Developing and deploying a community healthcare worker-driven, digitally- enabled integrated care system for municipalities in rural Nepal

David Citrin; Poshan Thapa; Isha Nirola; Sachit Pandey; Lal Bahadur Kunwar; Jasmine Tenpa; Bibhav Acharya; Hari Rayamazi; Aradhana Thapa; Sheela Maru; Anant Raut; Sanjaya Poudel; Diwash Timilsina; Santosh Kumar Dhungana; Mukesh Adhikari; Mukti Nath Khanal; Naresh Pratap Kc; Bhim Acharya; Khem Bahadur Karki; Dipendra Raman Singh; Alex Harsha Bangura; Jeremy Wacksman; Daniel Storisteanu; Scott Halliday; Ryan Schwarz; Dan Schwarz; Nandini Choudhury; Anirudh Kumar; Wan-Ju Wu; S P Kalaunee; Pushpa Chaudhari; Duncan Maru

doi:10.1016/j.hjdsi.2018.05.002

Developing and deploying a community healthcare worker-driven, digitally- enabled integrated care system for municipalities in rural Nepal

Healthc (Amst). 2018 Sep;6(3):197-204. doi: 10.1016/j.hjdsi.2018.05.002. Epub 2018 Jun 5.

Authors

David Citrin¹, Poshan Thapa², Isha Nirola², Sachit Pandey², Lal Bahadur Kunwar², Jasmine Tenpa², Bibhav Acharya³, Hari Rayamazi², Aradhana Thapa², Sheela Maru⁴, Anant Raut², Sanjaya Poudel², Diwash Timilsina², Santosh Kumar Dhungana², Mukesh Adhikari⁵, Mukti Nath Khanal⁶, Naresh Pratap Kc⁷, Bhim Acharya⁸, Khem Bahadur Karki⁹, Dipendra Raman Singh¹⁰, Alex Harsha Bangura¹¹, Jeremy Wacksman¹², Daniel Storisteanu¹³, Scott Halliday¹⁴, Ryan Schwarz¹⁵, Dan Schwarz¹⁶, Nandini Choudhury², Anirudh Kumar¹⁷, Wan-Ju Wu¹⁸, S P Kalaunee¹⁹, Pushpa Chaudhari⁵, Duncan Maru²⁰

Affiliations

¹ Possible, Kathmandu, Nepal; University of Washington, Department of Anthropology, Seattle, WA, USA; University of Washington, Department of Global Health, Seattle, WA, USA; University of Washington, Henry M. Jackson School of International Studies, Seattle, WA, USA.
² Possible, Kathmandu, Nepal.
³ Possible, Kathmandu, Nepal; University of California, San Francisco, Department of Psychiatry, San Francisco, CA, USA.
⁴ Possible, Kathmandu, Nepal; Boston Medical Center, Department of Obstetrics and Gynecology, Boston, MA, USA; Boston University School of Medicine, Department of Obstetrics and Gynecology, Boston, MA, USA; Brigham and Women's Hospital, Department Medicine, Division of Women's Health, Boston, MA, USA.
⁵ Ministry of Health, Department of Health Services, Kathmnadu, Nepal.
⁶ Nepal Health Sector Programme, Kathmandu, Nepal; Ministry of Health, Department of Health Services, Health Management Information Section, Kathmandu, Nepal.
⁷ Ministry of Health, Department of Health Services, Management Division, Kathmandu, Nepal.
⁸ Ministry of Health, Department of Health Services, Epidemiology and Disease Control Division, Kathmandu, Nepal.
⁹ Tribhuvan University, Institute of Medicine, Department of Community Health, Kathmandu, Nepal.
¹⁰ Ministry of Health, Public Health Administration, Monitoring and Evaluation Division, Kathmandu, Nepal.
¹¹ Contra Costa Regional Medical Center, Contra Costa Family Medicine Residency, Martinez, CA, USA.
¹² Dimagi, Boston, MA, USA.
¹³ Simprints, Cambridge, UK.
¹⁴ Possible, Kathmandu, Nepal; University of Washington, Henry M. Jackson School of International Studies, Seattle, WA, USA.
¹⁵ Possible, Kathmandu, Nepal; Brigham and Women's Hospital, Department of Medicine, Division of Global Health Equity, Boston, MA, USA; Massachusetts General Hospital, Department of Medicine, Division of General Internal Medicine, Boston, MA, USA; Harvard Medical School, Department of Medicine, Boston, MA, USA.
¹⁶ Possible, Kathmandu, Nepal; Brigham and Women's Hospital, Department of Medicine, Division of Global Health Equity, Boston, MA, USA; Harvard Medical School, Department of Medicine, Boston, MA, USA; Beth Israel Deaconess Medical Center, Department of Medicine, Division of General Internal Medicine, Boston, MA, USA.
¹⁷ Possible, Kathmandu, Nepal; Icahn School of Medicine at Mount Sinai, Arnhold Institute for Global Health, New York, NY, USA.
¹⁸ Possible, Kathmandu, Nepal; Brigham and Women's Hospital, Department Medicine, Division of Women's Health, Boston, MA, USA.
¹⁹ Possible, Kathmandu, Nepal; Eastern University, College of Business and Leadership, St. Davids, PA, USA.
²⁰ Possible, Kathmandu, Nepal; Brigham and Women's Hospital, Department of Medicine, Division of Global Health Equity, Boston, MA, USA; Boston Children's Hospital, Department of Medicine, Division of General Pediatrics, Boston, MA, USA; Harvard Medical School, Department of Global Health and Social Medicine, Boston, MA, USA.

Abstract

Integrating care at the home and facility level is a critical yet neglected function of healthcare delivery systems. There are few examples in practice or in the academic literature of affordable, digitally-enabled integrated care approaches embedded within healthcare delivery systems in low- and middle-income countries. Simultaneous advances in affordable digital technologies and community healthcare workers offer an opportunity to address this challenge. We describe the development of an integrated care system involving community healthcare worker networks that utilize a home-to-facility electronic health record platform for rural municipalities in Nepal. Key aspects of our approach of relevance to a global audience include: community healthcare workers continuously engaging with populations through household visits every three months; community healthcare workers using digital tools during the routine course of clinical care; individual and population-level data generated routinely being utilized for program improvement; and being responsive to privacy, security, and human rights concerns. We discuss implementation, lessons learned, challenges, and opportunities for future directions in integrated care delivery systems.

Keywords: Biometric identification; Community health workers; Delivery of healthcare, integrated; Electronic health records; Health information systems; Nepal.

MeSH terms

Community Health Services / methods
Community Health Workers / trends*
Delivery of Health Care / methods
Delivery of Health Care / trends
Delivery of Health Care, Integrated / methods*
Delivery of Health Care, Integrated / standards
Electronic Health Records / trends
Humans
Nepal
Rural Population

Grants and funding

DP5 OD019894/OD/NIH HHS/United States