Advanced Telemedicine for Preventive Healthcare Service in Rural Bangladesh

Rafiqul Islam Maruf, (Dr.Eng.) GLOBAL COMMUNICATION CENTER (GCC)

A joint Research & Development initiative of KYUSHU UNIVERSITY & GRAMEEN COMMUNICATIONS

Copyright © 2008-2014 - All right reserved to Global Communication Center

1. About Global Communication Center (GCC) 2. Bangladesh: Country Profile in Healthcare Sector 3. Portable Health Clinic 4. PHC Project Field Experiences 5. Conclusion

2

Agenda

Established in 2007 as a collaborative R&D Project between

Global Communication Center

Thus, GCC aims to • Development of Technologies based on Social Needs • Providing social services to the Target Community in a business way • Healthcare is one of the highest priorities in social service

Dr. Muhammad Yunus, Nobel Laureate of 2006 in World Peace is the chairman of Grameen Group. Yunus says:

“Don’t ask consumers to go to the service providers but ask service providers to reach the services to the consumers.” “Let’s put poverty to the museum with our joint effort.”

BANGLADESH:

COUNTRY PROFILE IN HEALTHCARE SECTOR

4

Bangladesh: Country Profile in Healthcare (1)

High population density 8th in the world (total) and 6th (density)

70% people live in rural areas but… Poor Healthcare Facilities in Village - Insufficient hospital and clinic - Absence of qualified doctors City Healthcare Facilities are Out of Reach - Long distance and take long time & effort to go - Need extra money for the travel - Woman denies to see unknown male doctor in person

Solution? Telemedicine but with technical advancement

5

30%

70%

Urban

Rural

Population Distribution in BD

Bangladesh: Country Profile in Healthcare (2)

Poor Doctor-Patients Ratio

3 doctors for 10,000 patients - BD has 53,000 Doctors instead of 110,000 shortage of 60,000 Doctors - BD has 23,000 Nurses instead of 300,000 shortage of 280,000 Nurses

Maldistribution and Migration - Less than 20% of Doctors work in village for 73% population - Rural-Urban disparity of (Urban= 1 : 1,500 & Rural= 1: 15,000)

Solution? (1) Increase number of doctors but … (2) Reduce number of patients by preventive healthcare

6

No. of Doctors Per 10,000 Patients in 2010 (Source: http://data.worldbank.org)

62

42

24 21

6 3

0

10

20

30

40

50

60

70

Possible Healthcare Solution

7

Now for the Technical advancement of telemedicine with Preventive healthcare system, here comes the solution from

Portable Health Clinic (PHC)

1. Installed with diagnosis tools

2. All tools are BAN enabled for direct data transmission to online server for remote doctors

3. Preventive healthcare services

4. Used by local female nurse or paramedics (health worker)

PORTABLE HEALTH CLINIC

Basic Health Check-up Package 1) Body Temperature 2) Blood Pressure 3) Pulse Rate 4) Arrhythmia 5) Height, Weight and BMI6) Waist, Hip and W/H Ratio 7) Oxygenation of Blood 8) Blood Glucose (random) 9) Blood Grouping 10) Hemoglobin Concentration (optional) 11) Urinary Sugar 12) Urinary Protein 13) Urobilinogen 14) ECG (optional) 15) Tele-Med by Specialized Call Center Doctors 16) (Environment data)

9

Internet / GSM Net

Patient @Home

Operational Model: 4 Components

Internet

GrameenHealthcare Lady

- Village women empowerment - New job opportunity - Service at the doorstep

PHC (Database) Server System

- BigData for medical science - Better clinical decision by doctor - Preserving PHR

Doctors @ Call Center with CC Application

- Opportunity for part-timers (1) doctors who are in study (2) house-wife doctors

Portable Health Clinic Device

- Business opportunity for the device vendor

11

PHC Service Process 2. Health Checkup Process 1. Patient Registration & Case History Collection

129 / 84

139 / 89

179 / 109

180+ / 110+

129 / 84

Example: BP Triage

1111111111111111

3. Category Identification & Report Printing 4. Video Conference between Doctor & Patient 5. Report & Prescription Delivery

12

PHC Server-Application System

e-Prescription by Remote Doctor

Web based PHC Server-Application System

PHC PROJECT FIELD EXPERIENCES

13

Field Operation Methodology

� Design and experiment with “One Community One Clinic” model.

� Serve thousands of patients, collect large data (>10,000 persons) for finding disease patterns and trial of info-medicine dissemination system.

� Train health-assistants (paramedic, nurses, etc.) for the portable health clinic.

� Deploy a centralized database to archive and monitor the status of patients.

� Carry out trials to develop a social business concept for sustainable operation.

14

1ST Phase Test Results (FY2012)

N=8527

Male 48%

Female 52%

Fig 1: Sex Distribution

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

6.8% 4.4% 5.9% 5.7% 3.2% 7.5% 17.0% 13.9% 14.6%

40.1% 47.6% 49.8% 49.1% 53.6% 65.6%

65.2% 62.6% 60.2%

46.5% 41.1% 38.9% 40.6% 38.1% 25.6%

16.9% 22.5% 23.5% 6.6% 6.8% 5.4% 4.6% 5.0% 1.3% 0.9% 1.0% 1.6%

0%

20%

40%

60%

80%

100%

7.8%

50.3%

36.8%

5.0%

Fig 4: Overall Triage

Fig 2: Participants Location Fig 2: Participants Location

Rural 69%

Urban 31%

5.1

37.6

19.3

10.8 13.76.9 4.0 2.6

<25 25- 29 30-34 35-39 40-49 50-59 60-69 70-106

Fig 3: Age Distribution of Subjects

Fig 5: Individual Site Triage

7.06%

47.36%

87.96%

37.81%

12.04% 7.76%

0%10%20%30%40%50%60%70%80%90%

100%

First Phase Second Phase

Fig 6: Health Improvement in 2 Months

8.0%

50.7%

100%

38.0%

3.3%

0%10%20%30%40%50%60%70%80%90%

100%

First Phase Second Phase

Fig 7: Improvement of Orange Patients

23.1%

36.4% 100%

40.5%

0%10%20%30%40%50%60%70%80%90%

100%

First Phase Second Phase

Fig 8: Improvement of Red Patients

2nd Phase Test Results (FY2012)

16

N=1004

Conclusion

Preventive healthcare with PHC has been found very effective and it could contribute in improving doctor-patient ratio. BigData on PHR can be achieved which would be essential for research and future public health policy making.

The main issue faced in using this system is the network coverage with sufficient bandwidth in rural areas.

Now the challenge is the implementation of PHC in sustainable business model We are working now for doctor consultancy to patients but next we hope for collaboration for doctor to doctor-students consultancy.

17

Thank You

18

Portable Health Clinic

19

Mobile Clinic: Booth Type Portable Clinic: Briefcase Type

Preventive Healthcare & NCDs

20

Danger of Non-Communicable Diseases (NCD) • Silent Killers: Hypertension, Diabetes, etc. • Global View: Kills 36 million/year. 80% (29 million) are low and middle income countries • Expensive and uncontrollable if not

detected at the earlier stage