Health caravans

Access to medical care is often the most important problem of rural and remote populations. Geographic access to medical services is one of the main factors for reduced healthcare utilization in rural areas, where there is a shortage of professionals and a lack of medical infrastructure. Studies have shown that rural residents have fewer medical visits to the doctor than their urban counterparts, an aspect which is explainable by the fact that many of the rural residents go to the doctor only when it is absolutely necessary, for acute care visits, often neglecting regular and chronic care visits.

The poor access of services and facilities in rural areas is also influenced by limited transport options. Consequently, people living in rural areas tend to have less access and to receive less formal support services in terms of healthcare and other social services, which leads not only to a lower quality of life, but to increased mortality rates.

The situation described above fully applies to Romania, which is among the top 3 countries in EU with the highest unmet medical needs (according to the Romania country health profile 2021, European Observatory on health systems and policies). Among the causes is the major gap between urban and rural distribution of healthcare infrastructure and professionals - 81.5% of all hospitals and clinics are located in urban areas, and 91% of all physicians (excluding GPs) work in urban areas.

The Doctors' Caravan Association is a non-governmental organisation (NGO) with over 8 years of experience in delivering medical services to rural and  remote areas where there is a vulnerable population which lacks access to medical care. The aim of the NGO is to create a national system through  which primary care physicians can identify the needs of the local communities and address these needs through medical caravans and specialized healthcare. Also, the aim is to allow doctors, nurses and local authorities to be able to deliver regular medical services and training sessions regarding health and well-being in the areas that are economically and  socially disadvantaged.

The medical caravans are organised in various locations by a team of doctors (general practitioners and medical specialists) in collaboration with the local  authorities and the local general practitioner or nurse where available. We offer various medical assessments by assembling a multidisciplinary team  (medical specialists and medical residents, as well as  medical students) and travelling to a remote location where we set up a mobile clinic. We evaluate the health status of the population through a 3 stage concept: first we perform blood and urine tests; afterwards we do clinical examinations and paraclinical investigations (i.e electrocardiogram, abdominal ultrasound and echocardiography,  specialty consults: internal medicine, cardiology, neurology, ophthalmology, dermatology, gynaecology, paediatrics, etc.); we give medical recommendations and perform follow up visits via telemedicine and remote consultations. We identify vulnerable patients and travel to their location in order deliver medical assistance and promote prevention programs.

The caravans can collaborate with the general practitioners in the local  areas, in order to triage the patients and reduce the need to access big medical centres for minor problems. The entire process is digitalised and there is a medical management platform that integrates all the data and  helps ensure good collaboration between GPs, specialists and local  authorities. It also allows for follow-up and monitoring of the assessed patients, as well as health data analysis and research purposes, including community health needs assessments.

Our solution covers the following areas:
- Provide improved measurement methods that are low cost, fit-for-purpose,  shareable across information systems, and streamlined for data collectors;
- Provide actionable, accountable, and accessible insights for health care  providers, administrators, and/or funders that can be used to optimize the performance of primary health care;
- Balance the opportunity for frontline health workers to participate in  performance improvement efforts with their primary responsibility as care providers.

The solution addresses the following challenges:
- Lack of comprehensive vision and purpose for data collection: the Caravans program is carefully designed done in collaboration with Public Health and  Medical Experts;
-Poor quality or impractical data, inconsistent connectivity and adoption of real-time digital tools: the processes and data collection are digitalized using a fully customized software platform;
-Systems lack feedback mechanisms for data collectors themselves: feedback sessions are performed on a regular basis together with the Public Health Experts.

The target group is the rural population, a vulnerable population which has reduced access to basic health care(remote locations, low income, not insured, elderly, children). 

The aim is to identify vulnerable patients and to travel to their location in order deliver medical assistance and promote prevention programs,to raise awareness regarding screening tests and to educate the rural population on taking care of their health.  One of our goals is to identify and deliver health services focused on the main pathologies, customized to the specific needs of the respective community.

There is also a prioritization of the main health topics (main pathologies + main community health needs) covered by the caravans, according to the specific epidemiological picture:
- general caravans (covering chronic diseases such as cardiovascular diseases)
- paediatric caravans;
- gynaecology and maternal health caravans

The Doctors' Caravan Association has a vast experience in organising caravans.The program started in 2014 and now has a national coverage, having formed branches is 6 major cities and having organised over 130 caravans from which tens of thousands of patients have benefited.

