Global Communication Center Established in 2007 as a collaborative R&D Project between Dr. Muhammad Yunus, Nobel Laureate of 2006 in World Peace is th

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1 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 All right reserved to Global Communication Center Agenda 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

Global Communication Center Established in 2007 as a collaborative R&D Project between Dr.

Yunus says: Don t ask consumers to go to the service providers but ask service providers to reach the

Thus, GCC aims to Development of Technologies based on Social Needs Providing social services to the

2 Global Communication Center Established in 2007 as a collaborative R&D Project between 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. 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 BANGLADESH: COUNTRY PROFILE IN HEALTHCARE SECTOR 4

& effort to go - Need extra money for the travel - Woman denies to see unknown male doctor in person Solution?

shortage of 60,000 Doctors - BD has 23,000 Nurses instead of 300,000 shortage of 280,000 Nurses 70 60 50 40 30 20 10 0 62 42 24 21 6 3 Maldistribution and Migration - Less than 20% of Doctors

3 Bangladesh: Country Profile in Healthcare (1) High population density 8 th in the world (total) and 6 th (density) 70% people live in rural areas but Poor Healthcare Facilities in Village - Insufficient hospital and clinic - Absence of qualified doctors 30% Urban Rural 70% Population Distribution in BD 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 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 No. of Doctors Per 10,000 Patients in 2010 (Source: 6

Possible Healthcare Solution Now for the Technical

healthcare system, here comes the solution from

transmission to online server for remote doctors 3.

4 Possible Healthcare Solution 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) 7 PORTABLE HEALTH CLINIC

5 Basic Health Check-up Package 1) Body Temperature 2) Blood Pressure 3) Pulse Rate 4) Arrhythmia 5) Height, Weight and BMI 6) 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 Operational Model: 4 Components Grameen Healthcare 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 Internet Portable Health Clinic Device - Business opportunity for the device vendor Internet / GSM Net Call Center with CC Application - Opportunity for part-timers (1) doctors who are in study (2) house-wife doctors

6 PHC Service Process 1. Patient Registration & Case History Collection 2. Health Checkup Process Example: BP Triage 129 / / / / Category Identification & Report Printing 4. Video Conference between Doctor & Patient 5. Report & Prescription Delivery 11 PHC Server-Application System Web based PHC Server-Application System e-prescription by Remote Doctor 12

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

7 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 Fig 3: Age Distribution of Subjects Female 52% Male 48% Urban 31% Rural 69% 5.1 37.

8% 0% Fig 2: Participants Location 100.0% 80.0% 60.0% 40.0% 20.0% 0.0% <25 25-29 30-34 35-39 40-49 50-59 60-69 70-106 6.6% 6.

6% 6.8% 4.4% 5.9% 5.7% 3.2% 7.5% Fig 5: Individual Site Triage 65.2% 62.6% 60.2% 17.0% 13.9% 14.

8 1ST Phase Test Results (FY2012) N=8527 Fig 3: Age Distribution of Subjects Female 52% Male 48% Urban 31% Rural 69% Fig 1: Sex Distribution 5.0% 80% 36.8% 60% 40% 50.3% 20% 7.8% 0% Fig 2: Participants Location 100.0% 80.0% 60.0% 40.0% 20.0% 0.0% < % 6.8% 5.4% 4.6% 5.0% 1.3% 0.9% 1.0% 1.6% 16.9% 25.6% 22.5% 23.5% 46.5% 41.1% 38.9% 40.6% 38.1% 40.1% 47.6% 49.8% 49.1% 53.6% 65.6% 6.8% 4.4% 5.9% 5.7% 3.2% 7.5% Fig 5: Individual Site Triage 65.2% 62.6% 60.2% 17.0% 13.9% 14.6% Fig 4: Overall Triage 2nd Phase Test Results (FY2012) N= % 80% 70% 60% 50% 40% 30% 20% 10% 0% 12.04% 7.76% 37.81% 87.96% 47.36% 7.06% First Phase Second Phase Fig 6: Health Improvement in 2 Months 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% First Phase 3.3% 38.0% 50.7% 8.0% Second Phase 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% First Phase 40.5% 36.4% 23.1% Second Phase Fig 7: Improvement of Orange Patients Fig 8: Improvement of Red Patients 16

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

9 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 Mobile Clinic: Booth

80% (29 million) are low and middle income

10 Portable Health Clinic Mobile Clinic: Booth Type Portable Clinic: Briefcase Type 19 Preventive Healthcare & NCDs 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 20

Social and Technical Challenges in Serving Preventive e-healthcare Services to Rural and Unreached People

Social and Technical Challenges in Serving Preventive e-healthcare Services to Rural and Unreached People Ashir Ahmed Kyushu University & Grameen Communications Agenda Can we trust the e-doctors? How to