aware. This should hopefully increase local acceptance of the program, and bring in extra revenue, which can later be used for the continued financing of maintenance costs. Delivery Model - How does your innovation reach its target populations? What mechanism(s) (e.g., communications, distribution channels, etc.) do you have in place? What is your current market penetration? How do you measure this? At present, PHASE Worldwide with its Nepalese partner PHASE Nepal implements integrated rural community development programmes in three remote hill districts of Nepal. Our programmes focus on health and education, as well as community strengthening and income generation.
We have a permanent presence in the target communities and are therefore able to facilitate change ata significant rate. We have strong support from the UK and other countries in Europe, and regular monitoring visits by both UK and Nepal senior management staff ensure the effectiveness of our interventions. For the context of the telemedicine aspect of our projects, we will ensure that local facilitators as well as health workers will be trained in use and mainenance of the equipment. This will allow the use of the equipment for educational and other purposes as well as health advice in the absence of the health worker. At present, PHASE projects cover a population of approx 12,000 in three village development committees, and is set to at least double this in the coming 2 years. Key Operational Partnerships - What key partnerships have you established to make your disruptive innovation model possible? Who are your partners (business, social, government, other) and what are their roles? How central are these partnerships for your initiative. We work in close cooperation with PHASE Nepal, a Nepalese NGO duly registered with the Social Welfare Council. PHASE Nepal is run by a group of development professionals who bring a wealth of individual experience in development work into the organisation.
Through our work over the last 18 months, we have established close and effective working relationships with the concerned District Administration (District Health and Education Offices as well as District Development Committees.) All PHASE programmes make use of available local and district government resources, and in the case of the telemedicine project, District Health Offices will be closely involved in the setting up and conducting of the project. Financial Model - Describe the financial model for your innovation. What percentage, if any, of the total operating costs does earned income (from products, services, or other fees) represent? Our innovation has a relatively high initial investment cost, (approx 1,000 USD per health centre) which will be borne by sponsors of PHASE Worldwide.
However, once the project is running and has been shown to be beneficial, local governments (Village Devlopment Committtees) do have funds that can be used for maintenance and replacement of equipment. The technology will also be made available for private users for small user fees. We anticipated that approximately 20-30% of the operating costs can be met by user fees.
Effectiveness - What has been the measurable impact of your project to date? How many people have benefited from your program in total? What policies, communities, or institutions have been influenced to make fundamental changes because of your work? So far, we are supporting three communities in remote rural areas in Nepal. In each community, we are supporting the local health post with extra staff and extra equipment, and have established an outreach health centre in the most remote area of the village development committee.
Improved supervision and monitoring have meant that in contrast to the governmnetal agencies, we have been able to ensure the permanent presence of health workers in the villages and high quality primary care. That this is perceived as such by the local population as well is borne out by the consultation figures: In a comparable period of time before and after the start of our intervention, 5-6 times more villagers have received services from the health centres in question. In the 9 months period since the start of our projects, approximately 5,000 people have visited the health posts, but the figure of beneficiaries is much larger than this, for four reasons: 1. - our health workers have also conducted health awareness and education campaigns, provided family planning and antenatal services, which benefit families as a whole. 2. - PHASE health projects also include water and sanitation projects: in cooperation with the villagers, toilets are built and water lines repaired or installed, which reduces the number of people affected by infectious diarrhoeal disease. 3. - Improving the health of mothers and family breadwinners also benefits the whole family, and can prevent the social and financial consequences of ill health 4. - by providing affordable health services locally, the project reduces the financial burden of disease on families and the village as a whole
Scaling up Strategy - What is your priority for the next 3 years and please describe why. Over the next 3 years, we would like to roll out the telemedicine idea in all hill and mountain VDCs of our current working districts: Gorkha, Lamjung and Sindhupalchok.
We would develop our working relationships with the ministry of health of the government of Nepal to facilitate copying of our strategy in other districts as well. Our priority in the second phase of the project is to prove the effectiveness of the intervention, especially quality of health sevrices, accountabiity of health workers, and attitude of villagers towards the health service. We also expect an effect on educational achievenments and on the democratic processes and people's participation in the target villages.
Origin of the Initiative - Tell the personal story that will help people connect to your work. How did the initiative start? Was there a particular individual or event driving the idea? Tell the reader the story behind the innovation. PHASE Worldwide and PHASE Nepal are both organisation which are led by a group of people who have wide experience in and feel passionate about development work in remote rural areas.
In our work with local health posts, trying to improve quality of care, we have found that one large unmet need of health workers is the opportunity to get instant clinical advice form a more experienced health professional. Initially we facilitated telephone consultations with an experienced family physician, but soon found that many problems are difficult to solve without the possibility of sharing pictures. As we had already been considering the possibility of establishing email links for local schools with Western schools, the step to equipping health centres with internet facilities seemed obvious. With this technology health workers can get in time advice on clinical problems, and plan referrals better Contact Information:
Gerda Pohl
Trustee and Medical Coordinator PHASE Worldwide (NGO) info@phaseworldwide.com Larch House, First Lane, Wickersley, Rotherham S661DU United Kingdom Tel: 01709 850266 Website: www.phaseworldwide.com Discussions about this entry
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Introducing Telemedicine in Remote Rural Health Posts in Nepal
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Dear Mr. Pohl:
With your focus on rural health, I thought, the Kiosk-based Clinics for Masses may interest you.
Thanks,
BP