How to bring health care to everyone, everywhere

 

At present, more than 1 billion people worldwide have no access to basic health care. This means no inspection, no vaccination, no medication, all because of the environment in which people live. They may be too poor to go to the clinic, or they may be living too far away, but the result is the same and often deadly. This is a troublesome question.

 

1. Think beyond the looks of traditional healthcare systems.

 

Good healthcare is more than just hospitals and clinics - it's even doctors and nurses. According to Panjabi and Berkley, good healthcare needs to extend the scope of care directly to the homes of vulnerable community residents. Training community members to become health workers is one of the best ways to achieve this goal. This is how the last mile is healthy: the village nominates members of the community to participate in the program, and outreach nurses train 30 people in these basic skills so they can diagnose and treat common illnesses. Last Mile Health community health workers have conducted over 100,000 patient visits in Liberia, and the organization now supports the Ministry of Health's plan to serve 1.2 million people by 2021.

 

"Much of what physicians do can be done by less educated workers," Berkeley said before talking to Pangkal about the impact of community health workers. In Ethiopia, for example, community health workers cut child mortality by half; in Pakistan, female health workers intervened to provide care in a society that banned men from treating women; and in India, "recognized social health activists" Change the welfare of people living in rural areas. The common thread connecting these workers? They are professional. Berkeley said: "Philosophy has long been a community health worker who volunteers in poor countries." But it's a professional movement with supervision and quality. "

 

It is worth noting that community health workers do not work alone. "We recognize that they will not succeed unless they are integrated into the existing health care system," said Panjabi. "In Liberia, nurses guide staff and work with them." Community health workers connect patients to trusted doctors or nurses if they suspect more serious medical problems than they can treat. Berkeley said: "It's not about having health workers there, but nothing about anything." "You want them to be trained, you want them to be supervised, you want them to have a referral system, you want them to be obsessed with supplies This means linking with the government, which sometimes makes it more difficult, but in the end it is the only way to get things going.

 

2. Local health workers provide invaluable benefits: trust.

 

During the Ebola crisis, Last Mile Health partnered with the Liberian government and a number of partners to train thousands of community health workers in favor of their neighbors. Staff members helped to stop the spread of the disease while continuing to provide care for children and pregnant women. Conversely, in neighboring Guinea, some communities are hostile to external health workers who come to them. In a shocking case, eight health workers were killed by villagers who were considered workers being infected. Unlike Liberia's followers of health workers' instructions, many in Guinea are hesitant to change the traditional way of funeral, such as kissing the dead, resulting in widespread disease.

 

Differences between the two countries: Prior to the outbreak, Last Mile Health had established a baseline of trust through super-local work. The community knows the workers who came to their doorstep. "I think one of the lowest leveraged tools in healthcare is home visits," Panjabi said. "There could be great things happening when you recruit a neighbor, a relative, a trusted friend and take care of your home." In southeastern Liberia, this helps to contain the outbreak.

 

3. Local health workers can fill gaps in critical data.

 

Remote areas, such as Panjabi and Berkley, are often the blind spots in health statistics. Although the national average may identify 81% of children vaccinated, this figure may mask the loophole. In remote communities, the average may be 22% or even 8% - or no record at all. "Without local national data, we do not know where to focus. We can go to a country and say 'your vaccination coverage is not good, but where do you start?'" Berkeley said. To counter this information vacuum, he and Gavi's team demanded that WHO begin reporting its statistics at the regional level. So, how to collect these data? Community health workers can help. "They can become followers," said Pan Jabi. As a reliable source, they can manage surveys and explain how to use those responses - showing people that they are part of a bigger story.

 

4. Community health workers can play a key role in vaccine delivery.

 

Trust is also crucial when it comes to vaccines. Community health workers are in an excellent position to fight fears and explain how vaccination prevents children from getting sick - and stop the epidemic from spreading. Local staff can also help solve another, often overlooked issue: vaccine delivery. Although Gavi usually has enough vaccines for diseases such as pneumonia, rotavirus and even Ebola (which have progressed rapidly and store it), they need to be capable of handling rough, off-road terrain transport, "cold chain" Warehouse to truck to delivery location) and people who know how to manage these shots. Berkeley said: "Connecting all of these components is a challenge." You may have no electric refrigerator, no refrigerator supplies, but if you do not have a health worker, forget about the rest. "

 

Currently, community health workers in most areas are not allowed to get vaccinated due to local regulations. However, if there is a better system for nurses to train and monitor them, both Panjabi and Berkley think they can. Panjabi is using the 2017 TED Award to create a community health college, a digital platform for modern community health workers learning. He sees great potential for working with organizations like Gavi to create training tools and ensure that children can safely and effectively vaccinate. Panjabi and Berkley also raised the possibility of developing vaccine certification programs for community health workers and their supervisors.

 

5. Contact between vaccinators and providers.

 

Vaccination may be the gateway to people who were previously excluded from health care. For example, in 2015, 65 million children were vaccinated through Gavi. Many vaccines come from multiple parts and each interaction gives caregivers and family members the opportunity to see health workers. Gavi estimates that a total of 195 million point-of-touch points can be reached in primary health-care systems. "It's a chance not only to reach out to your child, but also to get his or her parents in contact with other siblings of health services," said Panjabi. "It's unusual."

 

Building a good supplier-patient relationship is crucial. Berkeley said: "When people connect to systems, they need more than just preventive and curative care - it's going to be your early warning system." Some infectious diseases such as Ebola first broke out in remote communities; if health workers were already at There, the disease will be quickly noticed. "The staff member said to their patient, 'Well, it's a strange disease and we need to investigate it and send samples to the lab and respond,'" 

 

Berkeley said. "The basic system is separated from the rest It is as important as room and hospital. If [in cooperation with the Ebola outbreak] there is a small-scale outbreak. We will never spread it to urban areas and the bodies are piling up in the streets. "