BenevoCare Corporation PHC solutions

To assess the performance of Primary Healthcare (PHC) systems in Low to Middle Income countries presents many challenges, with the major one being funding to carry out basic activities. However, even when funding has been availed the challenges remain which are associated with actual implementation of assessment activities in remote areas with little or no technology, fuel, electricity or road infrastructure. This paper identified the problem of absent technology in these remote areas and will solve this problem by using existing sustainable systems to assess the performance of PHC in any set up through the improvement of the communication systems. While PHC activities may be happening, a strong communication system is needed to transmit data between the stakeholders in the field and at ministry level.

Our paper describes solutions in carrying out activities in such areas using basic resources that do not require expensive equipment and internet services. Using a basic cellphone, with SMS and calling capability ,and the usual pen and paper data can be collected, compiled, uploaded to higher levels with technology, analyzed and used to implement continuous improvement projects. The plan involves a tiered system with primary health care being at the lowest level, then a secondary level which would have more conventional technology to communicate data from Primary level to Tertiary levels and the reverse as well. The primary level relies on a basic cellphone that has USSD and SMS systems programed with the key performance indicators to be monitored and reported. There would be a training of the primary contact who does not necessarily have to be a qualified healthcare worker but who reports to the qualified nurse at the remote health center. Information is simply uploaded following steps set up in the USSD system.

This solution will benefit both the stakeholders in remote/rural areas and also Ministries to assess areas of continuous improvement. For example in Mashonaland West Province of Zimbabwe each of about 33 rural health centers are managed by one qualified midwife and a care taker. The people served by these centers have to travel between 5 and 8km to the nearest health center. However most of these citizens now have access to a basic cell phone in each household and network providers have provided access even though some people have to walk to higher ground to reach it. In this set up information from the ministry can be disseminated through these phone networks via SMS while the primary contacts who are community workers use the the same media to transmit information to the health center. This solution will assist in monitoring responses to announcements about PHC activities, e.g. immunizations, new disease outbreaks, etc. The primary contact is the key to collection of accurate information on the ground and other unconventional means to motivate this contact may be put in place, such as providing incentive based on targets achieved or exceeded. Basically all stake holders would have easier access to information about new activities and also about improvements that are being implemented.

Being residents in Mashonaland West Province has empowered us to study and know what the real needs of this population is. We have worked with these rural centers under other projects mainly HIV and TB programs and during the site visits we identified the challenges and also possible solutions to solving PHC issues in a sustainable and cost-effective way. Also since there is an acute shortage of qualified healthcare workers our previous roles involved training of community workers to disseminate and collect information and we found that this was very effective in reducing fear of divulging information to strangers. Selection of community workers should be done carefully to ensure that the primary contacts are excellent with communication with people of any age, gender, religion or tribe. Use of church and community leaders also helps in ensuring that instructions from the Ministry are understood and implemented.

The major challenge would be financial since the local government is unable to fund such a project. While the Ministry of Health and Child Care is monitoring the performance of PHC it is not done consistently and it only happens as a reaction to disease outbreaks with donor funding. Once donor funding is discontinued the program becomes erratic. We would overcome this barrier by setting up a sustainable system that would eventually run on its own once all stakeholders get accustomed to using existing systems to assess performance of their PHC system.

Our solution simplifies key performance indicator monitoring using the most basic technology available in most rural settings and can be used for programs other than PHC.

Our aim is to:

1. Bring focus to primary health care in remote areas despite the stressed up economy.

2. Increase awareness in self-care in the community by educating stakeholders on low cost means to improve well-being of all individuals regardless of financial status.

3. Decrease donor dependency in the next 5 years and beyond when it comes to primary health care by more community involvement in PHC activities particularly problem solving methods.

Our organization is focused on improving the quality of healthcare provision in low to middle income countries and our specialty area is laboratory testing. Our key indicators are based on number of people accessing basic laboratory tests in a timely manner and also as preventive rather than reactive. Wellness campaigns are carried out as part of outreach programs in collaboration with other partners and quality testing is done to detect diseases before outbreaks or serious illness sets in.

Our solution is targeted at normalizing monitoring performance, discussions, corrective actions and also preventing disease before outbreaks. Using this simple technology PHC performance would be discussed and communicated daily between stakeholders including affected communities. This in turn would increase awareness and encourage suggestions on improvements to the system.

Our solution uses basic cell phone technology with the Unstructured Supplementary Service Data (USSD) application installed. This will be linked to the more conventional technology for data analysis.

Data is collected by verbal communication and recorded on paper then transferred to the cell phone based application. Incentives include meal allowances, branded attire and transport allowances where applicable. Provision of solar powered systems for lighting homes and charging the phones will also be included.

The organization was formed by female directors due to challenges in fitting into already present organizations as older female team leaders. However, our organization employs all genders, races, ages and also includes young people who are normally excluded due to lack of experience and they are groomed to gain confidence in their current and future  roles.

Our organization is basically a consultancy which aims at empowering the target population in achieving their business goals while providing quality service to their customers and other stakeholders. 

We provide mentorship in setting up organizations, improving health care provision through quality testing and continuous improvement. We assist them in developing documentation for their operations and provide training and mentorship in actual implementation in alignment with the documents.

Generally our profits are ploughed back into assisting up and coming organizations but currently the profit is targeted at introducing mobile laboratory units to improve access to laboratory testing to remote places instead of having patients and/or samples transported to distant laboratories with better facilities. The mobile units will be operated during already existing primary healthcare systems . For example in Zimbabwe a doctor may visit a site only once or twice a week so the mobile unit will be available to assist in diagnostics while other voluntary wellness tests will be provided on site.

Currently we rely on investors and revenue realized from our clients but as the bigger projects get approval, donor funding may be required to accomplish the set goals within specified periods.

Our initial project was a client who needed an ISO based system set up in preparation for accreditation and they paid for all the documents generated and trainings conducted. Currently they pay hourly fees for any consultation needed. Other laboratories bring in revenue to our organization through consultations to assist them recover form the COVID-19 lockdowns that slowed down businesses while others seek assistance in improvement projects which they want to fund with revenue collected from COVID-19 testing which has now reduced or disappeared.