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2017 IEEE Region 10 Humanitarian Technology Conference (R10-HTC) 21 - 23 Dec 2017, Dhaka, Bangladesh

Technology-Based Public Policy Interventions to Enhance Access to Health Care Support: A Study in the Context of Rural Bangladesh Muhammad Hassan Bin Afzal Graduate Assistant, Bengal Solutions College of Business Idaho State University, 921 South 8th Avenue – Stop 8020, Pocatello, ID 83209 Email: [email protected]

L. Daniel Cravens, J.D., DBA, Director, Bengal Solutions College of Business Idaho State University, 921 South 8th Avenue – Stop 8020, Pocatello, ID 83209, Email: [email protected] Pocket payments for health care push 3.4 percent of households in the country into poverty. Non-communicable diseases, especially chronic conditions, which require hospitalization or surgery create a significant likelihood of placing Bangladeshi households into poverty [6]. Thus, against this backdrop, there is an urgent need to understand whether and how the government could utilize IT tools such as mobile apps to facilitate access to health care support.

Abstract— Bangladesh is one of the most populous countries in the world and the current population is 165.06 million. Almost more than half of the total population does not have proper access to proper healthcare support due to the shortage of the appropriate number of healthcare facilities and registered doctors. The latest research analysis and study conducted by WHO states that now there's only 3 doctors and 3 nurses per 1000 people in Bangladesh. Further comprehensive research indicates that there are certain rural and remote locations in Bangladesh where there are no available hospitals and/or registered doctors to provide required health care facilities. Thus, against this backdrop, there is an it is urgent need to understand whether and how the government could utilizes IT tools such as mobile apps to facilitate access to health care support. This exploratory research study thoroughly focuses on the various problematic areas in rural health care facilities available to the rural population of Bangladesh, and proposes an alternative and sustainable approach to overcome such gap in medical services for this underserved population.

Currently, this research is concentrating on building a userfriendly cohesive IT-based access to health care platform such as mobile apps, social media apps, mobile network platform etc. which can easily be utilised by disadvantaged rural population in Bangladesh, with limited to no academic background. Also, it strongly focuses on providing training on how access to the nearest healthcare facility as well as implementing health care agent in remote locations to provide emergency services during critical moments. Finally, this research article focuses on reformed health care policies which provide significant advantages in advancing the IT integration to provide much broader access to health care for the disadvantaged population. The five steps will be taken to strengthen the findings are

Keywords—Rural Health Care, Access to health Care, Mobile Applications, IT-based access to health care.

I. INTRODUCTION Bangladesh is one of the most populous countries in the world and the current population is 165.06 million [1]. Almost more than half of the total population does not have proper access to proper healthcare support due to the shortage of the appropriate number of healthcare facilities and registered doctors. The latest research analysis and study conducted by WHO states that now there's only 3 doctors and 3 nurses per 1000 people in Bangladesh [2, 3]. Further comprehensive research indicates that there are certain rural and remote locations in Bangladesh where there are no available hospitals and/or registered doctors to provide required health care facilities [2-5].

1) Rigorous review of academic literature/ research findings 2) Latest news clips, articles and interview experts to analyse the current trend 3) To forecast the upcoming health care industry with IT integration in rural Bangladesh 4) To suggest a unified and common IT platform in order to facilitate the rural disadvantaged population 5) Proposing a dedicated Model Framework that could appropriately leverage IT to enhance access to Medical care

This research builds off pioneering research on use of mobile computing technologies to conduct health monitoring in rural Bangladesh [18]. Since this research both mobile networks and mobile computing have advanced. Additionally, recent research indicates that the lack of access to affordable healthcare in rural Bangladesh contributes to poverty. Out of 978-1-5386-2175-2/17/$31.00 ©2017 IEEE 201

2017 IEEE Region 10 Humanitarian Technology Conference (R10-HTC) 21 - 23 Dec 2017, Dhaka, Bangladesh

The main reason for such high child death rate in rural and remote locations in Bangladesh is very limited access to health care facility in Bangladesh specifically in rural areas. For such a populous country like Bangladesh, the available doctor and nurse are quite low in numbers. Other than that, the majority of rural population suffer from low income, less information about available medical services and remote locations [7-11].

II. CURRENT HEALTH CARE STATUS IN BANGLADESH Bangladesh is one of the most densely populated countries in the world and available doctor to population ratio is very low. Based on recent WHO analysis, there are only 3 doctors and 3 nurses per 1000 people in Bangladesh. But in remote and rural locations, sometimes the availability of appropriate health care services for the local people is quite difficult and most of the times these rural and underserved population are suffering from various diseases. The following diagram illustrates the veracity of infant mortality rate in Bangladesh [1-3].

III. KEY CONCERNS FOR HEALTH CARE INACCESSIBILITY IN BANGLADESHI RURAL AREAS In recent times, more and more people from rural areas of Bangladesh are migrated to urban areas hope to achieve a better future and earn more money for better living. Regardless of this on-going trend, currently only 34% of the total Bangladeshi population lives in Urban areas and rest of the 66% of total population lives in rural and remote areas of Bangladesh with less scope to access a proper and fully functional health care facility on time when it is needed most.

TABLE 1: INFANT MORTALITY RATE IN BANGLADESH VS. COLOMBIA VS. GHANA (DIVIDED INTO URBAN VS. RURAL AREAS)

TABLE-2: RATE OF URBAN POPULATION VS. URBANIZATION [THE WORLD FACT BOOK, 2015]

Country name

Total population

Bangladesh Columbia Ghana

162,910,864 48,654,392 28,033,375

Urban population (of total population) 34.3% 76.4% 54%

Rate of urbaniz ation (annual rate of change) 3.55% 1.66% 3.4%

From table-2 it is clearly reflected that, more than half of the population Bangladesh are still living in the remote and rural locations where it is quite difficult and prolonging process for rural individuals to access to health care services on time. Some key obstacles are discussed below.

Source: The WHO Report, based on DHS 2011 Survey*, based on DHS 2010 Survey**, based on DHS 2014 Survey***

Although the average child death rates in both urban and rural areas are significantly high in Bangladesh compare to Columbia and Ghana, only unusual high child mortality rate is visible in Ghana for under-five. Other than that, in rural areas, the child death rate is quite high in Bangladesh [7,8].

1. Significantly low ratio of registered doctor versus overall population 2. Majorly dispassionate medical health workers to serve in rural areas 3. Low number health care facilities in rural areas 4. Very poorly managed health care facilities in rural areas 5. Poor rural transport infrastructure 6. Low literacy rate in rural areas 7. Poor mobile network coverage in rural areas IV. CURRENT STATUS OF MOBILE NETWORK COVERAGE IN RURAL AREA(S) This section of this report focuses on the availability of mobile network coverage in rural areas versus the overall mobile network coverage countrywide. It will provide a clearer idea as the current status of mobile network extent in Bangladesh and how the stronger and wider mobile network coverage can be hugely beneficial in extending the health care services to the rural population of Bangladesh as well as other developing countries in the world.

Figure 1: Higher child death rate in Bangladesh due to very limited access to Medical services

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2017 IEEE Region 10 Humanitarian Technology Conference (R10-HTC) 21 - 23 Dec 2017, Dhaka, Bangladesh

These online providers have gained recognition for their ability to provide easy access, at any time of the day or night, to a medical doctor who can diagnose a condition, and provide a prescription for medication. Online physician sites in the United States have also been credited with providing a more affordable health care option for many Americans [15].

The data illustrated in table-3 is most helpful to understand the current status of mobile network coverage in the aforementioned countries. It also shows that, Bangladesh has less mobile data speed compare to other countries. In order to spread the mobile based health apps to support the rural and remotely located people in Bangladesh it is highly essential to have better mobile network coverage and better speed. Still, it is also essential for people to understand the concept of utilizing the mobile app to get instant help in terms of health services.

Often the quality of care offered by online physician services in the United States is comparable, with regard to lessserious conditions, to that of a traditional office visit to a medical doctor [16]. As far back as 2009 mobile network technology has become a valuable tool in the reporting and subsequent treatment of malaria cases in rural Bangladesh. Current access to cellular networks in rural Bangladesh has already proven to sufficient tool to support better health care [17]. A futuristic approach that might worth considering where the USSD based mobile network can be used as a benchmark to provide a personalized voice activated medical care assistant to the isolated, rural and underserved population. Further research and pilot studies is required to prove the concept and validity of this idea, but it one of the better and easier approach to support the underserved population in medical needs.

