Re: UTexas Executive Summary
Date Due: Feb. 15, 2008
Contact:
135 College Street, Suite 323
New Haven, CT06510USA
Team Name:
CHWired
Mission
Can you say it in one sentence? (50 word limit)
We aim to develop information and communication technology solutions for community health workers in rural, impoverished areas that connect them with the knowledge and support they need to serve their patients.
Statement of Problem
What social issue will your project address? What community will benefit from your solution?
(150 word limit)
The World Health Organization estimates that a majority of the world's people live in areas without any trained healthcare providers. Extensive research has demonstrated the effectiveness of one particular approach to meet this need: training local citizens as paramedics, known as community health workers (CHWs). While the potential for CHWs to greatly improve health access and quality has been demonstrated in a vaccination, vitamin distribution and HIV programs, their wider potential has yet to be realized. This is largely because they lack the support they need to be effectively become integrated into healthcare systems. Recent advances in communications technologies can meet thesechallenges, but applications are needed that are user-friendly for CHWs. We propose a communications-technology system tailored specifically for CHWs that will be deployed in rural Achham, Nepal, a district that previously had only one doctor for 250,000 people.
Solution
How do you plan to address the problem? What logistics or resources are involved in making your idea work? (250 word limit)
We will developa CHW-centered telemedicine system, connecting community health workersto communications infrastructure being setup in rural Achham, Nepal by our student-run organization Nyaya Health. We will pilot an inexpensive Wi-Fi system for voice and data communications to connect the "foot soldier" CHWs to the "home base" clinic.
Applications for the portal will include the following:
1) Communication systems between CHWs and doctors or other health professionals at hospitals and clinics within the CHW’s home district. For example, a CHW seeing patients in a distant village could relate clinical history and images to a doctor at a central clinic for treatment and triage.
2) Inexpensive communications technology that will connect CHWs for mutual advice and experiential knowledge exchange, solidarity, and support. For example, CHWs experienced in caring for patients with HIV and tuberculosis may share their clinical knowledge with other CHWs in outlying villages.
3) Data collection and management tools for surveillance, using simple interfaces with minimal literacy requirements. These would be integrated with the government of Nepal’s disease reporting systems to provide public health planners with critical community-level epidemiological data and outbreak identifications.
4) Quality assurance and program monitoring tools. Such applications would fill the gap in monitoring and evaluation that is necessary to sustain effective health interventions.
5) A sustainable training system. By training CHWs and allowing regulated information exchange, we critically address the "brain drain" that removes healthcare workers from these areas, facilitating sustained transfer of medical knowledge and building future generations of healthcare delivery experts.
Social Innovation
What are the specific results or tangible difference that your innovation will make to the
community or people you are trying to help? (150 word limit)
We aim to change the debate about the directionality of information flow delivered by telemedicine in resource-poor settings. In our approach, information is not only valuable when flowing from resource-rich to resource-poor settings, but also when it flowsbetween experienced CHWs to other workerswithin poor areas.
Specific, measurableoutcomes include: 1) retention of CHWs in their postings; 2) recruitment of high-quality candidates for CHW postings; 3) skills assessment of CHWs; 4) CHW adherence to clinical protocols; 5) CHW job satisfaction; 6) geographical expanse of CHW roll-out; and 7) equity with which this expansion occurs with respect to existing socioeconomic inequalities. Additionally, we will conduct a microeconomic analysis to calculate the cost-effectiveness and potential scalability of our program, in line with the WHO’s "task shifting" callfor models that facilitate the role of CHWs as a new force for healthcare delivery to poor regions in the 21st century.
Financial Narrative:
Is this a nonprofit or for profit venture? What sources of revenue and what major expenses do you anticipate for your annual budget. (250 word limit)
This is a nonprofit venture conducted by leaders of the student-run nonprofit organization Nyaya Health. We will build from the community health worker network and the information and telecommunications infrastructure that we have been developing. The approximate budget for start-up and one-year costs to pilot the project in 15 villages is below. During the first year of piloting, we will conduct a detailed assessment to engage the government to expand the model.
TOTAL COSTS--$52,850
Personnel Subtotal-- $32,500
Salary support for clinic-based program coordinator:$7,500
Annual Salary of CHWs ($1000x15):$15,000
Fees for Kathmandu-based web portal design consultants$10,000
Materials and Equipment Subtotal--$12,150
Medical equipment for one CHW for one year ($500x15):$7,500
One VOIP cell phone per village ($60x15):$900
One Wi-Fi antenna per village plus wiring, mounting($250x15):$3,750
Training Subtotal--$2,250
Supplies and food for three 5-day training courses ($50x15x3):$2,250
Travel Subtotal--$2,250
Travel stipend for walking weekly to the clinic (50tripsx$3x15):$2,250
Evaluation Subtotal--$500
Payment of local data entry technician: $500
Information Dissemination Subtotal--$2,400
Food for community forums: $100x24=$1200:$2,400
General Overhead in Nepal--$800
Office and presentation supplies: $800
Other costs, such as travel costs incurred by expatriate student volunteers, are borne by the expatriates themselves. As such, nearly 100% of the funds indicated are spent within Nepal, and all staff salaries go to Nepalis. This is the organizational philosophy of Nyaya Health, in that donors' funds should stay within Nepal and be directed at building local capacity.
Implementation Plan:
List the steps to launching your innovation. (150 words limit)
We will develop and implement the system among 15 villages in Achham, Nepal. The prototype development phase is ongoing and will be completed by June 15, 2008.
1) Development of Wi-Fi communication systems to link villages in the district.
2) Community assessment to determine which 15 villages are most feasible to implement the program.
3) Development of preliminary communciations applications by Nepal-based software developers in collaboration with our team.
We will then take the following steps.
4)Equipping of CHWs with relevant equipment, and testing of applications with further refinement with the CHWs. This will take place over two months.
5) Implementation and evaluation phase. Over the subsequent year, we will monitor the program and implement improvements.
6) Expansion phase. We will work with the Nepali government to replicate the model and form linkages with other health programs in Nepal and beyond.
Idea origin/status:
Who's idea is this? List the team member name(s). When was the idea first conceived?
What is the current status of the project? (150 word limit)
The need for these solutions originated from our experience developing a primary healthcare program in the rural district of Achham, Nepal. This is an isolated and impoverished district, where there is only one doctor for 250,000 people, the median income is less than fifty cents a day, and the nearest functioning operating room is over ten hours away.
Our vision began to consolidate over the last year after we received support from the Open Architecture Network to open a telemedicine center. We quickly realized that we needed to develop innovative CHW-centered solutions to achieve effectiveness, access, and equity when using this telemedicine center to treat a widely-dispersed population of people, most of whom do not have transportation and live miles away, but can be reached by a roving CHW team.
Team members: Anup Patel, Ilana Brito, Robert Stavert, Paul DiCapua, Adam Kaye, Duncan Maru, Sanjay Basu, Bibhav Acharya