Objective="Improve access of health care services to undeserved regions."
Details for Reform Option "Mobile phone consultation for community health care, Haryana"
The innovation was experimented by Rural Health Training Centre of Postgraduate Institute of Medical Education and Research (PGIMER) Chandigarh, at Naraingarh in Ambala, Haryana during May to December 2005.
Mobile phone number of the principal investigator (PI) was communicated to general population. People were asked to contact the PI any time for medical consultation. All the telephone calls from people seeking medical advice or treatment were answered by the PI who was responsible for providing medical advice. For this purpose, detailed and structured medical history was taken from the patient and accordingly appropriate advice or treatment was given. Further advice on follow up and contact with the doctor again was also given. Details of the phone calls received were duly recorded. Short Message Service (SMS) was also used to provide correct prescription if the caller was unable to write during consultation (provided he/she also had a mobile phone.) At the completion of each call, permission was sought for a follow-up call to determine the caller's response to the advice/treatment given. Consent for the study was obtained from all the respondents. All data has been kept confidential.
To provide 24 hours, free of cost, mobile telephone consultation to rural community of Haryana, India through a community physician
To ascertain the acceptability, feasibility and scope of mobile phone medical consultation in rural areas of north India.
Results: A total of 660 phone calls were received during the study period. The main results found were:
Mean duration of a call was about 2.7 min, around 80% from Males
The mean age of callers was 32 years.
Gradual increase in the number of calls from 16 in May to 186 by December 2005. Approximately 60% (394) calls were from Naraingarh sub division.
Out of 417 calls for advice or treatment, 224 (53.7%) calls were regarding advice on a specific health problem and 193 (46.3%) calls were for treatment of some ailment. Most common morbidities were skin, respiratory, psychological and behavioural, sexual, gastro intestinal or locomotor problems.
During the follow up, 387 (92.8%) callers were traced and interviewed.
About 96% of users were in favour of continuation of the service in future also. About 302 (78.0%) followed the suggested advice.
Among these, 275 (91.15) found the advice very useful in tackling their health problems.
About 96% (371) users favoured continuation of the service in future also.
Among other results, 257 (61.6%) callers had minor health problems, so they were advised to manage it at home (self care) as per the suggested treatment, 74 (17.7%) callers were advised for routine appointment with specialists, 42 (10.1%) callers were asked for urgent local general practitioner visit, 29 (6.9%) callers were referred for emergency department visit, and 15(3.6%) callers were advised to visit some other nearly agency like NGO/Charity hospital for their problems.
Rural Health Training Centre, Sub divisional hospital at Naraingarh in Ambala, Haryana
1. Speedy advice
2. Savings on time and money spent in travel especially for handicapped, children, women and old people
3. Bypasses hospital formalities for consultation
4. Reduces shyness in discussing the problems
5. Convenient follow up process with increase in the medical knowledge of lay people regarding self-care.
A physical examination is crucial to a patient's diagnosis, without which, physicians may miss some important clinical finding. This can unintentionally harm the patient. Many medical problems need physical examination for proper treatment and cannot be dealt on the phone.
Ø Motivation, commitment and willingness to work for community.
Ø Mobile phone
Ø Physicians willing to spare few hours from his/ her routine life
Ø Provider should be familiar with the customs, belief, language of the area
Ø A small pool of funds for recurring costs.
Who needs to be consulted
The head of the Institution for the permission and consent to run such a service and department of communication or any private company for mobile phone connection and willing medical officers who are going to deal with this service. We also need to consult local media persons to disseminate the mobile phone number and ideas and needs of such services
Sustainability depends on the interest, attitude and commitment of service provider (doctor) towards community. If doctors can spare time and answer the calls and also get their phone bills reimbursed, then this system can be made self-sustainable. As incoming calls are free and most of the doctors have their own mobile phones, they can provide services in their respective places.
Chances of Replication
Replication is not difficult but the only thing is to find a motivated, determined, skilful physician for this services.
This service can prove beneficial in areas where commuting is a major problem especially in rural, hilly & tribal areas and sometimes in geographically difficult terrains. It can also be life saving in areas where doctors are not easily available and accessible.
Dr. Surya Bali, Lecturer, Allahabad University
Dr. Amar Jeet Singh, Addl. Professor, PGIMER, Chandigarh
Manisha Ghose, Research Consultant, CBHI.