Community-driven Municipal Healthcare Model
Explain your idea in details:
[PROBLEM]: More than two-thirds of Nepal's population lives in villages. Financial, geographical, sociocultural and educational barriers prevent access to healthcare for them. The fact that well-equipped health facilities and clinicians are concentrated on cities further exacerbates this divide in healthcare. [OPPORTUNITY]: Nepal is currently transitioning from a centralized monarchy into a federal republic. Duly, the country has recently been divided into about 750 municipal units with increased fiscal and decision-making autonomy. This political-administrative restructuring of the country is a golden opportunity to create a transformational model of healthcare system in low-resource settings. [IDEA]: Directly deliver high-quality healthcare at a Rural Municipal Unit TO FORM A MODEL, at costs lower than that of the government Structurally, the Municipal Health System will comprise of a major municipal health center and several sub-municipal facilities connected to the major facility. The integration will be ensured through optimal mobile-based and internet technology and a network of Community Health Workers. The Community Health Workers will also work to coordinate care in the communities and patients’ homes. Thus, there will be multiple hubs and spokes at different levels that are integrated into one whole, like a dandelion. Functionally, it will have: 1. Expanded Care the available care at clinics including 24-hour emergency and inpatient care besides the usual outpatient care. Regular outreach clinics at selected venues and dates will provide basic clinical and preventative services. 2. Extended Care in the community provided by Professionalized Community Health Workers who provide care right at people's homes, and 3. Coordinated care between different providers and sectors through more robust and integrated referral systems.
Expected impact of your idea on sustainable development
The evaluation of health systems has gradually evolved from the morbidity and mortality analysis increasingly to the analysis of value for investment in health. A robust system is necessary with a proper mix of qualitative and quantitative tools in line with the ideas of quality, equity, and dignity as we move towards universal health coverage for sustainable development. The following is an outline of the major targets that shall be used to evaluate the success of the initiative: [TARGET 1]: Related to Knowledge and Attitude on Health Increase the percentage of secondary school children with sound knowledge and attitude towards healthy lifestyle choices, regular physical activity, General and Mental Health to 95% by December 2018. [TARGET 2]: Related to Non-communicable and Chronic Diseases Increase the follow-up rates and medical compliance of patients with major Non-communicable diseases and Mental Illnesses to 95% and that with TB and/or HIV/AIDS to 99% by December 2020. [TARGET 3]: related to Maternal and Child Health including Infectious and Parasitic diseases Increase the percentage of pregnant women who deliver at a health facility to 95% and percentage of children treated according to protocols for diarrhoeal diseases, respiratory illness, and malaria to 99% by December 2021. [TARGET 4]: related to Equity, Justice, and Strengthening of Public Institutions Increase the percentage of days with clinical(including basic surgical) and public health services(including family planning information, diet counseling etc.) available to the general population within three hours from their homes to 95% percent of workdays by December 2022. The Indicators 1, 2 and 3 above specifically demonstrate the impact of the idea to Goal 3 [ Good Health and Well-Being ] and the Indicator 4 above specifically caters to Goal 16 [ Peace, Justice and Strong Institutions] of the Sustainable Development Goals.
Plans for implementation and sustainability
[EVENTUAL PURPOSE]: To develop a comprehensive community-driven Municipal Health System. [IMPLEMENTATION STRATEGY]: At the beginning, a few individual components of the health system model will be implemented based on the observed and felt needs of the local community and available resources. The summation of the major component interventions of the model implemented over time will give shape to the comprehensive model. [FINANCIAL STRATEGY]: The total budgetary cap of the project is 10 USD per capita per annum. That figure is derived from the current spending trends in the sub-district level in the country, projected investment needed to support additional infrastructure, human resources, and the standard public health services. [INVESTMENT] We understand however that a commitment of such proportions is not entirely feasible for the public sector in an underdeveloped country like ours until we are able to show promising evidence in favor of the model. So, the initial investment in such a project shall largely be from the non-state sector. Crowdfunding and donations from grants/foundations will make up the major part of the financial resources for the first three years. State or community contribution via direct state investment, state-managed insurance scheme or community micro-insurance will increasingly make up the major part of the financial resources after the first three years. Eventually, the project will essentially depend upon the public sector sources for day to day operations. As such, a proper distinction of the operations costs from the start-up costs of the model will be rigorously maintained. [SKILLS SUSTAINIBILITY] Experts in Public Health and Healthcare Administration will be involved in planning, program design, and implementation for the first time before the local staffs acquire essential skills. The guidelines and protocols developed thereof will be an open knowledge so that the process design and implementation can be replicated according to peculiar local conditions.
I am Bishal Belbase and I turned 29 this March. When I was around seven years of age, I had developed bronchitis and had to make frequent trips to a hospital 6 hours by road. Years later, I learned the fact that 15 out of 100 ‘peers’ in Nepal born in the same year as me, were not lucky enough to not make it to their fifth birthday due to treatable conditions like I had or diarrhea. This fact kindled in me a passion to do my part in overturning the fates of those who were most in need. Thankfully, I was awarded a scholarship to enroll at a government medical school. As a medical student, I helplessly saw many patients die just because they did not have enough money or paperwork on time for getting the care they needed. Working as a young doctor in rural far-western Nepal with an NGO, I saw first hand the extreme levels of poverty and the inefficiencies in public sector healthcare. The government health posts or hospitals, the only facilities which the majority of the households can afford, are understaffed, undersupplied and underprepared. Our team there launched Nepal’s first Facility-integrated Home Visits program and trained local women to act as Community Health Workers who would go to the homes of patients and pregnant mothers to ensure no one is left behind when it comes to receiving care. Still, a search to build a system that is so simple that it can be replicated everywhere, that is so low-cost that can be scaled nationally even in under-resourced countries like Nepal continued to haunt me. Now, we have a growing team where like-minded individuals volunteer, some full-time and some part-time, to do just that. This project here is a major step ahead in that direction.