Ed note: Today we welcome Junaid Nabi and Dr. Rhatigan to the blog. For more about the authors, please see the bottom of this post.
In the spring of 2013, on a cloudy morning in Dhaka, Bangladesh, the world witnessed the worst industrial disaster in history: the collapse of the Savar Textile building in Bangladesh. Warning of cracks in the structure of the unauthorized eight story textile building went unheeded by building owners, causing the deaths of thousands of textile workers. This incident garnered massive media attention as several Western textile giants were involved. It also brought to the world’s attention the issue of modern sweatshops in the developing world where teenage children work from dawn to dusk in unsafe conditions. The tragedy also revealed some glaring disparities in global healthcare delivery, as victims of the tragedy had little access to emergency medical services in the first hours following the collapse.
One of authors of this blog post (Junaid Nabi) worked as volunteer surgeon with the Bangladesh Red Crescent Society (BDRCS) at Savar, and noticed a pattern that the media did not focus on: before the Bangladesh Army was summoned to help with the rescue mission, hundreds of local volunteers had already started the process of extracting buried victims from the concrete rubbles, and the only instruction they had were a couple of YouTube and FEMA videos.
Video by FEMA HQTV – Sep 09, 2015
Although many videos were in English, a language not fully understood by much of the local population, the visual nature of instruction along with available subtitle features embedded in the online application improved their comprehension. This experience demonstrated how advances in telecommunications technology can improve global health: by empowering “community health workers” (CHWs).
Technology, in particular telecommunications technology, will play an increasing important role in global health, as was recently documented during the Ebola epidemic, where mobile phones were used to deploy community workers, disseminate information, and even track supplies for clinics. These achievements did not require massive investments – or a revolutionary vaccine – but rather, an innovative approach to utilization of available resources in low-resource settings.
Recent data from the World Bank reports the penetration of mobile technology in developing countries is rising at an exponential rate. Effective incorporation of telecommunications technology has the potential to revolutionize the delivery of global healthcare as we know it. Mobile technology is already the most important channel of communications in the developing countries with countries like Bangladesh possessing 131 million mobile phones for a population of 157 million; while India has 1.1 billion mobile phones for a population of 1.2 billion; with the usage of mobile internet in the developing countries, the barriers to access professional expertise and knowledge resources for global health are also removed.
Seeking external expertise is a major cost for global health projects. Telecommunications technology enables CHWs to execute grassroots work without having to constantly move to the cities for professional guidance, delivering care on the ground to those who need it.
One of the biggest challenges in any global healthcare delivery project is the the question of affordability and sustainability – how to ensure continuity of programs and at the same time, not lose the progress achieved. Telecommunication interventions can improve coordination within the projects and increase flow of information at low-cost, enhancing affordability of global health programs, and therefore improving the value of services rendered. In addition, with the expansion of mobile banking in developing countries, payment systems for CHWs have also improved, which could translate into higher personnel retention rates.
For instance, an integrative review in 2015 revealed that mobile phone based SMS reminders improved adherence to medications across multiple diseases in almost twenty percent patients. In addition, a randomized control trial conducted in Kenya demonstrated that in patients with HIV infection, those who received SMS support had significantly higher anti-retroviral therapy (ART) adherence. These findings were later supported by a meta-analysis in PLOS ONE, which illustrated that text-messaging interventions not only improved adherence, but even resulted in lower viral load and higher CD4+ counts in people living with HIV, at a minimal additional cost. In resource-poor settings, utilization of telecommunications can be low-cost investments that can improve patient outcomes. This will further empower the CHWs, augmenting their reach and impact in the societies where they serve.
The use of technology as a way to engage with people is a growing field, and will take time to be fully absorbed in the realm of global health. It is imperative to stay on the lookout for these kinds of opportunities, as the potential for improving health outcomes in impoverished populations through improved health care delivery is immense – and can save millions of lives.
About the authors
Junaid Nabi, MD, is a physician, non-profit executive, and a medical journalist. He is currently pursuing a Master’s degree in Global Health Policy at Harvard Chan School of Public Health. Dr. Nabi was a member of the Medical Rescue Team at Savar in 2013, and was awarded the annual Volunteer Medal by the Bangladesh Red Crescent Society (BDRCS). Twitter: @JunaidNabiMD
Dr. Rhatigan is associate chief of the Division of Global Health Equity and director of the Hiatt Global Health Equity Residency Program. He is one of the co-directors of Harvard’s Global Health Delivery Intensive summer program and an associate professor at Harvard Medical School and the Harvard Chan School of Public Health.
Competing interests: None to declare.