Abstract
Globally, there is a shortage of health workers in rural areas. Effective health systems depend on having sufficient, accessible health workers with the right skills. In countries like Nepal, highly skilled health workers often prefer to work overseas or in urban centres, and therefore, in the short term, it may be pragmatic to focus on ensuring support and skills development of mid level or paramedical health workers. Information technology has the potential to support these health workers. We describe a pilot intervention undertaken in Gulmi District, whereby all mid level health workers in the district have been provided with a free phone number to call three General Practitioner Doctors (GPs) in the District Hospital. The intervention aims to increase appropriate referral, and increase connectivity between the District centre and peripheral health facilities. We hope that our intervention will provide support to rural health workers, and, if implemented as part of a package of interventions, may increase retention. We present some initial findings from discussions with health workers and analysis of call-log data, and describe our next phase evaluation and possible scale-up.
Highlights
Where there are more health workers, there are better health outcomes.[1]
Qualitative data collected in this study indicates that the Peer Health Workers and health workers felt the intervention had a positive impact on patient care, access to medical advice, easy re-supply of drugs, confidence of PHWs, and improved relations between PHWs and health workers
Text messaging was perceived to be slightly less effective than phone conversations, some PHWs felt that this may have increased adherence with patients becoming more aware of reporting systems.[38] and three General Practitioner Doctors (GPs) to inform them about the intervention
Summary
Where there are more health workers, there are better health outcomes.[1]. In many low-income countries, there is a glut of health workers in urban areas, leaving rural areas underserved. They provided clinical and adherence monitoring and psychosocial support to patents at clinic and home visits They were able to call within certain hours, and a medical officer with training in HIV care answered their calls.[37] They tested the impact of the mobile intervention through a cluster randomised controlled trial, and found that the intervention had no effect on primary outcomes of cumulative risk of virologic failure at 24 weeks nor secondary outcomes of, patient adherence, virologic failure at 24-48 weeks, loss to follow-up or mortality. Text messaging was perceived to be slightly less effective than phone conversations, some PHWs felt that this may have increased adherence with patients becoming more aware of reporting systems.[38] and three GPs to inform them about the intervention In our pilot, these mid level health workers can use any phone - not necessarily a mobile phone - to contact any one of three GPs in the district hospital. Our experience suggests that interaction between health workers in rural areas and the district headquarters is minimal and our intervention aims to increase professional linkages between doctors in the district hospital and the periphery
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