Open2012 improved-health-care-in-nicaragua-singh


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  • Here is the hospital in Waslala. Although severely lacking funding, staff, and facilities, it has the basic necessities for healthcare but lacks X–Ray and while they report having an operating room, the hospital does not have the capacity to even do a Cesarean section. The women may have to travel 4 hours or more to the closest larger hospital.
  • Class of community health workers and getting aroun d in the rainy season (May – November) can be tricky
  • Can get national data but most recent report from PAHO 2007 (that we could find) demonstrates the lack of baseline data in our region and about ½ of Nicaragua.
  • Key informant have reported skepticism about the Ministry of Health’s reports on infant and maternal mortality. Their concern was validated by a report from PAHO which suggested that the Ministry of health’s statistics were underreported by 40 – 50%
  • Open2012 improved-health-care-in-nicaragua-singh

    1. 1. 1 Making Healthcare More Accessible to RuralCommunities In Waslala, Nicaragua Using Low Cost TelecommunicationsP. Singh, E. Keech, B. Mariani, R. McDermott-Levy and J. Klingler Villanova University, Villanova, PA Open 2012 – NCIIA Annual Conference March 22-24, 2012 San Francisco, CA
    2. 2. Outline Context: health, social and economic parameters Dimensions of challenge– Human, medical– Technical– Economic sustainability Progress-to-date Partners Future Plans 2
    3. 3. General Challenges• Poor Infrastructure• Low level of education• Residue of civil war still influences region• Generally low income communities• Language and culture 3
    4. 4. Project Context• Initial pilot location: Waslala - region of approx. 50,000• Central town surrounded by ~90 rural communities•Rugged terrain•Neglected by Public Health System Waslala 4
    5. 5. Healthcare in Waslala Ministry of Health runs regional hospital Only 6 trained doctors serve Waslala + rural areas Catholic Parish organizes and trains community health workers (CHWs) to promote health CHWs– serve their own community– have limited education (as low as grade 2)– are trained by parish to extend reach of medical services and health information– are volunteers 5
    6. 6. Main Hospital in Waslala 6
    7. 7. Three Dimensions of Challenge1. Human Factors, Nursing Training2. Technical Factors3. Economic Sustainability 7
    8. 8. 1st Dimension: Human factors, Nursing Challenge Approx. 90 rural communities 1-14 hours of travel from town (when possible) Community Health Workers (CHWs)– Primary healthcare contact– 2-10 grade education– Lack basic medical equipment.. thermometers, blood pressure cuffs, stethescopes, etc.– Need training in normal physiology, using medical equipment, preventive care, basic health assessments,basic medication, patient follow-up, documentation 8
    9. 9. Immediate Healthcare Goals Provide rapid, real-time computer-assisted assessment assistance Develop infrastructure to create, store and retrieve patient records Equip, educate & train CHWs Obtain accurate baseline data Set outcome measures to match national goals– e.g. prenatal visits with skilled professional 2-3 times before delivery– (hospital) deliveries with skilled attendant 9
    10. 10. Medical Equipment, Training 10
    11. 11. 2nd Dimension: Technical  Need technology to reach out to rural population  Few have access to electricity; no Internet access  Cell phone service widely available, although not everywhere 11
    12. 12. Proposed Solution Equip CHWs with inexpensive cell phones Set up organized system for– Collecting and transmitting patient information– Storing and organizing electronic health records– Health assessments and remote medical advice 12
    13. 13. System-Level Block Diagram Solar/Battery Backup Power Remote Monitoring CenterRural Sites Cellular Modem Router SMS Medical Server Doctors computer Internet Solar Chargers Remote Administration (Villanova) 13
    14. 14. Backup Power Supply 14
