News : Tiny Call Center Provides Health Services to 200,000 People
Balaka, Malawi, Jan 23, 2014 -- Doreen Namasala presses talk on her neon pink desktop phone to answer the latest call to the VillageReach health hotline. Speaking in Chichewa, the hotline worker asks the caller for her name, whether she is pregnant, when she is due and what symptoms she's experiencing. With the help of a custom software program and spiral-bound manual, Namasala will recommend a plan of action — perhaps getting rest or visiting a medical professional — after a few minutes on the phone.
"The callers are living in areas where transportation is difficult for them, like a pregnant woman walks for five kilometers to go to the health center, so we advise them to avoid overworking," Namasala says between answering calls.
Five days a week between 7 a.m. and 7 p.m., five hotline workers, including Namasala, answer health questions from residents of four surrounding districts at the call center, called Chipatala Cha Pa Foni (which means "health center by phone"). Located in a simple brick building behind the Balaka District Hospital in southern Malawi, the call center serves a community of more than 200,000 people. But the team hopes to one day serve many more and to take over an entire floor of a hospital and to expand its operations to serve Malawi's entire population of 16 million.
To give her diagnosis, Namasala, who is a trained health surveillance assistant, inserts the caller's responses into a touch-screen monitor, adapted by a local eHealth organization, Baobab Health Trust. The responsive software instructs Namasala on appropriate follow-up questions to ask based on the caller's answers. When the call finishes, the information will be stored in a database used to track trends. By the end of 75% of calls, clients have enough information and do not need to seek additional medical treatment. The remaining quarter of clients are referred to visit a professional at a nearby village clinic, health center, or district hospital.
"We provide information at home, and we leave the clients to go to the health center when there's a big problem," says Novice Gauti, a nurse consultant who works at Balaka District Hospital and specializes in safe motherhood and the integrated management of childhood illnesses.
In Malawi, there is just one doctor for every 44,000 people and one nurse for every 2,300 people. Hospitals are few and far between. This presents an almost insurmountable challenge for expecting mothers with questions about their pregnancies. Malawi's maternal mortality rate, among the world's worst, is 675 deaths per 100,000 live births, and 31 children out of every 1,000 born die during their first month of life, according to VillageReach.
This makes Malawi an awful place for expecting mothers who often live far from overcrowded and understaffed health facilities. Having the resources available where they live, through the distributed cellphones, can make all the difference.
In the areas surrounding the Balaka hospital, about 30% of households have cellphones and another 30% know someone who will give them access to their cellphone. To make the call center a resource for the entire community, VillageReach, the organization running the pilot with funds from the Bill & Melinda Gates Foundation, distributed cellphones to roughly 400 community volunteers living in different villages. The volunteers are allowed to use the phones for other functions besides calling the center. For example, community members are allowed to use the phone to call relatives who live far away. The volunteers also receive a crucial solar charger.
Launched in 2011, the hotline was one of the winning submissions to a nationwide competition run by Concern Worldwide's Innovations for Maternal and Child Health, which called for ideas to improve the quality of health services. The original idea, submitted by Soyapi Mumba, called for setting up a 24-hour, toll-free hotline to address questions from expecting mothers about their pregnancies, as well as new moms with concerns about their young children.
In practice, the Balaka pilot, which is now also funded by grants from mHealth Alliance's Innovation Working Group and the Seattle International Foundation, provides information to callers on maternal, neonatal and child health issues who live far away from health surveillance assistants and health facilities. It receives 30 to 50 calls each day, totaling 700 to 800 calls each month. To date, some 15,000 patients have been helped. Men can call the hotline with their questions as well, although about 75% of calls do come from women.
Following their telephone consultations, callers can choose to enroll in mobile phone tips and reminders, sent via SMS or voice message. The weekly tips and reminders, which have some 7,000 subscribers, cater to either pregnant women or caregivers of children during their first year of life. The messages are customized depending on the week of pregnancy or the child's age. They also come in the two local languages: Chichewa and Yao. Women who don't own phones can sign up to receive reminders on the community volunteer's phone.
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VillageReach is a non-profit organization working in the area of medical logistics, specifically the last mile delivery of vaccines to remote rural areas in developing countries. It is headquartered in Seattle, Washington, in the United States, and its main operations are in Mozambique, Africa. Secondarily, VillageReach invests in and develops social business models that complement its infrastructure needs, such as the VidaGas company that provides fuel for VillageReach's needs but also caters to local businesses in Mozambique.
Published: Friday, January 24, 2014