The WHO Constitution enshrines “…the highest attainable standard of health as a fundamental right of every human being. The right to health includes access to timely, acceptable, and affordable health care of appropriate quality.
There are five dimensions of accessibility (Approachability; Acceptability; Availability and accommodation; Affordability; Appropriateness) and five corresponding abilities of populations (Ability to perceive; Ability to seek; Ability to reach; Ability to pay; Ability to engage). It is this complex interplay between the healthcare provider and the client that decides the success of good healthcare delivery and thus good health. In short, access to healthcare thus has three principle dimensions: Physical accessibility; Financial affordability and Acceptability.
As much as there is a pressing need to provide physical access to quality healthcare services, which are affordable according to the socio-economic need of the person, care must be taken to win the confidence of the people that these services are required and will make a positive difference. Irrespective of the socio-economic status of the person, there is need of education regarding health and disease, health promotion and relevance of healthcare strategies. Along with social and cultural practices that maybe barriers, there is also a perceived deficiency of trust. There is a growing discontent among people that many of the strategies are superfluous and counterproductive. Due to the explosion of information which is disseminated through various channels, there is a great deal of confusion regarding accuracy of healthcare information. Negative publicity by a section of the media has not helped. This has led to shunning of healthcare by a section of the community.
Digital health is an excellent tool in this regard. As mobile technology is now viewed as an essential element of daily living, is ubiquitous and affordable, healthcare can now be taken to the people. Carefully constructed, succinct and two-way communication can be established and dedicated portals created for education regarding health and disease. This is important so as to avoid misunderstandings and improper communication which is often the basis of dissatisfaction. Overloading of information may be avoided and healthcare maybe viewed as an essential part of day to day life. As the first step in any behaviour modification is to know about and win the confidence of the people, this kind of proactive education can be a useful learning tool.
As we have seen earlier, one of the most expensive areas of healthcare is the costs of transporting patients and waiting in outpatient clinics, mobile health can be used to remove all non-essential clinic visits and provide more efficient and comprehensive care. This will also mean more efficient monitoring of patients even when they are not in clinics and watching trends in patient status may mean earlier intervention in deteriorating patients.
Another important aspect of remote monitoring and management is the ability to gain personalised insights into patients and study behaviour on an individual basis and intervene appropriately.
The most contentious albeit most important issue is the management of social determinants which determine the success of healthcare. Though this needs a lot of strategic and design thinking, mobile technology has entered this space and strategic partnerships maybe entered into which may be helpful.
Any kind of change needs the acceptance and will of the population at large. It is upto the healthcare providers to build a system and a network that does not raise any questions about the efficacy and safety of delivery. Though it is extremely simple to conceive and strategize a plan, it is in the execution that success or failure on a large scale and over a long term depends. There will be lessons learnt everyday and it calls for the providers to be extremely pragmatic because it is not just a cohort of people that this system deals with but it is managing the microenvironment and the person which is the most challenging.
Providers with a committed workforce and yeoman leadership at all levels will succeed and will be in a position to provide the greater objective of universal healthcare access for all.
Very well written and informative as usual.
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