Company

Pre-primary care is the biggest opportunity to improve healthcare

05 February 2020 in Company

Health is an information problem. 400 million people without access to healthcare need authoritative, trustworthy and actionable information as a priority. At the same time, millions of health workers in rural and urban communities need robust clinical support.

This growing ‘knowledge gap’ can only be addressed with a systemic approach driven by personal AI-powered digital healthcare services like Your.MD.

For decades, innovation in healthcare has focused on modern industrial societies, prioritised technically-advanced hospitals and payment through traditional service models. Modern healthcare systems work tirelessly to reassure the mother of a feverish child, the middle-aged man with heartburn and the declining pensioner.

Technology rarely considers how to alleviate the anguish of a Nigerian mother whose child is a day’s walk from a doctor or how to bring reassurance in Bangladesh where there is 1 doctor to care for every 10,000 souls.

Dr Margaret Chan, the former Director-General of the World Health Organization (WHO), in 2008 said: “We see a mother suffering the complications of labour without access to qualified support, a child missing out on essential vaccinations, an inner-city slum dweller living in squalor. These and many other everyday realities of life personify the unacceptable and avoidable shortfalls in the performance of our health systems.”

At Your.MD, we think the creation of a technically-enabled pre-primary care health sector can help to change this. In so doing, we aim to help the WHO deliver the 4 cornerstones of global health reform it identified in its 2008 report Primary Health Care - Now More than Ever:

  • Universal Coverage
  • Service Delivery Reforms
  • Leadership
  • Public Policy Reforms

The WHO believes the world has been unable to mobilise the resources and institutions needed to transform health. This has led to the gap between healthcare systems and the people they were designed to serve increasing instead of narrowing. This goes against the WHO’s 1978 Declaration of Alma-Ata that called for health equity, person-centred care and a central role for communities in health.

Pre-primary care can deliver the Alma-Ata declaration by providing free healthcare assessment, information and access to trusted services for everyone, forever. This is the basis of the Your.MD model that’s already used by millions around the world.

Pre-primary care’s goal will be to provide global parity in healthcare assessment, knowledge and personalised care centred in the community – free personalised healthcare for 1 billion people is Your.MD’s goal.
Universal health coverage

Digital universal health coverage

By opening up every citizen’s personal health black box with the assistance of AI, the global population can access a baseline of health knowledge and understanding via a mobile phone. The training and knowledge that is usually associated with a medical degree can be universally delivered.

This represents a step change similar to the mass adoption of mobile money transfer in Africa or the introduction of printing.
People are increasingly impatient with the inability of health services to deliver levels of national coverage that meet stated demands and changing needs, and with their failure to provide services in ways that correspond to their expectations.

Few would disagree that health systems need to respond better – and faster – to the challenges of a changing world. Pre-primary care can do that. It can maximise equity and solidarity, give everyone the right to an attainable high level of baseline health assessment, care, information and be responsive to people’s needs.

The WHO believes that, left to their own devices, health systems do not naturally move towards goals of health for all through primary healthcare, as articulated in the Declaration of Alma-Ata. Health systems are developing in directions that contribute little to equity and social justice, and fail to get the best health outcomes for their money.
Putting people first in healthcare

Putting people first

There is substantial evidence on the comparative advantages, in terms of effectiveness and efficiency, of person-centred care. Its characteristic features are: personalisation, holistic assessment, proactive intervention, comprehensiveness, integration, continuity and the participation of patients, families and communities.

Your.MD can provide all these characteristics, and in collaboration with respected partners like RB it can add authority and credibility.

The evidence from numerous studies is that people are more willing and able to care for themselves if they are confident, reassured and certain of support. Studies from around the world demonstrate that close to 75% of all primary care consultations are appropriate for self-care and resulted in health professionals providing little more than reassurance, information or non-prescription drugs.

Data from the WHO’s World Health Surveys, covering 18 low-income countries, show low coverage of the treatment of asthma, arthritis, angina, diabetes and depression, and of the screening for cervical and breast cancer: less than 15% in the lowest income quintile and less than 25% in the highest.

Your.MD can significantly enhance people’s understanding of the probability and risk of all these conditions with its personalised and confidential approach.
Healthcare professional with patient

Digital continuity of care

Comprehensiveness, continuity and personalisation are critical to better health outcomes. They all depend on a stable, long-term, personal relationship between the population and the professionals who are their entry point to the health system. Most ambulatory care in conventional settings is not organised to build such relationships - but digital pre-primary care is.

Information and communication technologies like Your.MD enable people in remote and underserved areas to have access to services and expertise otherwise unavailable to them, especially in countries with uneven distribution or chronic shortages of doctors, nurses and health technicians, or where access to facilities and expert advice requires travel over long distances.

The internet is a key factor in its success, as is offline content.

A further benefit of using information and communication technologies in pre-primary care services is the improved quality of care. Healthcare providers are not only striving to deliver more effective care, they are also striving to deliver safer care.

Tools, such as electronic health records, computerised prescribing systems and clinical decision aids like Your.MD will support practitioners in providing safer care in a range of settings.

