Around the world, the health status of people in rural areas is generally worse than in urban areas. In South Africa, infant mortality rates in rural areas are 1.6 times that of urban areas. Rural children are 77% more likely to be underweight or under height for age; 56% of rural South Africans live >5 km from a health facility; and 75% of South Africa’s poor people live in rural areas.1
Critical factors in the relationship between poverty and health are population and environmental health issues. Eighty percent of the poor in Latin America, 60% in Asia and 50% in Africa live on marginal lands of low productivity and high susceptibility to degradation. This tends to encourage migration from rural areas to the cities.
With the concentration of poverty, low health status and high burden of disease in rural areas, there is a need to focus specifically on improving the health of people in rural and remote areas, particularly if the urban drift is to be reversed.
Despite the huge differences between developing and developed countries, access is the major issue in rural health around the world. Even in the countries where the majority of the population lives in rural areas, the resources are concentrated in the cities. All countries have difficulties with transport and communication, and they all face the challenge of shortages of doctors and other health professionals in rural and remote areas. Many rural people are caught in the poverty– ill health–low productivity downward spiral, particularly in developing countries
People in rural communities need to know that if they are unlucky enough to be seriously ill or injured, then the system is there to ‘save’ them. Generally speaking, in the cities where there are hospital emergency departments and ambulance services, this emergency response is assumed to occur. In rural and remote areas, this cannot be taken for granted, and people tend to be focused on their security need. Generally speaking, people in rural and remote areas very much prefer to be cared for in their local environment.
The provision of health services in rural and remote areas is significantly affected by limited funding and other resource constraints. As mentioned already, in developing countries, there is considerable poverty and limited facilities and resources available for health care. In many developed countries, there has been a trend towards the reduction of funding and infrastructure support for health services in rural and remote communities.
Seeing a health care provider is a time consuming process for people living in rural areas. To reach a health care provider many people from rural areas must take a bus for hours to urban areas to find qualified providers. This need to travel to an urban area limits rural residents’ access to quality medical care and may impact health outcomes across the lifespan.
The substantial gaps that exist between the actual health spending of many poor countries and the spending required to provide a package of essential health services suggest that lack of availability is the root of the problem in many instances.
It is important to recognize, however, that many effective interventions are not prohibitively expensive, even for very poor countries. For example, one half of avoidable child deaths in sub-Saharan Africa could be realized through home-delivered interventions.
In order to resolve these issues, many organizations have started to use mobile clinics that allow medical providers to come to their patients rather than have patients try to travel to hospitals. According to an article published in the American Journal of Public Health, “developing countries almost universally suffer from severe health service shortages, particularly those in rural areas” (Zeighami).
Traditional rural clinics have limited diagnostic capabilities due to lack of affordable and appropriate devices, lack of trained technicians, lack of power, etc. Patients are thus misdiagnosed (and mistreated) or referred to advanced (and remote) facilities, an extra trip involving cost and time that patients can ill afford and thus often skip, leading to follow-up losses. Well-equipped facilities are sparse, overloaded and have long wait times and poor customer service. Lack of patient history also undermines quality of care. Patient information is typically recorded manually on paper (if at all), making it slow and costly to manage and share – plus it’s often erroneous. To make matters worse, patients often lack reliable means of identification, e.g., an ID card or driving license. Finally, tools to help clinicians follow standard protocols for quality care and to enforce adherence by clinicians are limited.
Innovative solutions such as the MediCart have the opportunity to create a huge imact in the approach of medical care among developing countries.
There are many one-off technologies but no sustainable delivery model for rural health care that can absorb these technologies. Our intent is not to reinvent the wheel, but to funnel, optimize and integrate best-of-breed technologies into a cohesive plug-and-play platform for a new paradigm of health care delivery – to provide quality services cost-effectively and at scale in rural markets.
The MediCart’s flavor of telemedicine and its suite of medical devices have features to operate robustly in low-bandwidth and energy-constrained settings.
The MediCart will come with tools to register patients and maintain rich patient history, e.g., health data, symptoms, prescriptions, referrals, etc., using biometric identification, significantly improving accuracy and speed of care and making it possible to hold both clinicians and doctors more accountable for health outcomes. This has far-reaching implications for the larger health system. As more cases are effectively diagnosed and treated at primary care clinics it will pre-empt needless escalation to advanced facilities, easing the pressure on an already overburdened patient population and health care delivery system.
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