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When a patient walks through our hospital doors in rural Nepal, our team is tasked with treating the whole patient, regardless of their condition and circumstances. On a given day, we may be responsible for providing antenatal care to an expecting mother, giving psychosocial counseling to a patient suffering from a mental illness, immunizing a newborn against polio, or performing an appendectomy on a patient with acute appendicitis. The spectrum of care we provide extends from prevention to diagnosis, treatment, and follow-up care.
But what if we were aware of disease outbreaks in the community before patients came to our healthcare system? Disease surveillance, or the monitoring of a disease’s spread and distribution, is an important part of any public healthcare system. A robust disease surveillance system can alert the healthcare system and inform decision-making, resource allocation, and community-level programming.
Stephen Thacker, one of the Center for Disease Control’s first epidemiologists, wrote: “Surveillance is the cornerstone of public health practice.” Dr. Al Ozonoff, Associate Professor of Pediatrics at Harvard Medical School and team member with Possible’s implementation research arm, Healthcare Systems Design Group, goes on to explain that “measuring health outcomes at the population level is fundamental and critically important both to assess where we need to improve and to track our progress. It should be the starting point for our efforts to improve public health.”
Rural Nepal lacks an integrated disease surveillance system due to its challenging geography, weak infrastructure, and lack of human resources. Considering that healthcare access is so challenging, many patients do not utilize healthcare facilities at the first onset of symptoms. These factors mean that expanding disease outbreaks may often go undetected by the healthcare system. Ranju Sharma, Possible’s founding Community Health Director and current Asia Regional Director for Medic Mobile, explains, “in remote places where information travels slowly over paper trails, it becomes near impossible to detect disease outbreaks early. Community health workers equipped with the right mobile phone based tools have the potential to fill this gap.”
To strengthen our healthcare system and solve for our patients, we partnered with Medic Mobile to implement a community-level disease surveillance system. Using mobile phones, community health workers serving our catchment area population recorded cases of diarrhea and respiratory disease they encountered in the community. David Meyers, Research Project Manager at the Harvard T.H. Chan School of Public Health, discusses the program.
“This light-weight program really allowed our community health workers to find out what conditions were affecting our communities, giving us weekly updates on the types of conditions we could expect. It was a night and day difference between collecting this data on paper alone.”
We studied the outcomes of this program and recently published our results. We found that the data collected by community health workers modestly correlated with disease trends seen at one of our hospital hubs. This indicates that such a community-based early warning system can help to better prepare our facilities for upcoming trends in patient needs.
Mobile tools offer the opportunity to connect communities with healthcare facilities. In recent years, the explosion of interest in mobile tools has given rise to an entire field: mHealth. Mobile tools have been used in low- and middle-income country settings to distribute microfinance loans, access lines of credit, and coordinate longitudinal care. By leveraging the strength of Nepal’s community health worker network, who at more than 50,000 are the backbone of the public sector healthcare system, we were able to develop a community-based approach to disease surveillance. As David Meyers notes, “we could not have done this program without our incredible community health workers, so we made sure to take as much time as was needed to train them and to give them whatever assistance they needed with the mobile technology.”
Solving for our patients requires use of innovative technologies, harnessing the knowledge and expertise of community health workers, and closing the implementation gap. David Meyers concludes:
“This is only a small study of one intervention, but our modest results will hopefully encourage other health systems and researchers to look into the potential of such a surveillance program.”
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