Telemedicine for Community Health Workers: An Analysis of the Effects of Connectivity on Health Equity in Rural Nepal

By: Shefali Oza (Nepal)

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Disparities in access to quality healthcare services are among the greatest humanitarian injustices present in today’s world. Exemplifying this problem is the district of Achham, Nepal, which has some of the highest maternal and child mortality rates in South Asia. The complex problems of Achham are similar to those faced by poor, rural communities throughout the world. Achham thus provides an ideal testing ground for developing programs to provide appropriate technologies for healthcare delivery.

Training and deployment of Community Health Workers (CHWs) has been identified by the WHO as pivotal to achieving healthcare access in underserved, rural communities. CHWs are similar to mobile paramedics. They are nurses who travel to dispersed villages and provide local diagnosis and treatment services. However, the full potential for CHWs to offer primary care to rural areas has yet to be realized, because these workers lack the support needed to receive adequate training, provide effective treatments, and conduct epidemiological studies. Many persons have thought that equipping CHWs with laptops and providing communications equipment to them can help them to communicate with doctors in city-based hospitals and clinics.

By investigating the application of telecommunications technology to healthcare outreach efforts in the region, we hope to develop a model for training and communication efforts that can be implemented on both the organizational and national levels. We will deploy mobile communications technologies among CHWs in Nepal, as part of the major medical relief organization Nyaya Health. Mobile CHWs will use laptops and communications technologies to obtain reference and triage information from doctors at a centralized clinic. We predict that the establishment of an integrated telemedicine program in Achham will not only improve access to healthcare, but will also empower villagers to participate actively in policy-making at local and national levels.

Following an initial assessment of available services and population health status, we will begin the pilot study, which is divided into phases of technology installation, CHW training, program implementation, and scale-up. Over three years, we aim to expand our program to cover the district of Achham, and eventually to establish a national telemedicine program.

The knowledge gained will provide an essential link between information technology and provision of healthcare, and a model that can be applied in rural settings worldwide.

Research Question(s)
How is CHW effectiveness in delivering health care to remote regions affected by the introduction of an extended telemedicine network?
What are the most common uses of telecommunications equipment at different levels of the medical care system, from mobile healthcare workers to clinic physicians?
What are the key barriers to more effective use of information and communications technologies when delivering care through the rural primary healthcare system model (PHSM) in rural South Asia, which is being expanded throughout the region?

General Objective
We intend to launch a pilot study to analyze the effectiveness of connectivity in training and improving performance of CHWs in Achham, Western Nepal. This initiative would expand the outreach abilities of an existing clinic, and would provide a model of health care networking which, if successful, could be adopted by other health facilities and governmental agencies in Asia.

By providing CHWs with access to comprehensive health care information and the means to communicate despite geographic distance, this system will serve to directly involve community members and alleviate disparities in healthcare accessibility. This will in turn empower populations in the area to obtain access to vital resources that will serve as platforms for further educational and economic improvement.

Specific Objectives
[1] This study aims to develop a system capable of establishing and sustaining the following services:

• Communication systems between CHWs and other health professionals within the CHW’s home district. This includes other CHWs for mutual advice and experiential knowledge exchange, solidarity, and support.
• Data collection and management tools for surveillance. These include detecting common patterns in reported symptoms for early outbreak identification.
• Communication systems linking CHWs to timely medical information. To deliver up-to-date care, CHWs will benefit greatly from access to internet-based medical resources on a regular basis to better treat and triage patients.
• An integrated, sustainable training system. By training CHWs to use information technologies (IT), we facilitate sustained transfer of medical knowledge and the development of future generations of healthcare delivery experts.

[2] Within current CHW models, CHWs typically work alone, often travel great distances, and rely completely on their own knowledge and the most basic of resources which they carry with them. In operating under these rudimentary conditions, only a small fraction of the potential for CHWs to impact their communities is realized. By equipping CHWs with innovative technologies tailored for local communities, this study aims to create a sustainable, scalable healthcare delivery system capable of addressing the most critical and immediate medical needs of Achham, Nepal.

[3] With the establishment of increased connectivity in the region, collaboration with specialist colleagues based at Yale University and in Katmandu on the diagnosis of complex patients will become possible, along with the development of a digitally integrated health system that can more efficiently and effectively be used for surveillance of emerging diseases, identification of disease and description of patterns of health and disease. This ability of the CHWs to input longitudinal data on their patients and communicate with the central clinic staff and external specialists will improve the effectiveness of home-based care for chronic diseases such as tuberculosis, HIV, diabetes, and chronic obstructive pulmonary disease.

The project was terminated mid-way.