Does your solution have the potential to answer one or more of these problem statements?
Inclusion of Community Health Workers (CHW) in Telemedicine
With efficient upskilling, CHWs (such as ASHAs) could become a driving force in delivering digital health solutions to the masses.
How might Community Health Workers (CHWs), such as ASHAs, be remotely upskilled to provide post-delivery connect with patients so that they trust and return to the online/remote doctor in a telemedicine set-up?
Note: Our research tells us that ‘people are used to in-person consultations’ and are wary of treatments or ‘doctors who are online’ (Field Notes 2021). The role of the CHW involves ‘providing education to communities and families on a range of health issues’ as well as ‘assisting families in gaining access to medical and other health services’ (ILO 2012). And even now, CHWs take the effort to ‘connect with the patient even after the process is over, so that they come back’ (Field Notes 2021).
The overcoming of patients’ fear and unfamiliarity with digital healthcare and a remote doctor is a major factor in furthering the social acceptance of telemedicine.
How might the potential and networks of CHWs be leveraged for community mobilisation to overcome the barriers of social acceptance for telemedicine?
Note: From our research, we know that the CHW is a social body and not an independent, individual actor (Field Notes 2021). And that responses to health are socially determined, not merely biomedical (Burgess & Horii 2012). We recognise therefore, that a holistic response is required to help CHWs realise their role as socio-political actors of health, touching upon multiple aspects such as training, dissemination of community relevant and accessible information to build awareness, infrastructural support, the technology itself, as well as a consideration of on-ground realities anchored in how health is negotiated through and by the community.
The effectiveness of ASHAs today is severely limited by an outcome-based incentive model and limited capacity development. They are treated as formal employees but remunerated as volunteers on an incentive model.
How might we strengthen learning and performance for CHWs in low resource settings so that their aspirations are taken into account and their capacity to work in incentive-based structures increases?
Note: We know that telemedicine’s ‘logistical ease and low cost provide a platform for increased CHW training and support availability, thereby decreasing multiple program barriers, including knowledge, competency, structural, contextual, and attitudinal’ (Vaughan et al, 2020). Prior research has also demonstrated that the effectiveness of building a community of practice around telemedicine can enhance the medical practice and sustainability of telemedicine interventions (Chandwani, Deb & Dwivedi 2018). As a final note, we submit (as our research also underlines) that this must be done in alignment with the ‘cultural map of aspirations’ (Appadurai 2004) which CHWs navigate as they help realise health interventions. While doing so, it is important to account for the relations in the ecosystem that influence the success of such initiatives, including supervisors, community leaders, other CHW workers as peers, family members, patients, health officials, and professional healthcare providers.
Once they are included, the stability of the telemedicine system will be linked to the financial and health risks of CHWs. Access to working capital finance could also open the door for CHWs to micro-entrepreneurship.
How could social security, access to insurance, and working capital finance be enabled for CHWs for them to perform well under incentive-based health outcome schemes?
Developing Multi-Purpose Health Workers - Auxiliary Nurse Midwifes (MPHW-ANMs) as Telemedicine Service Coordinators
For telehealth networks to penetrate remote areas of the country, the availability of Telemedicine Service Coordinators needs to grow. Multi-Purpose Health Workers – Auxiliary Nurse Midwifes (MPHW-ANMs) have the potential to fulfil this role, and provide impactful, empathetic care to patients and communities in form of better triaging and inputs for tele-health processes.
How might Multi Purpose Health Workers: Auxiliary Nurse Midwives (MPHW-ANMs) be upskilled based on their field work expertise so they can grow into a Telemedicine Coordinator role?
Note: From our research, we know that the set of interactions which the MPHW-ANM facilitates across the patient journey spans clinical, managerial and technical dimensions, which takes place equally before, after, and during the teleconsultation session itself (Chandwani, Deb & Dwivedi 2018). We also recognise that the MPHW-ANM imagines her work and aspirations in a manner which aligns with the career progression pathway which the role of the Telemedicine Coordinator (NSDC 2020) offers.
The Telemedicine Coordinator’s ability to ensure smooth, streamlined operations can improve the efficiency of doctors and reduce the cognitive load on them. Standard Operating Procedures (SOPs), exception handling, and decision making aids can assist Coordinators in this.
What technology and processes might aid MPHW-ANMs in facilitating telemedicine interventions in a manner which balances supply (doctor availability) with demand (patient time)?
Note: We know that ‘the low doctor-patient ratio in low-resource contexts like India is …[a]… dimension that needs to be addressed in the design and implementation of Telemedicine. The doctors in India, especially the super-specialists, are considerably overloaded with very high patient turnover.’ (Chandwani, Deb & Dwivedi 2018). At the same time, our research tells us that the consultation between a patient and a doctor is a social, relation-driven process, and not a one-time event. Here, we advance that MPHW-ANMs can play a bridging role, but recognise that they will need to be suitably enabled and empowered.
Steadily, over multiple interactions, Coordinators can improve patients’ understanding of technology such as computer screens and cameras and improve their knowledge, skills, and attitude towards the self-management of diseases. This could improve the efficiency of tele-consultations and improve outcomes.
How might MPHW-ANMs be upskilled to improve the quality of their interactions with patients with the aim of “moulding” patient behaviour into an expert patient?
Developing micro-entrepreneurs at the local level is a key aspect of telemedicine implementation and sustainable development.
How might MPHW-ANMs be upskilled and supported to grow into telemedicine micro-entrepreneurs through enablement of professional community networks for faster mobilisation and access to working capital finance?