HBX-CPCN REMOTE PALLIATIVE CARE SERVICES

Our solution addresses the pressing need for accessible palliative care for patients with chronic life-limiting illnesses in Nigeria. Classified in Category 3a of the global palliative care atlas, Nigeria faces significant challenges in providing adequate palliative care services, with only 0.09 palliative care services per million population. This deficiency leads to patients and their families encountering advanced stages of illness, resulting in increased pain, suffering, and diminished quality of life.

Globally, an estimated 40 million individuals require palliative care annually, with 78% residing in low- and middle-income countries like Nigeria. Despite this immense need, only about 14% of individuals currently receive the necessary care. There are two (2) main factors  A 2019 WHO survey revealed that while funding for palliative care is available in 68% of countries, only 40% reported that services reached at least half of patients in need. This disparity underscores a critical gap in equitable access to palliative care, particularly for individuals living with non-communicable diseases (NCDs), hindering progress toward universal health coverage and the 2030 Agenda for Sustainable Development.

Our solution directly addresses several factors contributing to the problem, notably the lack of information and access to palliative care services. Across many communities, there exists a significant gap in awareness and understanding of palliative care, leading to misconceptions and limited utilization of available services. Additionally, geographical and logistical barriers often hinder individuals from accessing quality palliative care when needed most. By leveraging telemedicine and technology-driven interventions, our solution bridges these gaps, providing accessible and timely palliative care services to individuals in need, irrespective of their location. Through our platform, patients and healthcare professionals can overcome barriers related to distance, transportation, and awareness, ensuring that palliative care is readily available and easily accessible to all who require it.

Our solution addresses the urgent need for accessible palliative care for patients with chronic life-limiting illnesses in Nigeria, particularly in Oyo State. Collaborating with the Centre for Palliative Care Nigeria (CPCN) and various stakeholders, we've developed a comprehensive approach focused on remote palliative care delivery through our telemedicine platform.

Through CPCN, we've successfully conducted remote palliative care monitoring for 340 patients, representing diverse demographics and chronic conditions. These patients, primarily from Oyo State, received quality healthcare services free of charge from their homes.

Initially, CPCN's services were manual, limiting patient reach due to logistical challenges. However, with support from the African Palliative Care Association (APCA), we overcame these obstacles.

Over 11 months, CPCN achieved significant milestones:

• Trained 50 healthcare professionals in palliative care skills.
• Recruited 340 patients for remote consultation, improving their awareness and knowledge of palliative care.
• Demonstrated improved patient outcomes and quality of life through remote consultation services, with high levels of patient satisfaction.
• Integrated the Healthboxes (HBX) telemedicine platform to enhance service delivery, enabling seamless communication and remote consultations.

Additionally, here's the breakdown of chronic diseases identified among the patients:

• Hypertension: 134 (39.41%)
• Hypertension and Diabetes Mellitus: 74 (21.76%)
• Stroke and Hypertension: 45 (13.24%)
• Diabetes Mellitus: 41 (12.06%)
• Arthritis: 24 (7.06%)
• Chronic Pain: 11 (3.24%)
• Lumbar Spondylosis and Hypertension: 9 (2.65%)
• Alzheimer’s Disease: 2 (0.56%)

Our solution also includes the distribution of remote monitoring devices for patients with high blood pressure and elevated blood sugar levels. This pilot program, initially targeting Oyo State, aims to expand statewide to reach more underserved communities.

Through technology-enabled healthcare delivery, stakeholder engagement, and innovative pilot programs, we anticipate significant improvements in patient outcomes, reduced symptoms, and enhanced support for caregivers. Our initiative contributes to building resilience within healthcare systems and advocating for equitable access to palliative care services.

With a focus on scaling and sustainability, we plan to expand the project statewide, leveraging AI-driven data analysis to guide continuous improvement.

In summary, our solution combines technology-enabled healthcare delivery, stakeholder engagement, and innovative pilot programs to improve patient outcomes and enhance the quality of life for individuals and their families, addressing the critical need for accessible palliative care in Oyo State and advocating for equitable healthcare services for all individuals with chronic life-limiting illnesses.

Access to primary healthcare (PHC) remains a significant challenge, with the average Nigerian residing 5 kilometers away from the nearest facility. Moreover, the healthcare sector faces a critical shortage of personnel, with an average of only 0.5 doctors per 10,000 patients. This scarcity disproportionately affects individuals with chronic Non-Communicable Diseases (NCDs) and their families, who often seek medical attention at advanced stages of their illnesses.

Patients living with chronic NCDs endure various physical, psychological, social, and spiritual challenges that significantly impact their quality of life. Despite the potential benefits of palliative care in alleviating suffering and improving well-being, only approximately 14% of those in need currently receive such support globally.

Our solution primarily targets older adults and individuals diagnosed with chronic NCDs, including cardiovascular diseases, cancer, stroke, liver cirrhosis, sickle cell anemia, Alzheimer's disease, diabetes mellitus, chronic obstructive pulmonary disease (COPD), and chronic kidney disease.

In addition to addressing the unmet needs of this underserved population through accessible and comprehensive palliative care services, we are also running a pilot program to further enhance our impact. Through this initiative, we

Our solution is poised to make a meaningful impact on the lives of individuals living with chronic NCDs in Nigeria. By addressing the unique challenges faced by this population through innovative and inclusive approaches, we strive to uphold the principles of equity, dignity, and well-being for all.

Healthboxes Telehealth, in partnership with CPCN, a non-governmental organization, is uniquely positioned to design and deliver effective solutions to the target population. Our team members have extensive experience and a long-standing commitment to improving palliative care in Nigeria.

CPCN, with its expertise in cancer care, pain management, and palliative care training, has played a pivotal role in advancing palliative care services in tertiary health facilities and community settings across the country. Since its inception, CPCN has been involved with the Federal Ministry of Health and other international organizations on various aspects of cancer care, including awareness, early detection, advocacy, and ongoing training of multidisciplinary health professionals in pain and palliative care. Members of the organization have been at the forefront of advocacy for the availability of oral morphine for effective and affordable cancer pain management in Nigeria. In collaboration with the University College Hospital, Ibadan, in 2007, CPCN facilitated the establishment of the first hospice and palliative care department within a tertiary health facility in Nigeria. The service offers holistic palliative care for adults and children in hospital, clinic, and home settings. The Center’s collaborative activities were also instrumental in the inclusion of the pain and palliative care module into the revised undergraduate medical students’ curriculum at the University of Ibadan and other institutions. CPCN has been engaged in the training of over 600 health professionals in palliative care across the states of Nigeria and ‘start-up’ palliative care service development in hospitals including the National Hospital, Abuja, University of Nigeria Teaching Hospital, Enugu, University of Ilorin Teaching Hospital, Ilorin, Ladoke Akintola University Teaching Hospital, Oshogbo, the University of Port Harcourt Teaching Hospital, and the Olabisi Onabanjo University Teaching Hospital, Sagamu. The organization coordinates clinical placement and research programs on palliative care for health professionals from Nigeria and other countries. Thus, CPCN has a record of accomplishment in training in palliative care for health professionals (including postgraduate students) and individuals and volunteers.

One of the key strengths of our team is our deep engagement with the communities we serve. We have strong roots in the healthcare landscape of Oyo State, with team members who are healthcare professionals, volunteers, and advocates from diverse backgrounds. Our leadership and team composition reflect the communities we serve, ensuring cultural sensitivity and relevance in our programs and interventions.

Our approach to solution design is inclusive and collaborative, prioritizing community engagement and collaboration. We will seek feedback and insights from stakeholders at every stage of the process, ensuring that our initiatives align with community needs and priorities. 

Our geographical reach as a leading telemedicine platform further enhances our ability to deliver impactful solutions. With over 1700 patients served to date through our telemedicine platform, Healthboxes brings valuable expertise and technological support to our initiative, expanding our reach and enhancing access to quality healthcare solutions.

In summary, our team's expertise, community engagement approach, and strategic partnerships position us well to design and deliver impactful solutions in palliative care.

So far, we have built and tested a comprehensive telemedicine platform in collaboration with CPCN, which has enabled us to deliver impactful healthcare solutions to communities across Nigeria. Through this platform, we have successfully served over 1700 patients to date, providing them with access to quality healthcare services from the comfort of their homes. CPCN has provided specific palliative care to over 340 patients in Oyo State.

The HBX platform is currently being upgraded to sync digital monitoring devices for HBP and diabetes. These devices are equipped with automatic monitoring capabilities, allowing for real-time data collection of patients' vital health metrics. These readings are automatically uploaded and monitored by our team of healthcare professionals. Our doctors conduct regular reviews of the data and proactively reach out to patients to provide personalized care and support. This proactive approach ensures that individuals with high blood pressure and elevated blood sugar levels receive timely interventions and guidance to manage their conditions effectively. The platform will be ready for testing by the first week in May, with monitors supplied to CPCN in anticipation.

