Background


As COVID-19 spreads throughout India and globally, the availability of essential and primary care services is critical now more than ever. Diversion of resources to the COVID-19 response coupled with lockdowns and mobility restrictions have compromised the availability of these services. Many communities are unaware of how to navigate the health systems in light of the pandemic, and require information and support on how to effectively protect themselves from COVID-19 and identify their risk of Covid-19 infection. In order to address these challenges, many dedicated organisations and associations have pursued the opportunities presented by remote or digital healthcare modalities. Tele-care is emerging as a key solution for helping address limitations surrounding the provision of care and supporting communities during this time. 

In order to explore further howtele-care innovations are working to address service gaps and help communities adapt to COVID-19 realities, the COVID Action Collaborative is publishing a series of articles that highlight various tele-care initiatives launched by CAC partners. This piece is the first article in this series. It highlights a tele-care solution implemented by Swasti with support from PCMH Restore Clinic, Aveksha and partners to address the gaps in service to the populations they serve.

The outbreak of COVID-19 has created a global crisis with far reaching repercussions on health, economy and society. While a pandemic of this proportion has the capacity to cripple health systems, cause loss of life and livelihoods, impact poorer populations disproportionately and destroy the social fabric we rely on; it also provides the potential for resilience, adaptation and innovation.

 Teleconsultation – the offering of remote health care for patients via telecommunications technology – has been an emerging service for several years. The COVID-19 induced lockdowns and challenges, however, were the catalyst that accelerated its multi-geographical, multi-sectoral application to support those most vulnerable. Not only has it exacerbated poverty and health conditions,  it has put millions at the risk of starvation, exploitation, violence or death. The deployment of such digitized solutions was critical and necessary since it allowed for early diagnosis, treatment and care to mitigate the impact of illnesses that drive families to further impoverishment. Additionally, telemedicine services reduce the burden on healthcare facilities, streamlines the process of consultations and addresses emotional wellbeing. With a healthcare system that was already buckling under the pressure of the outbreak and people forced to stay indoors with minimal human interaction, reaching out to people at home through technology became crucial.

 Responding to the Pandemic 

Some organisations like the PCMH Restore Health Clinic had a head start – they had been using some elements of telephonic service delivery to support their patients for the past 3 years. When the pandemic hit they were faced with a significant drop in clinic visits and concerns about the safety of home visits for both families as well as healthcare providers. They recognized that teleconsultation was the need of the hour and launched it immediately. Dr. Ramakrishna Prasad of PCMH said, “Our teleconsultation initiative saw a great response, especially from the families of the elderly. They saw it as a great way to get the medical care and guidance needed for their family members without the stress and anxiety of exposing them to the virus given that they are a highly vulnerable population.”

 While PCMH successfully launched teleconsultations, there were some organisations that responded to the need for protecting the vulnerable from exploitation. The months of lockdown amplified emotional stressors with massive job losses, economic instability, lack of essential supplies, etc. which led to a spike in violence and abuse. Arpan, an NGO focused on tackling Child Sexual Abuse, already had helplines for reporting cases of abuse. After COVID-19 they made these available to everyone for any help, support or guidance needed. They were able to leverage their existing systems to reach out to communities and check on the safety of the vulnerable.

 Going beyond health concerns

While many organizations are working to bridge the gap of primary care and emotional support services, Swasti recognised how a 360 degree approach is crucial to cushion the far-reaching consequences of Covid-19 on vulnerable populations. Being an organisation that designs, delivers and supports solutions for the health and wellbeing of the poor, Swasti realised that there was strength in integration and collaboration. Communities needed contextual, empathetic and culturally appropriate care- a one size fits all approach would fail to achieve the desired outcomes.  There was a need for a comprehensive solution which included health, counselling, community involvement and to facilitate social protection schemes, giving birth to the ‘Hello Swasti’ initiative. This integrated ‘telecare’ system was layered onto an offline model, with community outreach workers conducting risk assessments and referrals for appropriate care. 

The key to reaching underserved populations was choosing the right medium. Delivering services through a smartphone was a lucrative option, but many households lacked access to a smartphone. However, in the communities Swasti has been working with, every household has one basic mobile phone and family members are digitally literate to use voice calling and text messaging. Hence, it was a conscious choice to make services available via a traditional mobile phone through a hyper localized helpline number. 

Akshya, a clinical counsellor who has been conducting tele-counselling for clients with high risk conditions, said, “COVID-19 brought mental health to the forefront. People were suffering and struggling in isolation and felt the desperate need for support. Tele-counselling allowed us to reach out to these people and give them a platform to feel heard and cared for. More importantly it helped us in reaching out to them on time”. Another counsellor Jennifer said, “Through online sessions we have been able to support clients who are going through domestic violence, suicidal thoughts, depression, anxiety and a host of fears. We were able to empower them to take care of themselves. There is no fear of stigma since they can do it from home which helped people open up”.

Collaborating for greater impact 

Dr. Angela, Partner in Swasti, said “We first had to see how we can get a comprehensive program to be digitized and COVID-proof. We worked with PCMH to determine how we can conduct community surveillance using a digital interface focusing on those with chronic conditions, the elderly, and pregnant women. We then worked on an algorithm, layered new data on existing systems and trained the staff and outreach workers on how to use this interface.”

The key to collaborative efforts like the one Swasti adopted is looking for the right partners, clearly defining roles, identifying existing technologies or systems that can be used, piloting solutions and deployment. Bringing together partners with complementary strengths and areas of expertise allows for community involvement and buy-in and also ensures integration of these services. Said Bhoopathy, National Social Protection Co-ordinator at Swasti, “This innovation has allowed us to reach the grassroots effectively. It has also allowed for continuous monitoring and has garnered a positive response from the community.”. Bringing partners together will not only help tackle the existing crises but also set a precedent for tackling health system challenges collaboratively in the future.

The Future of Tele-consultation

While telephone based services solve many existing problems, experts caution against the use of technology as a silver bullet. Ahana, Health Technology Manager at Swasti added, “Getting technology to work for you is not always easy and comes with its limitations. Through the Hello Swasti program, we wanted to communitize technology and make individuals feel empowered. With our experience, we know how important the human interface is, and therefore our helplines connect to experts who have a deep understanding of the communities.” It is important, therefore, to approach tele-service delivery from the lens of how it can be made a value addition for communities and scaled effectively. While taking the solution to more people and communities the focus should be on empathetic, contextual and holistic care. It is also imperative to ensure a continuum of care at all times. This means integrating online and mobile solutions with offline follow ups to ensure end-to-end support for the beneficiaries.

Care delivery via phones is a solution that is here to stay, and rightly so. However the future of primary healthcare and its ability to reach the last mile effectively will depend on how organisations and collaboratives take this work forward. Utilizing existing community relationships, grounded experience, and expertise within groups is crucial to implementing a responsive, evidence-based, and patient-centered program that delivers outcomes that matter. We must consciously move away from transactional communication and making online and mobile-driven services a safe and caring space.

By Jaya Raizada & Ahana Chatterjee