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The Universal Clinic: A powerful solution for last mile healthcare delivery

In developing countries across South Asia and Sub-Saharan Africa, children and women are disproportionately affected due to lack of access to healthcare.

The Universal Clinic: A powerful solution for last mile healthcare delivery


Bringing affordable healthcare to developing countries: the challenges and solution   

Quality, affordable healthcare in rural areas, particularly for mothers and children, remains an elusive goal for most developing countries. The problem is multi-faceted and systemic. There are far too few functioning clinics in these regions, and not enough qualified clinicians. Existing medical devices are too expensive and complex to use. There is far too little funding in most developing country health systems to build the system from the bottom-up, and external aid has proven neither sufficient nor sustainable.

To overcome these inter-connected problems, we are developing an integrated turnkey solution to provide rural healthcare through the Universal Clinic.

What is the Universal Clinic?

The Universal Clinic model can deliver rural healthcare at unprecedented quality, in a scalable and financially sustainable manner. At the core, it combines a suite of an integrated healthcare platform with electronic health records, and point-of-care and therapeutic diagnostics to treat diseases. Rather than reinventing the wheel, we are modifying and incorporating a number of existing technologies and devices into an end-to-end turnkey system, to enable healthcare delivery at a fraction of the cost of existing systems.

We see these clinics as spokes in a hub-and-spoke system, enabling a broad range of services for primary, maternal and children’s health. The spokes are existing, or new clinics (public or privately-run) in last-mile rural areas, sometimes staffed with one qualified nurse only. The hubs in this system are high-quality urban/peri-urban hospitals or secondary care facilities that have qualified physicians, labs and other infrastructure, and other resources to manage the spokes.

Our model also includes training nurses on standardized clinical protocols to operate these clinics; track key health indicators for every patient; build a robust mechanism to ensure the community and patient engagement; ensure accountability of clinicians for quality healthcare; and develop excellent customer service.  We are implementing this model in India (with the government of Palghar district in Maharashtra), in Kenya (with Nairobi Women’s Hospital), and in Pakistan (with Indus Hospital).

Universal Clinic in India

Access to low-cost, high quality care continues to be a challenge for majority of rural population in India. Over the last decade, India has made significant progress in improving the primary healthcare system, particularly in terms access to government-run facilities such as Primary Health Centres (PHCs) and Sub-Centres (SCs). However, public healthcare remains highly inequitable across India. Existing facilities, both public and private, are poorly equipped with qualified personnel (fully trained doctors, lab technicians, trained nurses), and diagnostic and curative facilities.

On the demand side, challenges to healthcare delivery exist due to inadequate awareness about care-giving systems/models, as well as attitudes informed by local practices and beliefs.

In order to address these challenges, ITT is working with its partners to deliver an integrated healthcare model which combines technology, improved clinical protocols, and behaviour change communication at the last mile. Our model is deployed in government-run sub-centres (SC) as spoke clinics, where the ANM is empowered with the best-in-class technology (software platforms for patient consultations and integrated point-of-care diagnostics), as well as trained in clinical protocols. PHCs with medical officers act as the hub for the sub-centres, which is the first point of contact for a patient seeking medical care in rural areas. In addition, we work with the local self-help groups and community health workers to improve patient engagement and awareness. Our model has been deployed in Palghar district of Maharashtra state.

Universal Clinic in Kenya

In Kenya, despite much progress in healthcare provisions, key health indicators such as maternal and neonatal mortality rates remain poor. Major non-communicable diseases (cardiovascular conditions, diabetes, cancers) are a significant contributor to hospital admissions and deaths in Kenya. The country is also experiencing fresh outbreaks of malaria and cholera.

For a majority of Kenyans, the only affordable and accessible source of receiving healthcare is small privately-run clinics, which face many infrastructural challenges and inadequacies in terms of trained medical staff, simple diagnostic tools, standardized treatment protocols and medicine supplies.

In Kenya, ITT’s Universal Clinic solution will exist as the hub-and-spoke model to bridge these challenges, and provide basic and quality affordable healthcare to patients living in rural and peri-urban areas. The spoke will serve as a basic nurse-run clinic, which will be equipped with: a basic point-of-care diagnostic platform and standardized clinical protocols; essential pharmaceutical supplies; integrated patient records; and patient behaviour change modules. The clinic can also be occasionally run by a clinical officer, and will be powered with an easy-to-install solar-powered structure to make them viable as “off-grid clinics”.

The hub will be an existing advanced healthcare facility that will support the spokes in managing complicated cases, providing technical support, including ambulatory services, training the nurses etc. The hub will be equipped with telemedicine capability, so that the nurse at the spoke can consult the physician who is present at the hub.

So far, in Kenya, we have partnered with a number of small clinics as potential spokes, and existing hospitals as potential hubs to prove the concept. The hubs will be operated at the Nairobi Women’s Hospital, and the Topcare Nursing Home in Kitengela. Different point-of-care diagnostic devices have been tested for usability and accuracy, and a software application developed in-house. The first Universal Clinic opened in November 2017 in Isinya, Kajiado County.

  • A village level female health worker in Maharashtra's Palghar district undergoes training in clinical software use at a healthcare sub-center.
  • A patient being registered at a sub-center during ITT's first healthcare field trial in Pavarpada village in Maharashtra's Palghar district.
  • Nurses weigh a baby at Topcare Nursing Home in Kenya.
  • A lab technician examines a blood sample at a hub facility in Kenya. Rapid diagnostic tests are majorly used in spoke facilities.

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