    15. 15. 3rd Dimension: Economic Sustainability Yearly variable costs (per community) Cost per year Air time (plan of 1,000 text messages) $120 Replacement of medical equipment* $30 Total variable costs: $150Expected Yearly fixed costs  Costs Doctor’s wages $1,800 Technician’s wages $2,500 Total fixed costs: $4,300 One-time fixed costs** (per community) Costs per year Phone $30 Solar cell phone charger $50 Shirts and ID badges $20 Total one-time fixed costs: $100*Medical equipment – donated; Communities are responsible for replacement ofsupplies**Costs incurred at the beginning of system uptake; avg. equipment lifetime is 3 yrs 15
    16. 16. Funding Plan Operational costs– Community fund overseen by Waslala parish– Individual household contributions Community leader collects monthly fee of $2 per household Parish treasurer covers phone, medical or wage expenses from community fund Parish treasurer will manage funds through parish bank account 16
    17. 17. Progress-to-date Teams of ECE, Nursing and Business students and faculty have made six trips to the site thus far In-country office staff established Provided 25 CHWs with diagnostic equipment and training Provided cell phones and solar chargers to 25 health workers Installed server and backup power system in parish Simplified Spanish manuals and text training video produced Several partnerships established Doctor brought into team Some business model concepts established 17
    18. 18. Unplanned Challenges• Personnel Changes• Spam messages from Claro• Turmoil at the Parish• Closing of Internet café in Waslala 18
    19. 19. Future Plans Continue to train and equip more CHWs Put program into the “Cloud” Add diagnostics and decision features to software Maintain emphasis on ultra low-cost Release software under open-source license Measure outcomes of pilot project -Identify baseline assessment measures  Continue to work with communities to develop and implement a sustainable business model (including exploring mPeso) 19
    20. 20. PartnersEstablished Partners:• NCIIA• Connelly Foundation (supports Nursing travel)• Halloran Philanthropies• Parish Health Program in Waslala• Claro• UNI (National Engineering School of Nicaragua)• UNAN (Nursing School in Nicaragua)• Suni SolarEmerging Partners:• MINSA (Ministry of Health in Nicaragua)• Pro Mujer• Nicasalud (?)• Inter-American Development Bank (?) 20
    21. 21. AcknowledgmentsElectrical & Computer Engineering StudentsCraig Baumer, Arpita Kothari, Brendan McCoy, Andrew Robinson, Peter Shaw, John BeyerNursing StudentsRebecca LaMarca, Fruna Lara, Caitlin Krenek, Katie Weatherbie, Alexandra Reo, present senior nursingstudents, Tracey DesjadonBusiness StudentsDerek Ferguson, Christina Radossi, Tyler Weinrich, Tara McHugh, Alejandro AvellanaArts and Science StudentCarolina WolnickiUNI Faculty and StudentsMaria Virginia Moncada and Carlos RuizUNAN Faculty and StudentsMiguel Estapinon and Yolanda, and othersNational Collegiate Inventors and Innovators Alliance (NCIIA)Sustainable Vision Grant FundingHalloran PhilanthropiesClaro 21Tim Hansell
    22. 22. Thank you! 22
    23. 23. Backup Slides 23
    24. 24. 1st Dimension:Human factors, Nursing ChallengeIdentifying Measurable Outcomes Nicaragua Profile, WHO (2002) PAHO 2007 24
    25. 25. 1st Dimension (outcomes contd.) Inacurate statistics Ministry of Health figures estimated to be 40 – 50% underreported (PAHO 2007) 25
    26. 26. Lessons Learned Human Factors to Consider– CHWs prefer to remain unpaid volunteers– Teaching first time cell users to SMS is really hard!– Frequent communication with CHWs avoids frustration– Keep realistic expectations about project progress– Motivated in-country project co-ordinators are indispensable 26
    27. 27. Lessons Learned Technical and Logistics Problems– Even in major towns, electricity, and Internet connections are unreliable– Publicly routable IP addresses are the exception, not the norm!– Even thorough testing using parallel setups does not ensure easy success– Shopping for simple hardware on-site can take several days!– Local supplier relationships are essential 27
    28. 28. Lessons Learned Business Hurdles– Banking infrastructure cannot be taken for granted– Money moves in mysterious ways– Credit systems are localized and peer-pressure based– Custodian of funds is essential– Entrepreneurial mindset may be lacking 28