In today’s Academic Minute, Dr. Prabhjot Singh of Columbia University’s Earth Institute examines how practices introduced in the developing world could improve the efficiency of the healthcare system in the developed world.
Prabhjot Singh is a medical doctor and an assistant professor of international and public affairs at Columbia University. His work focuses on strengthening medical implementation systems and technical decision making capacity at community, district/municipal, and national levels in low-resource settings. His approach blends operational research, analytical tool/technology development, with policy analysis to support sustainable development planning for practitioners, entrepreneurs and bureaucrats. He received his Ph.D. in Neural and Genetic Systems from Rockefeller University and an M.D. from Weill Cornell Medical College.
Dr. Prabhjot Singh, Columbia University – Community Healthcare Workers
Usually, when it comes to matters like public health, we imagine that it is the developed world that must show the way for the developing world. But in our own rich society, where health care can be ruinously expensive or not available at all for poorer citizens, we may have something to learn from others.
Across rural Sub Saharan Africa, where doctors and nurses are much scarcer than in the United States, so-called Community Health Workers are already a vital link between households and health systems. In Tanzania, for example, the ratio of doctors to patients is about 1 for every 27,000; but for community health workers, the ratio is one to 1,000. UNICEF reports that 2/3 of child deaths there are due to preventable causes, including malaria, pneumonia, diarrhea, measles and some newborn infections. Malnutrition underlies 1/3 of these deaths. Armed with protocols, rapid diagnostic tests, a small number of medicines and mobile phones, community health workers are making decisions that save lives. For example, for a child with a fever, a worker can confirm a case of malaria with a rapid diagnostic test, and if positive, administer the proper medicine, while alerting the local clinic for follow-up support with a mobile phone.
We have seen this first hand working in Africa, where long-term projects have shown that systems are affordable for even the most vulnerable. Even though Community Health Workers have been around for 40 years in countries as varied as Brazil, Nigeria and India, the convergence of management systems, diagnostic and mobile technology, and political leadership is minting a new generation of community health systems.
The amazing story is that the same techniques that are making Community Health Workers the heroes of health in the developing world are spreading to support chronically ill patients in places like New York City. This is an incredible example of developing countries leading the way for the developed, helping build stronger, more supportive communities for everyone.