Medic: Digital tools for better community healthcare in Nepal

Nepal has made significant progress in public health – including halving rates of infant mortality and pregnancy-related mortality – over the past three decades. Despite such advances, it spends only 1.9% of GDP on health, while evidence suggests that countries should spend 5% of GDP to progress towards universal health coverage. In addition, only 61.8% of households have access to health services within 30 minutes, a figure that’s much lower in rural than urban areas.

In low-income countries, community health workers (CHWs) play a particularly important role in bridging the gap of healthcare delivery in last mile communities. Unfortunately, 76% of CHWs in Nepal receive only minimal pre-service training and rely on antiquated, paper-based protocols that not only make inefficient use of their time but also leave the resulting documentation prone to error and to being lost in transit.

While Nepal’s technology and communication infrastructure is rapidly advancing, its community healthcare system has yet to reach the full potential of utilizing innovative technologies that could increase both its quality and accessibility.

Medic builds, innovates, applies and scales open-source, low-cost digital health tools in collaboration with communities, governments and healthcare providers around the world. It is the technical steward and core contributor of the Community Health Toolkit, a collection of open-source software and open-access resources used to create digital health tools, or apps. In Nepal, the toolkit supports the work of a non-clinical cadre of CHWs called Female Community Health Volunteers (FCHVs), who coordinate care for maternal and child health, and of clinically skilled Community Health Nurses (CHNs), who support maternal health, family planning, mental health and screening for non-communicable diseases such as cervical cancer.

In close collaboration with Nepali-based partners, Medic is working with the national government to scale the toolkit’s use by the community health workforce to provide high-quality in-home-based assessments, diagnoses and treatments based on global standards and protocols. Currently, Medic deploys innovative digital health tools across all seven of Nepal’s provinces, supporting 12 155 FCHVs with an SMS-based product and 42 CHNs with a mobile app. Together, these health workers have provided 1.4 million care services to more than 197 000 individuals since collective reporting began in 2015.

This Swiss Re Foundation-supported intervention aims to:

• Scale the SMS-based tool to 20 000 FCHVs by 2025
• Implement a federally led pilot of the mobile-based app for clinically trained CHNs to new use cases, users and sites
• Enable high-quality in-home care, such as pregnancy registration and antenatal care, for at least 200 000 unique individuals by year-end 2025

Empowering and equipping community health workers with effective digital tools is expected to open a pathway to better, faster, more equitable care and potentially to universal health coverage in Nepal.

Medic Impact Performance Report - 60 Decibels

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