Our experience collaborating with individuals and health systems around the world shows that there are no standard, one-size-fits-all solutions to improving primary healthcare. Healthcare needs vary by region with diseases and conditions more prevalent in some areas than others. Mandera County in Northern Kenya, for example, has a far higher maternal death rate during birth than more southern areas. People living near coastal swamps or the large African lakes experience more malaria. Urban areas experience more incidents of trauma and violence. This complexity is compounded by demographic variations, such as population density, cultural practices, availability of infrastructure (such as power, water, connectivity and roads) and distance to a referral hospital.
These differences in needs and circumstances create the demand for customized primary health programmes. But customized can be synonymous with costly and difficult-to-scale. To truly make progress in providing primary care delivery – vital to universal health coverage – we need to think in terms of mass customization. This means configuring standardized modules into customized solutions that meet local needs. Scalability and flexibility must go hand in hand.
Digital technology has the potential to transform solutions and radically change the way quality healthcare is delivered. Standalone medical devices no longer deliver the level of care or speed that today’s world demands and we are quickly moving to an interoperable, networked world that relies on connectivity. For example, an electrocardiogram (ECG) device can be used in a frontline health facility and that patient’s data can link back to a cardiology centre where the cardiac issue can then be diagnosed. The same situation applies to ultrasound devices monitoring pregnancies. Ultrasound has now reached the stage of ultra-portability, where trained community health workers can take an ultrasound image using a smartphone in a person’s home. Technology elevates care delivery from a one-to-one patient to provider relationship to a scalable, population health model.
Telehealth also now complements standard care delivery across most clinical disciplines, benefiting patients in the hospital and the home. Using a hub and spoke model, leading hospitals are being connected with smaller, rural care units, including video connection and data transfer, so that advanced care can be provided anywhere. With these new capabilities, we can overcome key challenges such as a lack of skilled personnel in the field or patient access to a medical facility.
Digital innovation will also support the seamless referral of patients and their electronic medical records for future diagnostic and treatment purposes both within facilities and along the healthcare referral network. In addition, innovative digital payment solutions will play a practical role in ensuring access to quality healthcare and transparency of service delivery.
Supporting and strengthening primary care by listening to local communities’ needs and providing flexible, modular solutions that are digitally enabled has led to increases in the quality and utilization of primary care and efficient referrals. When we effectively combine people, processes and technology, we see progress. For example, we see more people visiting primary care centres, more prenatal check-ups, more baby deliveries and more engaged staff owing to improved conditions. Other projects using this approach show a three-fold increase in the early detection of very high-risk pregnancies, which is crucial to bringing down maternal mortality rates.
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In order to strengthen primary care in their region, governments need to make sweeping changes to financing, services offered, management and the use of technology. Such transformations, we believe, will be most effectively accomplished via partnerships between the private and public sector.
A good example of this is what’s happening in Kenya. The Government of Kenya, in partnership with the Kenyan UN-system, development partners, financiers and the private sector, are making strides to kickstart a new Sustainable Development Goals (SDG) Partnership Platform. The aim is to expedite large-scale primary care transformation and improve the health and well-being of 46 million Kenyans by 2021 through public-private partnerships. This will support the overall attainment of Kenya’s SDG agenda involving all levels of the Kenyan government.
Such a platform helps to align all stakeholders with solutions that are meaningful to the local people. Strengthening primary care remains the main factor in achieving universal health coverage.