The program was so successful that we proposed a legislative bill - The Mobile Healthcare Bill - which passed in march 2022 and has now become the foundation through which any medical professional can offer medical services in caravans.

I am applying because it is our desire to scale up our solution so that is becomes a national (and maybe international) model for improving healthcare in rural and remote areas. We require funding to improve our digital platform and analysis protocols in order to correctly identify the medical needs of the population.

Our solution is innovative because it combines a novel approach to delivering healthcare. Through mobile caravans, you can bring a team of doctors that can perform screening and diagnostic tests and improve the healthcare of a population that lacks access to basic medical services. The digital system that we have employed helps GPs identify medical needs and allowed them to request the services (through caravans) that would improve the health of the population. Our platform also helps identify patients that are in need of further investigations or follow-up and assists in providing solutions (proximity clinics, reminders, etc).

Moreover, the rural caravans provide the patients with a high "dose" of  empathy and enthusiasm coming from the young students and doctors,  fundamental for a creating a proper relationship between doctors and patients and trust among the beneficiaries. It is a win-win solution, as the young students and doctors have the unique opportunity to see and examine  patients, in the middle of their community, and understand the whole picture of their determinants of health.

We have recently achieved a major goal by passing The Mobile Healthcare Bill and our plan is to promote the deliverance of medical services through medical caravans. We hope more professionals / institutions will adopt this solution, and thus contribute to lowering the poor access to medical services for rural and remote areas.

This effective program can also be scaled-up by designing a community based model where various stakeholders are involved in order to offer better support and more regular access to healthcare services.

We measure our progress through the total number of population that has benefited from our health services and through the number of patients that have been treated and have consequently enrolled in our electronic medical platform to be followed-up and counselled so that they can receive quality healthcare. We also see a huge enthusiasm from the volunteers who organise the caravans, which are constantly growing.

Our solution changes the way healthcare is delivered. Instead of the patient coming to the clinic (which can constitute a problem for some categories of the population), we promote the concept of mobile healthcare. Through this concept, a team of doctors periodically visits rural and remote areas and offers medical services. This changes the paradigm that a patient only has to see a doctor when he has a medical problem / an ailment. Our proactive approach not only improves access to healthcare in remote areas, but also improves the general well being of the population through routine screening and prevention programs.

We envisage to change through this approach the behaviour of the local  population from passive seekers of medical support to proactive citizens seeking for preventive health services and maintaining their health.

The technology that powers our program is a medical management program that allow all the involved parties (patients, GPs, medical specialists, clinics, local authorities) to be connected, to identify the medical needs of the population and to help provide it afterwards. The solution is currently a web based platform that is mobile friendly and that uses advanced security protocols to ensure that all the medical information is protected.

Both GPs and the doctors participating in the mobile health caravans collect data. We examine the patients and include medical information on to a secure medical management platform that allows us to further investigate and follow-up the patient. The incentive is simple: if you digitalise all the data and use the algorithms that we have included in the system, then everybody can easily benefit: GPs can easily follow-up the patients, or refer them to the medical specialist/medical services that they require. And the patient can easily keep track of his information and follow all the recommendations that the doctor/doctors have given him.

We support and encourage diversity and equity within our Association. These actions can be seen by the large and diverse number of volunteers that have joined our group, comprised of medical students, medical residents and specialist doctors, but also nurses, midwives, community assistant and any other specialist that is connected to the field of healthcare. Moreover, the scope for which we started and developed this project was to provide medical care to the most distant and disadvantaged communities, regardless of gender or race.

So far, we have obtained financial donations / support from numerous companies that either had active projects in the health sector, or had CSR programs and wanted to get involved in our project. Our target group are the distant communities that have poor access to healthcare and we provide medical services free of charge. In the future, we plan to involve the National Health Insurance House and multiple stakeholders that have an interest in investing in the health of the local community.

One of the next objectives after passing the Mobile Healthcare Act is to regulate the framework for funding these services by the National Health Insurance House. We also plan to involve multiple stakeholders that have an interest in investing in the health of the local community (City hall, GP,s community nurses, territorial clinics and county hospitals, pharmacies, private companies).

So far we have received numerous grants from CSR projects and have won several funding projects from companies that organise funding contests. Through the private funding that we have raised we were able to organise over 130 caravans and provide medical services to more than 20.000 patients. Moreover, we have expanded into branches in 6 other cities and have been able to acquire medical equipment (i.e EKG devices, abdominal and cardiac ultrasound devices, colposcopy units). Also, we have recently acquired a medical trailer.