Medic Mobile

LOCATION: Malawi

SUMMARY: Medic Mobile equips community health workers with digital tools to provide better care and reach more people. With our new equity lens people will be able to rapidly assess equity in local health systems and respond at the household level--a precision approach to making healthcare more equitable.

PROBLEM SPACE: "Five of the leading causes of death in lower-income countries, including diarrheal diseases, HIV, tuberculosis, neo-natal infections and malaria, are treatable conditions that have become rare in wealthier settings. Particularly among children, the distribution of morbidity and mortality is at least partially attributable to chronic malnutrition having weakened individual and population level immunity to infectious diseases. In concrete human terms, many of our partners and patients have buried their children of diseases that they know are curable, often for a few dollars. Our work grows out of an ethic of partnership with communities of people who are struggling, and too often failing to survive.

The World Health Organization has estimated that 57 lower income countries face a collective shortfall of 4.3 million health workers. In many of these countries, the severe health worker shortage is exacerbated by the urban concentration of highly trained health professionals and the geographic dispersion of rural populations. When we began working in Malawi in 2008, four of the country's 27 districts had no doctors at all, five had fewer than one nurse per facility, and 15 had fewer than 1.5 nurses per facility.

In such settings, community-based lay health workers (CHWs) can dramatically improve access to care because they are recruited from and live in the neighborhoods they serve. However, their training is minimal and they often lack the equipment or expertise to deal with difficult cases. Managing a distributed lay workforce is remarkably complex and many large-scale CHW programs fail to live up to the promise of smaller studies. While most CHWs collect health data, overburdened program managers often provide little ongoing training and support that could foster data-driven proactive care at the household level. As a result, CHWs can become nearly as disconnected from the health system as the rural patients they serve."

SOLUTION: "Our early projects in Malawi showed that using ordinary text messages to coordinate CHWs can be as much as 4x cheaper and 134x faster than the most common alternatives of walking, cycling and public transit. Since 2010 we have designed a novel thin-SIM system for collecting data using locally available $15 phones, a smartphone application for more complex task management and a web application for facility based health staff. These tools are open source and have been used by over 13,000 health workers who care for eight million people.

Developing an equity lens for global health is our next major initiative. Addressing health inequity means more than working in disadvantaged regions; it entails reaching the most disadvantaged people within a project area. Yet the the vast majority of equity data is siloed in one-off studies and census surveys, often reported in 5-10 year time spans and in group-level or national averages that are too broad to inform local action. There is a pressing need for real-time, locally granular equity data to be integrated with digital tools for rapid analysis and care coordination."

CONTACT: Isaac Holeman, [email protected]"

Images: