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With the World Cup in South Africa ... All eyes are now on the African Continent ...

Perhaps as a result, there have been a spate of encouraging news items highlighting the prospects for improving healthcare delivery in Africa ... See links to MedTech-IQ postings:  Africa’s growth story;  Botswana Hospital Takes Major Digital Leap Forward, and What does it take to succeed in Africa? ...

... I now invite your attention to a fascinating McKinsey & Company report on "Three practical steps to better health for Africans ... A new model to make care more accessible to Africa’s people is not only possible but affordable" ...

... In it, McKinsey suggests 3 strategies to rapidly improve healthcare delivery:

  1) To employ community-based health officers who would provide essential primary care at the village level,

  2) To adopt mobile phone–based “telemedicine” approaches that connect health officers and
rural patients with specialized care, and

  3) To create networks of mobile health clinics that transport diagnostics and other technologies to remote places.

Together, the Mckinsey asserts, these approaches could quickly save many lives at relatively low cost—about $2 to $3 per person a year, compared with about $8 for traditional clinics.


... The McKinsey team studied the experience of eight countries that have improved on more than one of the United Nations’ Millennium Development Goals for health...

... Next they examined 100 or so delivery models being explored by private, public, and nonprofit groups around the world. From these, they identified the three they considered most promising ...

... The new model suggests that combining local health officers, telemedicine, and, where possible, mobile clinics could help African countries leverage existing health systems to scale up access to primary health care quickly, effectively, and cheaply. While the model’s individual components aren’t new, together they could help revolutionize health care ...

Local Health Officers:

By complementing standard medical doctors with less intensively—though professionally—trained local health officers who serve their home communities, African countries could dramatically improve access to health care. Successful programs have tended to hire local women, with training of about 9 to 12 months of formal instruction (classroom and field work) paired with practical apprenticeships.  The health workers had manageable territories of roughly one health officer for every 1,000 to 1,500 people, and were paid compensation ranging from
perhaps one-sixth of an average nurse’s salary to 125 percent of the country’s average salary. The health services offered need to be focused enough to be manageable and affordable yet broad enough to cover a range of essential needs including: first aid, basic preventive and diagnostic services, the distribution of materials (say, nutritional supplements or condoms), and
essential curative care—as well as the monitoring and, occasionally, treatment of chronic conditions.  The ratio of health workers to professional medical personnel should be eight-to-one ratio ...

These best practices require one local health officer per every 1,000 to 1,500 people, at a cost of about $1 a year per capita, and yields approximately three meaningful interactions a year with
trained medical personnel—a dramatic improvement over the status quo...


Once critical mass of local health officers as first responders has been obtained, one can harness the power of mobile telephony to dramatically increase the reach of the care that more extensively trained health - doctors and nurses - can help to provide.  Most people in Africa have access to mobile phones.  Urban call centers staffed by nurses and doctors could act as hubs that increase the impact of local health officers by providing them with advanced clinical support.  Mozambique has successfully used mobile phone–based diagnostic tools for this purpose.  Call centers could also support personalized training.  Assuming one check-in a week, a supervisor could support 50 or 60 health officers; biweekly check-ins would double the span of control. Such call centers, which would cost about $0.75 a year per person.  In Mexico today, MedicallHome (partly owned by the telecom provider Telmex) provides over-the-phone medical advice and
triage to one million households (five million people) for a flat $5 a month each, fielding 90,000 calls a month, using protocols developed by Cleveland Clinic...

Mobile Health Clinics

The third piece of the puzzle are mobile clinics to bring diagnostic tools, medicines, and supplies to local communities.  In recent years various organizations have begun employing them at
scale lowering transport barriers that keep many Africans from receiving care.  For example,in India, the nonprofit Health Management and Research Institute has deployed 475 mobile clinics across Andhra Pradesh to improve medical coverage for the state’s massive rural population. Turkey, Egypt, Namibia, Nigeria, and other African countries have begun experimenting with this model. Key success factors emerging appear to be:

  • Smaller is generally better: vans can cover more of Africa’s diverse terrain and poor roads than larger vehicles can.
  • Focus on providing care for chronic conditions and more complex follow-up interventions (i.e., antenatal care).  Supplies should include test kits, basic medicines, and diagnostic equipment (ultrasounds, ect.), and services should include education and awareness,
    screening, diagnosis, treatment, the delivery of supplies, and
    supplemental training for local health officers.
  • Routes must be chosen carefully so that each community can receive a visit at least every four weeks. .
  • Routes must be well advertised and timetables kept.
  • Finally, maintenance and running costs must not be overlooked.

Operating costs can be quite reasonable, with a mobile clinic staffed by two nurses costing less than $0.75 per person a year in most African countries.

Altogether, McKinsey estimates that these models will require one-fifth to one-tenth as many nurses and doctors as traditional clinics...

I tend to agree with the McKinsey analysis.  I believe the whole world is moving toward more distributed models of healthcare delivery based on Electronic Health Records (EHR)s, shared databases, and coordinated care facilltated by mHealth and Telemedicine ... These developments may set the stage for rapid transformation in African healthcare delivery capacity, and consequent access to care ...

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