TABLE-3: CURRENT STATUS OF MOBILE NETWORK COVERAGE VS. OVERALL SPEED OF MOBILE DATA [THE OPEN-SIGNAL REPORT, 2017]

Country

Mobile Network Coverage

Time spent connected to mobile Wi-Fi connection

Overall Speed of Mobile Data

Bangladesh

68.71%

3.75 Mbps

25.47%

Columbia

84.64%

8.07 Mbps

52.93%

Ghana

65.74%

4.81 Mbps

12.62%

Finally, table-4 focuses on current socioeconomic statuses for these three selected countries. This dataset shows that, the healthcare expenditure percentage of total GDP is lower than other two countries. Further research and policy upgradation is strongly suggested to increase investments in healthcare sectors in Bangladesh specifically focusing on rural and disadvantaged population. TABLE-4: CURRENT SOCIOECONOMIC STATUS [THE WORLD BANK API, 2017] Country

Current Account Balance (BoP, current US$)

Populatio n Density (people per sq. km of land area

GDP per capita, PPP

Health Expendi ture total (% of GDP)

GINI Index (World Bank estimat e)

Bangla desh

2.687

1251.84

3580.69

2.819

32.13

Ghana

-2.809

123.96

4293.57

3.557

42.76

Colomb ia

-12.541

43.85

14157.6 3

7.201

53.5

(Curre nt intl. $)

.

Source: World Bank API V. INFORMATION TECHNOLOGY PLATFORM TO PROVIDE HEALTHCARE SUPPORT TO RURAL POPULATION

Figure 2: USSD Based Personal voice assistant to provide medical support to rural population

Information technology platform can be a revolutionary platform to provide health care support to rural and remote areas in Bangladesh and other developing countries. Currently, in the United States there has been a dramatic rise in the past few years in online websites which provide access to a live medical provider.

But there are certain complications to overcome before expanding the appropriate IT based health care support to the rural population in these countries. These complications are listed below.

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2017 IEEE Region 10 Humanitarian Technology Conference (R10-HTC) 21 - 23 Dec 2017, Dhaka, Bangladesh

1.

User Interface:

Literacy rate in these remote and rural areas are significantly low and it would be difficult for them to navigate a health based IT app in English language. Also it would require certain training for these population segments to navigate a health app and seek proper health support on time from health care workers. 2.

[2] [3]

Regional Language Support:

[4]

It is essential to provide multiple language support in those dedicated health care mobile apps. As an app developer, it is highly important to consider local dialect and/or tribal languages. A fitting voice-over service might be more useful along with the traditional mobile app navigation. 3.

[5] [6]

Minimum Requirements but Maximum Support: [7]

These mobile apps need to be built on such manner that requires minimum specification in their mobile phone/hand held devices. The installation process and auto update are also significantly important to be considered about.

[8]

VI. FUTURE APPROACHES This collaborative research is still in its primary stage, with appropriate research, collaborative analysis and further investigative study, this will focus on providing reformed health care policies, and dedicated framework to support the remote disadvantaged population. This modelled framework can be utilized in other developing countries to provide an allinclusive health care support.

[9]

[10] [11]

The expected outcomes of future collaborative research works are: 1) A roadmap for government in Bangladesh to consider in implementing m-health-based intervention 2) The knowledge from this study could also be beneficial for public policy experts and administrators of rural areas in other countries, including rural Idaho.

[12] [13] [14]

VII. CONCLUSION AND FINAL REMARKS This research paper principally focuses on integrating IT platform into health care industry in Bangladesh to significantly improve the access to healthcare for the people from remote and rural locations in Bangladesh. The government is offering their best effort to enhance the medical care support for the disadvantaged population in Bangladesh. But due to certain limitations such as bad mobile network, no access to internet and inability to use mobile app platform to seek medical help makes it difficult for the disadvantaged population to get access to medical support. This paper focuses on examining what policy interventions certain policy rectification to increase the ratio of access to healthcare.

[15] [16]

[17] [18]

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