e-Health for Resuming care to Papuans during conflict

Indigenous people in some districts in Papua region has been in the middle of armed conflicts between Indonesia policy and army, and the resurgent guerrillas. People access to health facilities and healthcare workers access to communities were directly affected by the conflicts, resulting from displacements, road blocks, disruption of supplies from district health offices to the facilities and frontline healthcare workers. In addition, the Papuan health workers, nurses and midwives must resume services, and in many occasions they have no idea to treat and care patients requiring more advance medical care or requiring emergency care while they do not have sufficient information, knowledge and supplies to provide to these cases. Land transport is problematic due to geographical difficulties, and air transport by Christian/Catholica missions resume to be an alternative for air referral and supply distribution. This however needs a sustainable and practical communication among them in the widespread use of mobile phone among villagers and health workers. 

While internet access and phone communication are problematic in the conflictual districts, we will use a text based messaging technology for: 1) sharing clinical information and education sessions between specialist doctors in the district hospitals to the frontline workers, 2) digital consultations from frontline workers with the specialist doctors on how to do when there is complicated patients, considering the available medicines and other supplies, and for preparing for referring patients to the upper level facilities, 3) communication between frontline workers and the district health office for reporting the availability and stock-out of medicines/other supplies, and requesting replenishment of vaccines, medicines and other supplies from district authorities, 4) arranging the transport for supplies and medical evacuation for emergency cases requiring advanced facilities. Through a human centered approach, we will design a user friendly application for the use in the simple mobile phones. 

In addition to that, we will also use text messaging based technology to blast public health education and information to the Papuans and other villagers to generate demand for basic healthcare such as for child vaccination,  regular weighting for children, ante-natal care for pregnant mothers, screening for tuberculosis, HIV, hypertension, and other priority diseases; and how to seek care when people worrying some symptoms and signs. Through a human centered approach, we will develop a strategic communication and the informational materials that meet the need of the Papuans and other families, both men and women, different age groups and social characteristics. 

With this digital communication solutions, we expect that frontline health workers received enough supports and increase their confident level to resume their services to the Papuan clients, regardless of the conflictual situation. This will indirectly improve the priority public health outcomes among the community they serve.

In addition, we will generate people demand to services which also improve the health seeking behaviors among the communities, indirectly increase the care coverage, vaccination coverage etc., and also change the community perception toward healthcare system, and mobilize the community support for more resiliency healthcare system.

We have been implementing Maternal and Neonatal Health programs in several districts since 2017. We are also implementing the screening and care for congenital defects since 2022, and the Mental Health Resiliencies among mothers and families through hybrid learning mode. These include the use of e-learning, distance communication, digital application for improving referral network from family, village level facility into district hospitals. We are currently working for educating families for their children screened and get preventive TB treatment if contact positive with active TB cases. 

We will engage the frontline healthcare workers in Papua districts and the Papua community in the conflict districts in the design and development of the text message communication application. We will engage students from universities in Papua in the design of the application and the technology to be applied. We will also include translation to Papua language and ethnic dialects so that different sub Papua ethnic group could understand the message we are about to convey.  

We will expand the use of MoH digital platform "Satu Sehat" that connect client database and the hospital database. In Papua fragile context, we will change the internet based application into text messaging platform. In addition, we will add features on communication system between frontline workers and the district health offices/hospitals, and communication to alert medicine and supply stock-out and the link to the air transport system managed by Catholica/Christian mission. We will also advance the use of Satu Sehat to convey messages to the communities/Papuans to generate demand to services.

None

We are challenged by the technology barriers in the conflictual situation where phone communication and internet access are problematic, and we week support to use text messaging platform for a mobile application that was originally developed for good internet access regions. In addition, we look for some financial support for piloting the application in a geographically challenging and delicate situation of the conflicts.

This approach will help the communication between frontline workers and the district health authorities and hospitals that currently is ruined by the conflicts and fragile situation. While phone communication and internet access are very problematic, this will use old technology (text messaging) for enable the communication that support frontline workers to resume services to the communities they serve. In addition, we will expand the use of text messaging platform to generate people demand to services, using the simple mobile phone that widely spread used by the Papuans in the remote villages.

Next year, we will finalize the application for further used by one conflictual district in Papua, and in the next five year period, this will be scaled up for free for healthcare workers and the Papua communities.

The outputs will be measured with the number of frontline workers and communities used this application within the conflictual districts in Papua.

The impact will be measured with the increase coverage of child immunization, ante-natal care, child weight monitoring participation, visits of healthcare workers to the community at risk for priority diseases, and number of people use screening services (TB, HIV etc.)

If the health workers used the simple mobile application to improve communication with health authorities and hospitals, and if the Papua communities use the simple mobile platform to receive educational and informational of priority diseases and public health subjects, then the coverage of public health priority will increase, and the people wellbeing and health outcomes of Papuans in the conflictual districts will be improved, sustainable, and more resilient.

We will expand the use of SMS text messaging in the simple mobile phone to communicate about the need by healthcare workers to resume services and to blast messages to community to demand for services

This approach will improve the health and wellbeing of Papuans living in remote and conflictual districts that are currently neglected from basic health care. 

We will resume the basic health services to the communities in the conflictual Papua districts, improving the health system to support frontline health workers, and to send educational contents to generate demand from Papua communities to services. This services will be given for free for both health workers, the health system and the communities. This however need to be budgeted from the district government that have unspent public budget.  In addition, we will explore the compensation fund from National Insurance agency that is mandated to provide compensation to those who can not access quality health care due to remoteness and other barriers. 

The services need to be budgeted from the district government that have unspent public budget.  In addition, we will explore the compensation fund from National Insurance agency that is mandated to provide compensation to those who can not access quality health care due to remoteness and other barriers. 

We receive grants from Johnson and Johnson Give2 Asia for Maternal and Neonatal Health. This could provide seed fund to finalize the development of the application. For the future, the application needs to be budgeted from the district government that have unspent public budget.  In addition, we will explore the compensation fund from National Insurance agency that is mandated to provide compensation to those who can not access quality health care due to remoteness and other barriers.