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Revitalizing%20Informal%20Healthcare:%20Solutions%20and%20Strategies

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Revitalizing Informal Healthcare: Solutions and Strategies Rakesh Biswas Professor of Medicine, LNMCH, Bhopal, India This definitional criteria doesn t seem to be ... – PowerPoint PPT presentation

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Title: Revitalizing%20Informal%20Healthcare:%20Solutions%20and%20Strategies


1
Revitalizing Informal Healthcare Solutions and
Strategies
  • Rakesh Biswas
  • Professor of Medicine,
  • LNMCH, Bhopal, India

2
Perspectives in Informal healthcare
  • ... he noticed a pea-sized lump on the roof of
    his mouth. A local GP dismissed it as a reaction
    to a fish-bone, but having borrowed textbooks
    from a medical student in the next room, he
    self-diagnosed a squamous-cell carcinoma. 

3
Perspectives in Informal healthcare
  • ... it took him months to arrange a biopsy at
    Chittaranjan Cancer Hospital the pathology
    confirmed his diagnosis. Knowing he had received
    a death sentence, Sen and his family pushed for
    what was then, in India, a new form of treatment
    radiotherapy. 
  • Quoted from Paul Farmer http//www.lrb.co.uk/v37/
    n03/paul-farmer/who-lives-and-who-dies

4
What is Informal healthcare?
  • Self-Care?
  • Care provided by a relative?
  • Care provided by a medical student?
  • Care provided by unlicensed-healers/generalists/ex
    perts?

5
Perspectives in Informal healthcare? Definitional
Criteria
  • No training?
  • No salary (Entrepreneur)?
  • No registration?
  • No professional association?
  • Sudhinaraset M, Ingram M, Lofthouse HK, Montagu
    D (2013) What Is the Role of Informal Healthcare
    Providers in Developing Countries? A Systematic
    Review. PLoS ONE 8(2) e54978. doi10.1371/journal
    .pone.0054978

6
Informal vs. Formal healthcare
  • Generalist vs. Expert
  • Approachable vs. Ivory tower
  • Unique Exploratory vs. Usual Evidence based
  • Accommodator vs. Assimilator (learning style)

7
Informal to Formal transition?
  • A medical students journey
  • Quest for knowledge and power
  • Accommodator to Assimilator cyclical Learning
    style (Kolbs)
  • Informal formal duality ( experts also need to
    think informally anew when confronting the
    unknown)?

8
Perspectives in Informal healthcare?
  • Todays Formal was yesterdays informal?
  • Todays standard treatment was yesterdays
    experimental and tomorrows junk?
  • Nature of scientific revolutions and shifts?
  • Learn to live with and optimize constant change ?

9
(No Transcript)
10
Informal healthcare Strengths?
  • Effective error and power check? (Sen first
    slide?)
  • Informally negotiate the jungle of evidence that
    naturally keeps changing
  • Potential window to better current day formal
    healthcare?

11
Who is an informal healthcare provider?
  • Everyone

12
Can we involve everyone in healthcare?
  • Everyone has been involved informally since time
    immemorial by virtue of their being a patient at
    some point in their lifetime?
  • The Informal healthcare movement has run in
    parallel over the ages since the birth of human
    healthcare?

13
Can we optimize everyones participation in
healthcare toward achieving better health
outcomes?
14
Can we do this in an open, transparent,
accountable, ethical and legal manner?
15
How?
16
Informal healthcare lessons for Indian healthcare?
  • Current healthcare needs of India are to a large
    extent met by unlicensed healthcare
    practitioners.
  • Current crop of unlicensed-healers in India tend
    to copy 'formal-healthcare,' and this is often
    done poorly resulting in low quality health-care.

17
Unlicensed healthcare to Informal but
open-accountable healthcare?
  • Create a different group of 'informal-health-care
    ' workers such as 'patient-information-communicati
    on-managers. PICMs
  • Not to provide medicines or care but to create
    informational awareness in the community both
    among patients and doctors
  • Serve as effective 'clinical-auditors' and
    instil error-check mechanisms to benefit both
    doctors and patients.

18
Informal participatory learning ecosystem?
  • Pilot project currently serves both urban and
    rural-remote areas in two locations in India
  • Patients receive access to a local and global
    network of 1000 health-professionals through
    their information communication managers PICMs.

19
Village healer unlicenced
Patients Wife and family
Experienced Global physician
Patient
Primary doctor at the PHC
Community health worker CHW and Patient
information communication manager PICM
  • Physicians and medical students in Urban India

ANM at the village PHC
20
Informal healthcare as Informational healthcare?
  • Patients information requirements are gathered
    by a community based informal intermediary PICM
  • Shared (after obtaining informed patient consent
    and de-identification) with an online global
    network
  • Eventually an evidence based resolution of
    patient requirements achieved with a lag time in
    days

21
An Informal social media driven participatory
learning ecosystem
22
Informal social media driven participatory
learning ecosystem
23
Publications as a formal by-product of an
informal learning ecosystem?
24
So what?
  • Strengths
  • Weaknesses
  • Opportunities
  • Threats

25
Strengths and Opportunities
  • Generation of new employment in the community.
  • Transition of workload from over-tasked
    physicians to community based Patient information
    communication Managers PICMs
  • Exposure for students and professionals to
    unique cases and innovative, interdisciplinary
    health solutions.

26
Strengths and Opportunities
  • Expansion of this ecosystem to other sites in
    India and globally.
  • Engagement of students and physicians globally
  • Vibrant global online community and open-access
    learning platform, interfacing society with
    science as well as delivering improved care to
    more patients in real time.

27
Weaknesses and Threats!
  • No takers in formal medical curriculum
  • Threat of usurping the formal medical curriculum
  • Patient privacy and confidentiality ethics
    optimization

28
Q and A Brutally honest feedback please!
  • Did they catch the chimp who made your
    slides?---Dilbert
  • rakesh7biswas_at_gmail.com
  • Next slide for QA

29
QA Lets begin?
  • First step toward collaborating to develop a
    global participatory learning ecosystem?
  • Scale from a grassroots village-sub-center level
    by training their local potential PICMs?
  • Formalize training initiation, assessment and
    participatory deployment or just let it continue
    informally?
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