The Last Mile
Disclaimer: This is an op-ed
We’ll start off with definitions for better understanding on why last mile access is important.
What is Accessible Health Care
As per a cursory glance from google scholar, accessible health care is, as cited from University of Missouri School, of Medicine:
“The ability to obtain healthcare services such as prevention, diagnosis, treatment, and management of diseases, illness, disorders, and other health-impacting conditions.
What is Primary Health Care (PHC)
As per wikipedia (yeah I know, no scientific rigor.. this is an op-ed!):
1. Primary health care (PHC) is “essential health care” that is based on scientifically sound and socially acceptable methods and technology. This makes universal health care accessible to all individuals and families in a community. PHC initiatives allow for the full participation of community members in implementation and decision making.
2. An approach to health beyond the traditional health care system that focuses on health equity-producing social policy. PHC includes all areas that play a role in health, such as access to health services, environment and lifestyle. Thus, primary healthcare and public health measures, taken together, may be considered as the cornerstones of universal health systems.
In continuing with this definition, an excerpt from the World Health Organization (WHO):
Primary health care enables health systems to support a person’s health needs — from health promotion to disease prevention, treatment, rehabilitation, palliative care and more. This strategy also ensures that health care is delivered in a way that is centred on people’s needs and respects their preferences.
The components of PHC, as per WHO are:
- Integrated health services to meet people’s health needs throughout their lives.
- Addressing the broader determinants of health through multi-sectoral policy and action.
- Empowering individuals, families and communities to take charge of their own health.
Now that we are done with preliminaries, off the top of my mind some challenges for achieving PHC include:
- Infrastructure (roads, facilities, equipment, specialization),
- Information and data,
- Government leadership and policies
Whilst some problems have straightforward answers — the only way around the challenge of roads and infrastructure is to build and improve on these — the implementation of these is usually hampered by red-tape, bureaucracy, misconfigured or misplaced priorities and the endemic problem of corruption.
The absence of adequate road and facilities infrastructure significantly diminishes accessibility for primary healthcare (PHC), essentially prompting the conceptualization of the last-mile concept.
This leads to ideation of some novel and semi-novel solutions. A sample of these solutions include automated drone deliveries for vaccines and medicine (e.g. Zipline), community health promoters and volunteers (e.g. CHPs network in Kenya, ASHAs in India), Mobile clinics and many more examples.
What’s the idea of the last mile
As per definition in this USAID paper,
In the context of developing-country public health, the last mile may take different forms, depending on the design of the health system, but it always involves commodities reaching the SDP. Most commonly, the last mile is envisaged as the shipments of health commodities from the district level down to the SDPs
As noted from the extract, the definition of ‘last-mile’ continues to expand as an important part of achieving Primary Health Care. Our definition of last-mile will focus on the areas disease prevention, treatment and referral.
There are numerous strategies of achieving the last mile. I will highlight two: Mobile Clinics and Accessible health data.
Mobile Clinics in achieving last mile PHC
I have been privileged with working in the health informatics space in a sector with much travel, both within our country’s borders and beyond.
This has been a mind opener in observing development and infrastructure in different parts of the country; Coming from the capital city, and whilst I had fore-knowledge on the status of the nation, I was taken aback by how much we had to go as a nation. Theoretical knowledge was confronted by real life.
The exposure also brings a new perspective, as one is able to observe how users interact with the developed tools.
Observing the challenges of poor road infrastructure we ask ourselves a rhetorical question; If the mountain will not come to Mahomet, Mahomet must go to the mountain? Taking centre stage, the mobile clinic.
The idea of a mobile clinic is not a recent innovation; it has its roots in early human history when doctors would travel between towns.
The mobile clinic increases access to PHC by aiding in atomic diagnostic measures at the community level. These diagnosis can lead to either a prognosis and/or referral therefore achieving the third goal defined by WHO: Empowering individuals, families and communities to take charge of their own health.
The purpose of these clinics are malleable, that is, the clinic could be used to provide a myriad of services in different periods. For example, a clinic can be used for vaccine dispensation in a specific period, and then be adapted with equipment for diagnosis of NTDs (Neglecated Tropical Diseases) in another period. This malleability is a big advantage of these clinics.
Another use case could be having these clinics perch in a specific location and serve the community for a longer period, for example one month. These could enhance services to the community via tele-medicine, or having these clinics equipped with lab equipment enabling on-the-ground real-time lab testing.
Read more on mobile clinics from these links:
Easily Accessible Health Data
As part of the growing definition of the term ‘last-mile’, access to useful and critical data is a gap to be bridged. Some quick examples are developing a country-wide framework for Electronic Medical Records as a strategy for ensuring patient-level data is shared quickly to aide in diagnosis and prognosis, or having robust supply chains mechanisms ensuring medicines are efficiently distributed and allotted.
As this is a very wide ranging subject, traversing topics from government policies to ethical practices in health-data sharing, it is important to approach accessibility with care and sensitivity. Robust policies and mechanisms should be prioritized and employed to ensure health data is both protected and useful for the patient. Two major questions that should be asked when dealing with health data are:
- Who is the end-user for the data?
Ideally the end user should not only be licensed but also trusted to ensure that the data is used ethically
2. What is the scope of indicators that should be shared?
The amount of data indicators to be shared should be pegged on the requirement scope of the requesting entity. Essentially answering the questions ‘we trust the user, but how much data should we shared? what is the data being used for?’
Novel solutions are also being designed and developed to solve different parts of this challenge. An example of one of these solutions is an app we’ve built that helps track the nearest facilities (article link , app link) to a user. This provides querying services offered by facilities across the country.
Conclusion
There is still much more to be discussed around the last mile touching on health financing, government policies lobbying, legislation and implementation.
On this I would urge us, at our different statures and positions in life to have active involvement on the state of affairs pertaining health; for us to hold our governments accountable in these matters, and to contribute towards the health agenda.
The health of nations is more important than the wealth of nations — Will Durant