In addition to our pilot program, we have also conducted sensitization efforts and training sessions with healthcare workers in Oyo State, where 50  healthcare workers in palliative care have been trained. These initiatives have built local capacity and raised awareness about the importance of palliative care services in the community.

We are seeking support from Solve to address specific financial and technical barriers hindering the scaling of our pilot telemedicine program. Currently, the telemedicine services are provided through direct phone calls to patients, and monitoring and record-keeping are conducted manually. However, to expand our reach and improve efficiency, we require financial and technical assistance to integrate a robust telemedicine platform.

With funding from Solve, we aim to properly integrate a telemedicine platform into the existing operations and extend our services to additional communities. This financial support will enable us to onboard more patients, add AI component to optimize our telemedicine services, and enhance patient care outcomes.

In addition to financial assistance, we require technical expertise to develop artificial intelligence (AI) and machine learning (ML) platforms for data analysis. These platforms are crucial for analyzing patient data, identifying trends, and making informed decisions to improve our telemedicine services.

Our training sessions are conducted in person, limiting the number of healthcare workers we can train cost-effectively. With Solve's support, we plan to record training courses in Yoruba. This initiative will enhance accessibility and enable us to train a larger number of healthcare professionals efficiently.

By partnering with Solve, we anticipate significant improvements in our telemedicine program's scalability, efficiency, and impact. Through proper integration of a telemedicine platform, training enhancements, and technical support for data analysis, we aim to elevate the quality of healthcare services provided to underserved communities across Oyo state.

In summary, we believe that Solve's financial and technical support will play a pivotal role in overcoming barriers to scaling our telemedicine program. By leveraging Solve's network of partners and expertise, we are confident in our ability to expand our reach, enhance patient care, and make a meaningful impact on healthcare delivery in Nigeria.

Our solution stands out for its innovative approach to addressing the pressing need for accessible palliative care in Nigeria, particularly in Oyo State. Here's what makes our solution innovative:

1. Telemedicine Integration: We integrate telemedicine into palliative care delivery, leveraging the Healthboxes (HBX) platform. This allows patients to access quality healthcare services remotely, from the comfort of their homes. By utilizing voice, video, and electronic medical record capabilities, we facilitate seamless communication and information sharing between healthcare providers and patients, enhancing accessibility and convenience.

2. Remote Monitoring Devices: As part of our pilot program, we distribute remote monitoring devices for patients with high blood pressure and elevated blood sugar levels. These devices automatically upload vital health metrics to the HBX platform, where healthcare professionals can review and analyze the data. This proactive approach ensures timely interventions and personalized care for patients, improving health outcomes and reducing the burden on healthcare systems.

3. Stakeholder Collaboration: We prioritize collaboration with stakeholders, including healthcare professionals, patients, caregivers, and community leaders. By engaging stakeholders throughout the process, we ensure that our solution meets the diverse needs of the community and fosters trust and cooperation within the healthcare ecosystem.

4. Capacity Building: Through training initiatives, we empower local healthcare providers to identify and address palliative care needs within their communities. By equipping them with the necessary skills and knowledge, we build resilience within healthcare systems and promote sustainable healthcare delivery.

5. Data-Driven Improvement: We utilize AI-driven data analysis to guide continuous improvement and ensure the effectiveness and sustainability of our palliative care services. By leveraging data insights, we identify areas for enhancement and tailor our interventions to better meet the needs of patients and caregivers.

In summary, our solution is innovative in its integration of telemedicine, use of remote monitoring devices, emphasis on stakeholder collaboration, focus on capacity building, and utilization of data-driven improvement strategies. By combining these elements, we aim to revolutionize palliative care delivery in Nigeria and improve health outcomes for individuals with chronic life-limiting illnesses.

Our solution aims to make a real difference in addressing the challenges faced by patients with chronic life-limiting illnesses, particularly in Nigeria's Oyo State. Here's how and why we expect our solution to have a positive impact:

1. Accessible Healthcare: By leveraging telemedicine technology, we're bringing quality healthcare services directly to patients' homes. This means individuals with chronic conditions don't have to travel long distances or face barriers to access essential care. It's like bringing the doctor's office to them, making it easier for them to receive the support they need.

2. Training and Capacity Building: We're not just providing healthcare services; we're also empowering local healthcare professionals with the knowledge and skills to deliver palliative care effectively. Through training programs, we're equipping doctors, nurses, pharmacists, and other healthcare workers with the tools they need to identify patients in need of palliative care and provide them with appropriate support. This means more patients can receive quality care, even in remote areas.

