Wednesday, July 10, 2013

HEALTH / TECH SPECIAL..... HEALTH ON CALL



 HEALTH ON CALL 

Mobile phones are being used to identify and manage diseases like TB in rural India 

    Dayanand Bharti is a 42-year-old health worker in Sarmari Bazar, a village of around 6,000 people in Bihar’s Bhagalpur district. But his healing touch isn’t aided by a stethoscope. Instead, he uses a mobile phone to take healthcare to the neediest and the poorest.
    “They call me up from home and describe the symptoms. I give them some basic medicines or get them to undergo some tests. Most of the complaints are of TB (tuberculosis) and diarrhoea,” says Bharti over the phone.
    Bharti’s job includes identifying TB suspects and maintaining data on the number of tuberculosis patients and their adherence to DOT (Directly Observed Therapy) treatment, all of which he does via mobile phone on the MOTECH-TB platform. He, along with thousands of other village practitioners, is part of the Bill & Melinda
Gates Foundation-funded Ananya programme, being run in the state with the help of World Health Partners, an international non-profit organisation that provides health and reproductive health services in low-income countries by harnessing local market forces to work for the poor.
    The Mobile Technology for Community Health (or MOTECH) Platform is an open source software project delivered by Grameen Foundation, an international nonprofit organisation, through funding from Bill and Melinda Gates Foundation. MOTECH enables organisations building mHealth (mobile health) solutions to develop, manage and monitor those solutions better and at cheaper costs.
    Like Bharti, Satyendra Kumar has been bringing healthcare to villagers in Mohanpur in Samastipur district. Even though he is a pharmacist by education and professional experience, he has set up his own clinic in the village and treats villagers for some basic ailments, like cold and cough, flu and stomach infections. In villages in Bihar it is common to see compounders, pharmacists, lab technicians and other similar informally trained workers, doubling up as ‘village doctors’. “I see close to 30 patients a day. Those who can’t come to the clinic call me. Later, I visit them at home,” says Kumar who started working with WHP in December 2011. He has identified 29 confirmed cases of TB since. Twelve have completed the treatment and 18 are on it.
    With India facing an acute shortage of doctors — just one physician for 1,700 people against the ideal doctor-patient ratio of 1:500 set by WHO — mobile phone technology with its massive reach — over 900 million users in India — is proving to be a very useful tool for bringing healthcare to all. This is especially is true of rural areas where there’s a 60 per cent shortage of doctors.
    “Across the world, healthcare in rural areas is shifting from doctor’s clinics to algorithms and other software solutions, on smart phones that can enable front-line health workers to identify disease,” says Dr Anna Stratis, chief medical officer at WHP, India. WHP is helping the Bihar government tackle TB in 13 districts by empowering rural private health providers via Motech-TB, which features both mobile and web interfaces for increased options in areas with poor internet connectivity. “Most villages in Bihar have informally trained health providers or ‘village doctors’ who administer basic healthcare. They put in Rs 60,000 or Rs 70,000, and we help them set up telemedicine centres equipped with a computer, internet connection and printer. The new generation of providers will have a smartphone-based telemedicine solution, on which they will facilitate and mobile health care via teleconsultation with a city doctor. We teach them how to use IVR (Interactive Voice Response) calls to share data relating to disease identification and management. They charge Rs 10 to Rs 50 per patient,” says Stratis. When the local health provider is not able to help, a web interface with doctors in the city is facilitated.
    A recent PricewaterhouseCoopers report predicts that the growth of the mHealth (mobile health) market in India will lead to a revenue opportunity of Rs 3,000 crore by 2017. Airtel’s mHealth service, Mediphone, has been operational since November 2011 and is available to its 170 million users.
    “With the help of Mediphone, Airtel customers can call a doctor or nurse, who will assess the clinical symptoms described by the customers and offer medical advice. The service also provides information about the nearest emergency facilities,” says an Airtel official. Each mobile consultation costs Rs 35.
    Health workers say cellphones have proved useful in identifying diseases in rural areas and collecting medical data. Health workers in villages collect patient data and upload records to a centralised database. Patient records are analysed to establish personalised care schedules and reminders are sent to nurses and patients about visits. Recorded messages containing advice on pregnancy-related issues and important facts about foetal development are sent to expectant mothers. Or a patient with suspected TB is told how to collect a sputum sample for testing. “I call them and explain that how they should burn the container which contained the sample so that it does not spread the infection,” says Bharti.
    Within the domain of health, MOTECH Platform from Grameen Foundation powers multiple projects related to child and mother health, TB and HIV. MOTECH-TB, is one such implementation. “One of the challenges we face is to train the large health-worker field-force on how to use mobile technology and work in an organised fashion,” says Kamalika Sen, project head, Grameen Foundation-India.
    ‘Mobile Kunji’, another project under the Ananya programme, is aimed at maternal and child health. Mobile Kunji offers an IVR service and a printed deck of high quality cards to the health workers. The cards have health information with pictorial representations of problems and solutions for maternal, pre-natal and ante-natal care. The user can dial a mobile number also printed on the card and listen to a recorded message given by ‘Dr Anita’, a fictional character who imparts health tips in the local dialect. Mobile Kunji has been developed by BBC Action Media, an international charity arm of the news corporation.
    Mobile phones are also being used to share lab and diagnostic test results with doctors. At rural health camps organised by Global Hospitals in Mumbai, ECG images are sent to doctors in Mumbai via SMS. “In case there’s an indication of a heart attack we ask the paramedics at the camp to take patients to the nearest hospital. This saves valuable time as doctors can give instant feedback. The hospital will be prepared when the patient arrives. We always keep our phones on and respond to these SMSes at once,” says Dr Gauri Shah, consultant cardiologist, Global Hospital, Mumbai.
    Till the time doctors reach our villages, mobile phones will keep ringing in good health.
SHOBITA DHAR TCR130629

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