The articles from this week have mentioned a variety of frameworks to assess the current problems in health systems. Health system can be assessed by vertical versus horizontal, preventive versus primary (or secondary/tertiary) care, public versus private, functional (stewardship, financing, service provision, resource generation) versus efficiency, and rural versus urban perspectives. Targeted assessment will bring to light varying problems and gaps that are particular to the specific country, region, or village with different histories of health intervention and players. Mapping out all constituencies and problems in the current system is a complicated process, but it is important to go beyond the categories or dichotomies and see inter-linkages or behavioral dynamics of each layers and relationships between the actors. These intersections are often where the gaps are found, between the rural and urban, and between the resources available and cost/accessibility, etc.
I like the word “Health Eco-system” to capture all important linkages between different levels of current health system and behavioral changes from within. This was the term used by the social enterprise I was interning at this summer in Bangladesh. The company was a social venture capital that launched mobile health (mHealth) for rural and slum households, by equipping community health workers with mobile technology to provide quality healthcare through remote consultation under a central medical information system at an affordable rate. Through extensive field research and system studies, the problems identified were not only the accessibility and cost of health care, but also mistrust in private hospital care, lack of health awareness or culturally embedded mindsets. Through a colleague’s translation when we visited several women’s microfinance groups who were partnering with for their health program, women expressed discomfort in delivering babies in private hospitals because they felt pressure for C-section at slightest complication by the healthcare providers who would charge more for surgeries. I also learned that despite a large number of women with breast cancer in a particular slum in Dhaka city, women waited until the last minute to visit hospital for care due to an extremely high cultural resistance to be publicly open about women’s bodies.
The concept of community health workers (CHWs) is an interesting one to attempt to fill in several gaps in the health system – accessibility through direct service deliverance, behavioral change through regular health check-ups integrated with health education, and cultural sensitivity by deploying female community health workers to deal with women’s health for example. Implementing innovative (but simple enough to be useful on the field) technology bridges several gaps in the system, first through centralizing access to information and second by lowering the cost of healthcare through reducing the transportation cost which is a major expense rural households must pay to attain quality healthcare often in the city.
Lastly, I would like to point out that these innovations and ideas can be well-driven and be sustainable by the market force, based on the proof that poor people are willing to pay for quality healthcare given accessibility, affordability and choice as well-informed consumers. Although market principles cannot solve all problems, they should be openly if not actively pursued and integrated to identify and trigger leverages to target changes in the dynamics of the health eco-system. Public-Private partnerships then becomes a critical gap to be filled in order to involve non-traditional actors in improving health care system, through creation of new innovative channels to implement quality healthcare and induce behavioral changes efficiently and effectively.