Biggest obstacles to decent health care in the developing world are managerial

Biggest obstacles to decent health care in the developing world are managerial
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Picture yourself going to the doctor. You arrive by car, park nearby, and when you enter a receptionist greets you and checks your information on a computer. You're led into a comfortable, well-lit office; the cabinets are fully stocked. Your records are on hand. The nurses and doctors are well educated and knowledgeable, their equipment at the ready. If they can't help you, they refer you to someone who can.

Now try to picture the same scene in sub-Saharan Africa. If you're wealthy, your experience may be similar. But if you're not, it's altogether different. The roads are unpaved and riddled with potholes; it might take all day to get to the clinic by public transport. The queue to see the doctor is long--an eight-hour wait is not unusual--and there's nowhere to sit. You might have to bribe someone to be seen. The electricity is unreliable; the clinic's supplies are running low. Your medical records are incomplete, perhaps even non-existent. The doctors and nurses, while trained and dedicated, are not up-to-date on current treatments, and lack access to the tools they need.

These scenarios offer a stark contrast in healthcare delivery. (Our healthcare system isn't perfect, but it has certain attributes we take for granted.) There is a reason, after all, that even as life expectancy rises globally, it remains stubbornly low in the developing world. In Zambia, for instance, average life expectancy is 55, according to the World Health Organization. In the US, it's 79.

Medical research continues to advance, and with the growth of interest in global health we're seeing spectacular technological innovations.

But what's needed now is management innovation.

Without management innovations, emerging markets still face the challenge of deploying new technologies, making sure healthcare workers' knowledge is current, and that patients get the follow-up care they need.

For the past five years, I've taught a course at MIT Sloan called GlobalHealth Lab. The course pairs teams of students with clinics, hospitals, and medical startups in the developing world to help them provide healthcare in more effective ways. Over the years, my students and I have generated practical ideas to improve healthcare delivery. Even the simplest ideas make a big difference:

Improve the patient experience. At the Chebaiywa Health Centre, based in rural Kenya, patients used to wait up to an hour before their first interaction with a member of staff. Often they waited only to find out that the medication they sought was out of stock, or the clinician they needed to see was out. To improve the patient experience, my students and I created systems that ensure that patients are greeted upon arrival, wait-times are minimal, and visit flow is smooth. As a result, the clinic has seen an improvement in patient satisfaction and a large increase in the volume of care it delivers.

Focus your data collection. Badly designed paperwork is disempowering for the patient--it sends a message that your time is not valuable. This year, we worked in Lusaka, Zambia with publicly run clinics. After study and observation, my students generated ideas to improve how paperwork is handled. We tested their proposals right away, which yielded immediate insights for better management of patient charts.

Make the most of your human resources. Making efficient use of employees' time is critical in medical organizations. Working with staff at a children's clinic in Muthaiga, Nairobi, my students mapped patient flows and tasks, and then made suggestions for how to reassign steps and standardize appointments. A year later, the clinic increased the number of children it screened for developmental delays--who then got the therapies they needed.

Find expansion opportunities in technology. Nearly 80% of people in the developing world have access to mobile phones--more than have access to toilets. Herein lies an opportunity to leverage a technology that's already in use. At LifeSpring Hospitals, a chain of maternity hospitals in Hyderabad, India, students examined how mobile phone software tools could enable outreach workers to better find and track patients. We tested tools in less than 24 hours, immediately showing that the tools were feasible and appreciated.

There's much promise in these ideas, but they present new challenges, too. We must keep building our evidence base and work to get these tools and approaches out to more of the managers, clinicians, and staff who need them. We must also keep working to understand what is needed to enable next steps. Along with my colleagues, I hope to do just that in the next five years of GlobalHealth Lab.

Anjali Sastry is Director of the MIT GlobalHealth Lab and a Senior Lecturer in System Dynamics at the MIT Sloan School of Management.

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