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

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.

An integrated intervention for chronic care management in rural Nepal: protocol of a type 2 hybrid effectiveness-implementation study

“…The CHWs are employed by the public-private partnership between Nyaya Health Nepal and the Ministry of Health and Population. They are distinct from the robust Female Community Health Volunteer network that exists throughout Nepal [63,78], who have historically focused on vaccination, public health messaging, and other community preventive interventions rather than on household care delivery and follow-up. These staffing, supervision, and training structures are described in greater detail in Additional files 1 and 2.…”

An integrated intervention for chronic care management in rural Nepal: a protocol of a type 2 hybrid effectiveness-implementation study

“…Achham is a remote, impoverished district of 260,000 people, with large migrant populations and a history of social disruption during the Nepali civil conflict. [70][71][72][73][74] network that exists throughout Nepal, [63,78] who have historically focused on vaccination, public health messaging, and other community preventive interventions rather than on household care delivery and follow-up. These staffing, supervision and training structures are described in greater detail in the Supplemental File 1 and 2.…”

Designing and implementing an integrated non-communicable disease primary care intervention in rural Nepal

“…Bayalpata Hospital serves approximately 90 000 outpatients per year, of which 72% are Bahun/Chhetri and 28% are other castes. The intervention was designed and initially implemented to serve a local catchment population of 60 000, who receive their care at Bayalpata Hospital and are served by a cadre of CHWs 31. All services provided at Bayalpata Hospital and by the CHWs are free of charge, without any point-of-care user fees.…”