3. Tailored Support: Our solution isn't one-size-fits-all. We recognize that each patient is unique and may have different needs. That's why we're integrating remote monitoring devices for patients with specific conditions like high blood pressure and elevated blood sugar levels. This allows us to personalize care plans and provide timely interventions based on each patient's health data. It's about meeting patients where they are and providing the right support at the right time.

4. Improved Awareness: Many people in our target communities may not be aware of palliative care or its benefits. Through our initiatives, we're not only delivering healthcare services but also raising awareness about palliative care. By educating patients, caregivers, and community leaders, we're breaking down barriers and reducing stigma surrounding chronic illnesses and end-of-life care. This increased awareness can lead to earlier interventions, better symptom management, and improved quality of life for patients and their families.

5. Scalability and Sustainability: We're not just focused on short-term solutions. Our goal is to create long-lasting impact that extends beyond our initial pilot program. By leveraging technology, building local capacity, and fostering partnerships, we're laying the groundwork for sustainable healthcare delivery systems. This means our impact will continue to grow over time, reaching more communities and helping more individuals live healthier, more comfortable lives.

In summary, we expect our solution to have a positive impact by making healthcare more accessible, empowering local healthcare providers, providing tailored support to patients, raising awareness about palliative care, and building scalable and sustainable healthcare delivery systems. Through these efforts, we aim to improve patient outcomes, enhance quality of life, and advocate for equitable access to healthcare for all individuals with chronic life-limiting illnesses.

Our impact goals for our solution are centered around improving patient outcomes, enhancing the quality of life for individuals and their families, and advocating for equitable access to palliative care services. We measure our progress towards these goals through a combination of quantitative and qualitative indicators, as outlined below:

Improving Patient Outcomes: Our primary goal is to improve the health and well-being of patients with chronic, life-limiting illnesses. We measure this by tracking key health indicators such as symptom severity, pain levels, and overall quality of life before and after receiving palliative care services. Through regular assessments and follow-up consultations, we monitor changes in patients' health status and assess the effectiveness of our interventions in alleviating symptoms and improving overall well-being.
Enhancing Quality of Life: We aim to enhance the quality of life for both patients and their families by providing holistic support, including symptom management, psychological counseling, and spiritual care. To measure progress in this area, we use standardized quality of life assessment tools and patient-reported outcome measures. These tools enable us to quantify improvements in physical, emotional, and social well-being, as well as assess the impact of our interventions on caregivers' quality of life and coping mechanisms.
Advocating for Equitable Access: Our solution aims to advocate for equitable access to palliative care services for all individuals, regardless of their socioeconomic status or geographic location. We measure progress in this area by tracking the demographic characteristics of patients served, including gender, age, income level, and geographical distribution. By analyzing these data, we assess the reach and accessibility of our services and identify any disparities in access to care among underserved populations.
Scaling and Sustainability: Another key goal is to scale our solution statewide and ensure its long-term sustainability. We measure progress in scaling by tracking the expansion of our telemedicine platform to new regions and the recruitment of additional healthcare professionals to deliver palliative care services. Additionally, we assess the financial sustainability of our initiative by monitoring funding sources, cost-effectiveness, and resource utilization over time.
Stakeholder Engagement and Capacity Building: We aim to engage stakeholders, including healthcare professionals, patients, caregivers, and community leaders, in the design, implementation, and evaluation of our solution. We measure progress in stakeholder engagement through feedback surveys, focus group discussions, and participation rates in training sessions and community outreach activities. Additionally, we track the acquisition of palliative care knowledge and skills among healthcare professionals through pre- and post-training assessments and evaluations.
By systematically tracking these impact goals and progress indicators, we ensure accountability, transparency, and continuous improvement in our efforts to address the critical need for accessible palliative care services in Oyo State and advocate for equitable healthcare services for all individuals with chronic life-limiting illnesses.

At the heart of the solution is a secure telemedicine platform that enables patients to connect with healthcare professionals remotely.  The platform has been developed to adhere to industry standards for data privacy and security. Each community healthcare worker will be provided with an internet enabled tablet, laptop, or phone to use at the patient's home during visits.

The use of an EMR system can help streamline patient management and record-keeping, enabling healthcare professionals to access patient information remotely and track progress over time. It will also help facilitate communication between healthcare providers, patients, and families.
Data collected on patient outcomes, service utilisation and other key metrics will be analyzed through the use of data analytics tools and dashboards that provide real-time insights and reporting. Artificial intelligence and Machine Learning can be used to analyze patient data and identify patterns or trends that can inform treatment plans and improve outcomes.
The training content will be recorded and developed into e-learning modules, giving healthcare workers access to training materials and resources online. This can include video tutorials, interactive quizzes, and other multimedia content that can be accessed remotely and at the healthcare worker's own pace. To ensure the scalability and flexibility of the business model, the telemedicine and training platforms are cloud-based infrastructure that can handle increasing demand and support remote access for healthcare professionals and patients. This can also help reduce infrastructure costs and enable faster deployment of new features and services.

