Abstract
Patient data collection, emergency health services, routine healthcare delivery, and the intersection of these three components are the primary challenges faced by medical practitioners in rural regions of low income countries. This is certainly the reality experienced by healthcare providers in Achham, Nepal, and is the crux of the following publication. Achham, a remote district in Nepal’s Far-Western region, is a collection of small villages racked by poverty. The principal source of healthcare is delivered by female community health volunteers (FCHVs): lay primary care providers that service the communities they were born and raised in. Achham’s FCHVs are supported by Bayalpata Hospital, the sole source of formal medical care accessible to the 260,000 population. In the past FCHVs communicated with Bayalpata Hospital, the volunteers’ provider of medications, updated training information, and patient referrals, on a mixed oral and paper-based system. FCHVs would orally communicate to their literate peers of their patients’ needs, which would then be transcribed into binders that were delivered to Bayalpata’s staff by hand. This paper-based form of data collection had been found as a source of delay to health service delivery throughout Achham. There exists a communication gap that, if filled, could capacitate Bayalpata Hospital and Achham’s FCHVs alike to respond to evolving health needs in a more effective fashion. The explosive expansion of mobile and social networking technologies, even in the most remote communities, offers a unique opportunity to achieve this. \r \r \r This publication seeks to evaluate the viability of an intervention aimed at real-time surveillance of and public sector response to maternal health needs in the impoverished remote district of Achham, Nepal. The intervention will be undertaken in a partnership with the local non-governmental organization Nyaya Health, regional Bayalpata Hospital, the district-wide network of FCHVs and the technology non-governmental organizations MedicMobile and HealthMap. The intervention involves implementing real-time cellular-phone-based data collection and a communication resource for female community health volunteers (FCHVs). In other words, the proposed intervention will harness the power of smart phone technology to expedite communication between FCHVs and Bayalpata Hospital, making healthcare delivery more efficient. \r \r \r This particular intervention will focus on improving maternal health for two reasons, 1) pregnant women are a focal group of the Nepali government’s core public health service delivery scheme, and 2) for social and cultural reasons, maternal health may be the most easily monitored subset of care Bayalpata Hospital is able to provide in the context of this study.\r \r \r The evaluation of the viability of this intervention will be multi-faceted. The first chapter of this publication will more clearly define mHealth, an umbrella term for mobile phone based health interventions, the proposed intervention, and its goals. The second chapter will examine the social nuances of gender and caste, providing incite as to why maternal health, specifically maternal mortality, should be the subset of healthcare examined in this intervention. The third chapter will review the history of FCHVs in Nepal, examining why providing FCHVs with mobile phones, as opposed to other healthcare providers in Achham, makes the most sense. The fourth chapter will examine the status of healthcare in Achham as a whole, while the fifth chapter will closely examine the status of maternal health. These two chapters will provide a baseline understanding of the current norms of healthcare in Achham, and further, how the proposed intervention can be a source of improvement. The sixth chapter will examine the spatial and temporal benefits of the proposed intervention. The seventh and final chapter will provide case studies of similar interventions that have proven successful in Nepal’s neighbors: India, Bangladesh, and Indonesia. This seven part analysis was conducted in an effort to provide an integrated clinical, historical, sociological, and topographical assay of the viability of the proposed intervention. This publication is of the opinion that based on this seven part examination, the proposed mHealth solution is a pro-active platform for rapid health service to improve maternal health in rural Achham.