Engaging village doctors in mHealth program? An experience from rural Bangladesh.

Author(s) Shahidul Hoque1, Mohammad Iqbal2, Sabrina Rasheed3, SMA Hanifi 4, Tanvir Ahmed 5, Abbas Bhuiya6.
Affiliation(s) 1Centre for Equity and Health Systems, icddr,b, Chakaria, Cox's Bazar, Bangladesh, 2Centre for Equity and Health Systems, icddr,b, Dhaka, Bangladesh, 3Centre for Equity and Health Systems, icddr,b, Dhaka, Bangladesh, 4Centre for Equity and Health Systems, icddr,b, Dhaka, Bangladesh, 5Centre for Equity and Health Systems, icddr,b, Dhaka, Bangladesh, 6Centre for Equity and Health Systems, icddr,b, Dhaka, Bangladesh.
Country - ies of focus Bangladesh
Relevant to the conference tracks Health Workforce
Summary Bangladesh is one of the 57 countries with a serious shortage of trained doctors, paramedics, nurses and midwives. Village doctors, a group of informally trained practitioners in modern drugs, are the dominant health care providers in the rural area. Village doctors, trained by the Centre for Equity and Health Systems (icddd,b) who had achieved an acceptable level of performance in dispensing drugs and in other desired areas related to the practice, were branded as ShasthyaSena (health soldier). The ShasthyaSenas took part in an intervention that combined their competence with that of qualified physicians through an mHealth call centre with the objective of bringing better health services to the rural community they served in.
Background Bangladesh is one of the developing countries where 80% of the population lives in rural areas. The village doctors were most prominent contact person for consultation for any illness by the rural poor in Bangladesh. 53% of the rural population resorted to village doctors for their health services. But the village doctors are not recognized by the public sector as authentic health service providers. icddr,b has tried to train the village doctors in order to reduce harmful treatment practices since 2006 in Chakaria. There is a dearth of study regarding the engagement of village doctors or informal healthcare providers in tele-consultation (mHealth) of patients with formal provider. icddr,b operates a project to engage village doctors with the consultations of graduate doctors through mobile phones and with technical guidance from Telemedicine Reference Centre Limited (TRCL) a private entrepreneur in Bangladesh.
Objectives The objectives of the project were to design a) an appropriate disease management scheme available to the village doctors for on the spot consultation with qualified medical personnel through a mobile phone. The range of management includes prescription by the formal physicians through SMS, prescription drugs supplied by the village doctors and referral to appropriate facilities if needed.
b) A business model aka financial incentive that can compensate village doctors and limit excess profit gained from unnecessary prescriptions.
Methodology The study was carried out in Chakaria, a rural south east sub-district of Bangladesh. Village doctors were trained on do and don’ts for providing treatment to patients and a membership-based-network involving trained and eligible Village Doctors branded as “ShasthyaSena” (Health Frontiers) was established which give the Village Doctors logos and badges. In 2011 ShaysthaSena’s were trained on the use of mobile phone (mHealth) for consulting with graduate doctors for their patients within a revenue sharing process. A Call Centre was established, eClinic24, to link the informal providers with the formal by (TRCL). TRCL provided technical and expert support for the project. We kept all the details of implementation i.e. inception, modification, challenges, perceptions etc. and periodic process documentation.
Results During 2011-12 program implementation periods, 110 ShasthyaSenas participated in the training and 55 registered with the eClinic24 system. Of those who registered, the utilization of the services was somewhat low. A total of 415 calls were enacted and only 26 ShasthyaSenas made those calls. 50 calls ended up in receiving prescriptions. Although there was a lot of enthusiasm among the ShasthyaSenas and the community about the mHealth, as the numbers of utilization indicates, the uptake was far below than what was expected. The major reasons for the low uptake of mHealth services mentioned by the ShasthyaSenas revolved around the problem of accessing the call centre, such as doctors not picking up the calls, long waiting period, and problems with the phones the ShasthyaSenas owned.
Conclusion Despite low uptake at initial program implementation, mHealth can be an effective means of health services in future and ShastyaSenas can be a viable options to engage as the community have confident on them. More research in this field needed by resolving the technical problems encountered during initial phase.

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