CHWs-Newfrontier to drive innovations in rural healthcare delivery

The need:

Jayashree,is a Community Health Worker(CHWs) in her village called Hubli, in Karnataka. One day,while she visited a woman named Pushpa in her first trimester,she looked quite unwell. On enquiring Pushpa was found to suffer from Epilepsy. Her family also revealed, she has been prescribed with medicines by a local doctor, but she didn’t take them regularly. Epilepsy is a disorder of the nervous system and such patients during pregnancy have major concerns. Jayshree felt the need! She promptly captured her vitals on her smart phone loaded with Wireless Health Incident Monitoring Systems, (WHIMS), and pushed the patient’s vitals on to the cloud for a quick doctor reference. For the next few days, Jayshree monitored and screened her closely and counselled her and family about different preventive measures pertaining to her health conditions. Soon after,Pushpa recovered and gave birth to a healthy child. Like Jayashree, there are over 330 CHWs who are trained and strategically deployed across six states in rural India to become the frontier in iKure’s healthcare delivery system.
 

Context:

India faces large disparity in workforce distribution especially in rural regions where burden of diseases is high. With 44,000 doctors for 833 million people, the shortage of doctors in rural areas is severe where each doctor serves a community close to 19,000 people. The severe lack in rural areas has been attributed to lack of effective training and recruitment, ineffective distribution of workforce and failure to retain labour where needed the most.
With the urgent need of creating new cadres of frontline health workers that meets the demand of rural health, iKure implements strategic training, evaluation and monitoring programe with the judicious use of digital technology to address the gap. iKure has developed a cloud based platform called Wireless Health Incident Monitoring System (WHIMS) designed with an intuitive graphics user interface that health activists, with basic education can use. WHIMS is accompanied with instruments to measure vital statistics of patients, and for it to be a more reliable diagnostic tool, iKure created Medic Bags with low-cost POC instruments to assist CHWs to measure basic statistics. iKure has established ecosystem partnership with Public Health Care (PHC) system, and low-cost private healthcare providers, under which diagnostics collected by the CHWs are shared in real-time with doctors in these hospitals, who suggest treatments and prescribe medication through the WHIMS platform to the health workers, who relay this information to the patients. The evidence based data collected using WHIMS platform offer huge potential to drive policy and advocacy on the health status of the rural community.
 

CHW’s MEDIC BAG:

To address the fragmented approach of primary care delivery in rural community, iKure establishes integrated care enabled by the CHWs at different levels of the delivery system. To ensure quality care at each level, we build the capability (both technology and clinical) of the CHWs as the first step, to build technology enabled health system support, improve health practices at the household level, and bring integrated actions for health at community level. These cadres will be mobilized by iKure for different handholding of their designated roles in performing household visits, community level outreach camps, and facility based concept clinics. CHWs equipped with a Medical Kit that consists of devices such as BP machine, Stethoscope, pulse oxy meter, Thermometer, First Aid Kit, Weight machine, Height measuring scale, gloves etc., they carry medicines for basic common ailments, non-invasive haemoglobinometer, Haemoglobin kit to measure Hb level, mobile phone based sphygmomanometer, urine analyzer, calorimeter, ECG, flipcharts/Hoardings & registers. Through these CHWs, every patient is also provisioned with Digital Health Card (DTH) encrypted with a QR (Quick Response) code and during home visits, DTH gets updated with latest clinical indicators. The health data obtained from the health cards is synced to a cloud for effective utilization in the upward heath chain at both secondary and tertiary levels.

Prior to working as CHW, these village women remained mostly confined as homemakers performing daily household chores. As iKure build their capacity both technologically and clinically to work as frontline health workers, they also gain respect and position from their communities in the long run. Further, their contact and association with the community helps iKure drive effective community mobilization measures and act as a catalyst to drive behavioural change. While they interacts and communicates the necessity on the ground and identifies appropriate health needs, they conduct street plays, demonstrates hoardings and facilitates automatic health nudges through mobile phones of the beneficiaries at different levels. They are also attuned to provide nutritional counselling, and spectacle services based on the community needs.

iKure also build sustainable model for its CHWs. Through robust supply chain model, these CHWs promote various lifestyle products such as sanitation pads, branded spectacles, hair care, skin care products etc, which helps them gain daily incentives apart from monthly income.

 

Conclusion:

The CHW model of empowering the women community and gender mainstreaming represents transformational change in rural healthcare delivery. As they champion tech-savvy cultural values in otherwise austere facilities, and limited supply of doctors, such effort has established inspirational leaders driving catalyst change in public healthcare delivery.