As the costs of delivering healthcare continue to rise, information and communication technologies are providing new avenues for personalised, citizen-centred and home-centred care.

Clinicians who want to promote health and prevent illness in international organisations see how Your.MD can be the place to go for health advice to complement or replace the need to seek the advice of a health professional in the first place.

New digital applications, services and access to information will permanently alter the relationships between consumers and health professionals, putting knowledge directly into people’s hands.
Transforming healthcare

Scaling digital pre-primary care

In some countries, a large part of the population lives in extremely deprived areas with absent or dysfunctional healthcare infrastructure. Such patterns occur in low-income countries such as Bangladesh, Chad and Niger.

In other parts of the world the challenge is providing health support to widely dispersed populations, for example small island states, remote deserts and mountainous regions.

Providing healthcare in these regions requires grappling with the economics of service provision over vast areas. Elsewhere, countries like Colombia, Nicaragua and Turkey have well-organised systems that can’t be used by large sections of the population because of the risk of catastrophic bills.

As a result, in urban and increasingly in the rural areas of many low and middle-income countries – from India and Vietnam to sub-Saharan Africa – much healthcare for the poor is provided by small-scale, largely unregulated and often unlicensed providers, both commercial and not-for-profit.

Often, they work alongside dysfunctional public services and capture an overwhelmingly large part of the healthcare market, while the health promotion and prevention agenda is totally ignored.
Healthcare in rural areas

Promoting universal coverage

Vested interest makes the promotion of universal coverage more difficult in these circumstances than in areas where the challenge is to build healthcare delivery networks from scratch.

Pre-primary care delivered by companies like Your.MD with ethical principles and values can challenge this way of doing things.

Health planners face a strategic dilemma in these areas: whether to prioritise massive scale up of a limited intervention or a progressive roll-out of a more comprehensive system.

Pre-primary care, enabled by Your.MD, provides an alternative approach for health planners that facilitates scaling and roll-out. Ethiopia has deployed thousands of health workers to provide a limited package of preventive care. Armed with Your.MD, that same package could be extended and the scope could be personalised and education spread.

In Iran, where primary care is being rolled out, the communities waiting could have coverage provided by Your.MD in the interim. Your.MD can place healthcare physically within reach of both urban and rural populations with its online and offline approach.
Female doctor with a stethoscope

The way forward

People want effective healthcare when they are sick or injured. They want it to come from providers with the integrity to act in their best interests.

The demand for competence is not trivial: it fuels the health economy with steadily increasing demand for professional care (doctors, nurses and other non-physician clinicians who play an increasing role in both industrialised and developing countries). For example, throughout the world, women are switching from the use of traditional birth attendants to midwives, doctors and obstetricians.

However, this trend is unsustainable, and the WHO estimates the world needs to train 2.6 million more doctors and 9 million nurses and midwives to meet current demand.

The world has underestimated the speed with which the transition in demand from traditional caregivers to professional care would bypass attempts to provide access to healthcare via non-professional ‘community health workers’.

Talk to the doctor services exacerbate this demand rather than alleviate it by placing doctors in call centres and increasing access instead of appropriately prioritising it.

Pre-primary care can stem this unsustainable shift to professional care only by placing trustworthy, authoritative and actionable information into the hands of every citizen to encourage personal accountability and responsibility.
Boy on mobile phone

How Your.MD can help

Technologies like Your.MD can transform the information given by lay workers and ‘power users’ from poor to average to good.

Citizens in the developing world, like those in wealthy countries, are not looking for technical competence alone, they also want healthcare providers to be understanding, respectful and trustworthy. They want healthcare to be organised around their needs, respectful of their beliefs and sensitive to their particular situation in life. They do not want to be taken advantage of by unscrupulous providers.

Your.MD’s vetting of services can provide reassurance and certainty, and its extensible framework can provide information in different languages and culturally-appropriate information.

This journey will begin later this year with the mass translation of our health content into Hindi - the first small step on our journey to help 1 billion people find their health.


References:

WHO | New report shows that 400 million do not have access to essential health services [Internet]. Who.int. 2020 [cited 5 February 2020]. Available here.

Global strategy on human resources for health: Workforce 2030 [Internet]. World Health Organization. 2020 [cited 5 February 2020]. Available here.

[Internet]. Who.int. 2020 [cited 5 February 2020]. Available here.

Pillay N, Tisman A, Kent T, Gregson J. The economic burden of minor ailments on the National Health Service in the UK - Selfcare Journal [Internet]. Selfcare Journal. 2020 [cited 5 February 2020]. Available here.

Prenissl J, Manne-Goehler J, Jaacks L, Prabhakaran D, Awasthi A, Bischops A et al. Hypertension screening, awareness, treatment, and control in India: A nationally representative cross-sectional study among individuals aged 15 to 49 years. 2020. Available here.

L G. Trust and the development of health care as a social institution. - PubMed - NCBI [Internet]. Ncbi.nlm.nih.gov. 2020 [cited 5 February 2020]. Available here.

Important: Our website provides useful information but is not a substitute for medical advice. You should always seek the advice of your doctor when making decisions about your health.

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