Community Health Workers and expanding primary care in rural Uganda, Paul J. Krezanoski, MD

Another discovery on my recent trip to Uganda is the growing use of technology to augment the ability of lower skilled health workers to improve care delivery. The Healthy Child Uganda cell phone project, funded by an aid organization from Canada, is a perfect example.

They have piggy-backed a cell-phone based technology project onto a Uganda national government initiative to utilize communty based health workers. These health workers are designated by their communities as respected leaders at the village level. Depending on the size of the village, there is usually 1-3 CHWs identified. Their typical job is to help with training and mobilization for vaccine campaigns and other national priorities.

Healthy Child Uganda has rolled out a full scale point-of-care treatment program using cell phone technologies. They have programmed phones with interactive algorithms that CHWs use to treat the patients they see in the villages. Using the age of the child, the symptoms and a checklist of red flag symptoms, teh algorithm designates intital treatment options (amoxicillin for fast breathing (?pneumonia) or artersunate for fever (?malaria)). Then, based on the symptoms, the phone will recommend referral to a local clinic and automatically update that clinic of what to expect via a web application.

They are using this platform for stock delivery of medications at the CHW and clinic level and have a sophisticated web application which provides real-time data about what cases the CHWs are seeing in the field categorized by age, symptom and geographic location.

The hope is that these sorts of low-end technological solutions are gonig to allow the health systems in poor countries to overcome logistical challenges to provide higher quality primary care in remote locations. I thought this was a great example of that concept.