Articles
Ashir Ahmed, associate professor in the faculty of information science and electrical engineering, Kyushu University, Japan
One billion people – 15% of the world’s population – lack access to quality healthcare services. Most of these people live in rural areas in developing countries. Meanwhile, the developed world is facing a different situation – there will soon be more old people than children, and more people in extreme old age. This transition will have an impact on long-term healthcare systems, local community support, and the social structure, as a large percentage of elderly people will be living alone or with a spouse.
For both problems, we need healthcare delivery models that rely less on doctors and more on other health workers who can reach people even in remote locations. In the drive to empower local health workers to provide accessible, quality healthcare, engineering solutions are key. The recent Engineering a Better World conference in London, hosted by the Royal Academy of Engineering, highlighted this role and showcased new technologies that are improving access not only to healthcare but also to energy, water and sanitation.
One such technology, developed by Grameen Communications in Bangladesh and Kyushu University in Japan, is the Portable Health Clinic (PHC) – a compact telehealth system that seeks to bring quality healthcare to remote communities. The portable clinic, resembling a briefcase, contains diagnostic equipment and software for archiving and searching health records.
A community health worker visits patients and takes clinical measurements using diagnostic tools in the briefcase. They track data via an app on a tablet computer, and upload new data to a database. A simple algorithm is then used to categorise the patients in four colours: green (healthy), yellow (caution), orange (affected) and red (emergency).
To secure urgent treatment for those most in need, the health worker sets up a remote session for orange and red subjects, using mobile network coverage to connect the patient to a medical call centre. Doctors access the electronic results of check-ups, and provide advice and an e-prescription. The health worker prints the prescription and explains the medication procedures to the patients in easy-to-understand language. In this way, the portable health clinic can offer all the features of a traditional clinic.
For any accessible technology, the key design requirements are that it has to be low-cost and easily transportable. The PHC briefcase will cost less than £245, and is light enough to be easily carried.
So far, we have completed a trial project with experiments in 32 remote locations in Bangladesh, by collaborating with local organisations. The objective was to identify low-income people at risk and improve their health. In the first large group health check-up, 8,527 patients were screened, with 1,629 identified as high-risk and the same number of patient-doctor telehealth consultancies established. The high-risk patients were prescribed medicine, and a follow-up health check-up was scheduled for two months later. The measurements then showed a remarkable improvement – 481 (48%) orange patients had moved to the yellow category and 70 (7%) patients had moved to the green zone.
Technologies such as artificial intelligence and improved internet capability will continue to open up opportunities to improve and implement remote healthcare. With time, algorithms such as ours will be improved by considering age, gender and local environment properties, to provide tailored care.
If we get it right, the result could be equal healthcare for everyone, irrespective of location, age or wealth.