53 People

Management Team (full-time) -  7

Project Co-ordinators (full-time) - 4

Volunteers - 6

Staff (full-time) - 3

Interns - 4

Members Part-time (Consultants, Doctors, Nurses, Physiotherapists, Counselors, Rev and Imams) - 20

Marketing (full-time) - 1

Data Analytics (full-time)  - 1

IT Support (full-time) - 1

Community healthcare workers (full-time) - 6

The need for remote consultation via telemedicine was conceived due to challenges faced with service delivery during the COVID-19 pandemic in 2020. It was initially for patients in need of palliative care at isolation centers but was extended to patients with chronic non-communicable disease at the secondary health care level about 24 months ago. 

We recognizes diversity as a crucial value that promotes inclusivity, respect, and varied perspectives and drives progress towards achieving health equity. We acknowledge all types of human differences, including those at the individual level, such as life experiences, learning and working styles, and personality types, as well as those at the group level, such as socioeconomic status, race, ethnicity, language, nationality, gender identity, sexual orientation, religion, geography, disability, age, and more.

Our diversity policy aligns with the medical profession's obligation to meet the health needs of all populations in an increasingly diverse society. The medical community's diversity enhances the quality of education for all learners, and exposure to diverse perspectives can improve complex thinking skills. This results in more effective and culturally competent physicians and patients who understand the link between sociocultural factors and health beliefs and behaviors, making them better equipped to serve a culturally and linguistically diverse patient population.

At Healthboxes Telehealth, we concentrate on the types of diversity that we believe add significant value to our community and have the potential to address health disparities. Health disparities, which stem from differences in geographic location, socioeconomic status, race, ethnicity, and education, remain pervasive, and we are committed to mitigating these disparities.

Healthboxes Telehealth and CPCN business models takes an integrated approach with a combination of subsidised fees and fees from training, donations and grants. Our service offering includes the provision of home-based palliative care to patients with chronic illnesses, physically and/or virtually. This will reduce wait times for access to medical consultations and drugs and improve on psychosocial aspects of life. Patients will have convenient access to healthcare professionals through the telemedicine platform. This will impact their family positively by reducing their time away from work to care for their loved ones.Patients are introduced by the secondary healthcare institutions and on-boarded based on our criteria, onto the platform by trained community healthcare works. The patient have an initial consultation with the medical doctor and treatment plan recorded on the patient’s EMR. Community healthcare workers will visit the patient weekly to ensure treatment plan which includes lifestyle changes are adhered to.  Quarterly sensitisation exercises on the importance of preventative medicine and how to live with their chronic illnesses will be carried out. The monitoring results are recorded in the EMR, and if a consultation is required,an appointment is set up with the doctor via the telemedicine platform. Anonymized data is assessed to show impact.

We provide paid-for community training to individuals as caregivers, both virtually and onsite on palliative care. This provides further impact within the community as trainees can use this as a source of income. We will earn revenue by placing the trained carers with families who would like continuous care provision. Lastly, we provide consulting support and training to healthcare organisation looking to establish training facilities in other states.

With the inclusion of the telemedicine platform we will also have access to commissions earned from prescriptions delivered to patients. 

Our other partners include local and state governments, secondary healthcare institutions, insurance companies, and donor agencies.

A lean approach is taken to staffing using members who are paid according to time spent on the project and volunteers. 

Our marketing strategy will leverage a mix of channels, including social media, online advertising, and community outreach. The aim is to attract trainees, patients and increase brand awareness to help build partnerships and collaborations with local and state governments, secondary healthcare institutions, and donor agencies.

Through our existing board made up of medical and non-medical persons, as the organsiation grows and expands, it's important to strengthen governance and oversight in place to ensure that resources are being used effectively and efficiently, and that the mission and values of the organization are being upheld. Ethical approval for the study will be obtained from Hospital Ethics Committee before commencement.

CPCN has been getting funds from the following;

1. Regular grants from our partners, especially the College of Medicine alumni class and Global Partners in Care.

2. Proceeds from workshops and training conducted for health professionals and volunteers 

3. Consulting and setting up palliative care practices for some teaching hospitals and local governments 

4. Proceeds from clinical services rendered on home visits 

5. Investment of some of our funds in money markets to obtain returns