Health caravans

Access to medical care is often the most important problem of rural and  remote populations. Geographic access to medical services is one of the main factors for reduced healthcare utilization in rural areas, where there is a shortage of professionals and a lack of medical infrastructure. Studies have shown that rural residents have fewer medical visits to the doctor than their urban counterparts, an aspect which is explainable by the fact that many of the rural residents go to the doctor only when it is absolutely necessary, for acute care visits, often neglecting regular and chronic care visits.

The poor access of services and facilities in rural areas is also influenced by limited transport options. Consequently, people living in rural areas tend to have less access and to receive less formal support services in terms of  healthcare and other social services, which leads not only to a lower quality of life, but to increased mortality rates.

The situation described above fully applies to Romania, which is among the top 3 countries in EU with the highest unmet medical needs (according to the Romania country health profile 2021, European Observatory on health systems and policies). Among the causes is the major gap between urban and rural distribution of healthcare infrastructure and professionals - 81.5% of all hospitals and clinics are located in urban areas, and 91% of all physicians (excluding GPs) work in urban areas.

The Doctors' Caravan Association is a non-governmental organisation (NGO) with over 8 years of experience in delivering medical services to rural and remote areas where there is a vulnerable population which lacks access to medical care. The aim of the NGO is to create a national system through which primary care physicians can identify the needs of the local communities and address these needs through medical caravans and specialized healthcare. Also, the aim is to allow doctors, nurses and local authorities to be able to deliver regular medical services and training sessions regarding health and well-being in the areas that are economically and socially disadvantaged.

The medical caravans are organised in various locations by a team of doctors (general practitioners and medical specialists) in collaboration with the local authorities and the local general practitioner or nurse where available. We o?er various medical assessments by assembling a multidisciplinary team (medical specialists and medical residents, as well as medical students) and travelling to a remote location where we set up a mobile clinic. We evaluate the health status of the population through a 3 stage concept: first we perform blood and urine tests; afterwards we do clinical examinations and paraclinical investigations (i.e electrocardiogram, abdominal ultrasound and echocardiography, specialty consults: internal medicine, cardiology, neurology, ophthalmology, dermatology, gynaecology, paediatrics, etc.);

we give medical recommendations and perform follow up visits via telemedicine and remote consultations. We identify vulnerable patients and travel to their location in order deliver medical assistance and promote prevention programs.

The caravans can collaborate with the general practitioners in the local areas, in order to triage the patients and reduce the need to access big medical centres for minor problems. The entire process is digitalized and there is a medical management platform that integrates all the data and helps ensure good collaboration between GPs, specialists and local authorities. It also allows for follow-up and monitoring of the assessed patients, as well as health data analysis and research purposes, including community health needs assessments.

The Doctors' Caravan Association is a non-governmental organization (NGO) with over 8 years of experience in delivering medical services to rural and remote areas where there is a vulnerable population which lacks access to medical care. The aim of the NGO is to create a national system through which primary care physicians can identify the needs of the local  communities and address these needs through medical caravans and specialized healthcare. Also, the aim is to allow doctors, nurses and local authorities to be able to deliver regular medical services and training sessions regarding health and well-being in the areas that are economically and socially disadvantaged.

The medical caravans are organized in various locations by a team of doctors (general practitioners and medical specialists) in collaboration with the local authorities and the local general practitioner or nurse where available. We o?er various medical assessments by assembling a multidisciplinary team (medical specialists and medical residents, as well as medical students) and traveling to a remote location where we set up a mobile clinic. We evaluate the health status of the population through a 3 stage concept: first we perform blood and urine tests; afterwards we do clinical examinations and paraclinical investigations (i.e electrocardiogram, abdominal ultrasound and echocardiography, specialty consults: internal medicine, cardiology, neurology, ophthalmology, dermatology, gynaecology, paediatrics, etc.);

we give medical recommendations and perform follow up visits via telemedicine and remote consultations. We identify vulnerable patients and travel to their location in order deliver medical assistance and promote prevention programs.

The caravans can collaborate with the general practitioners in the local areas, in order to triage the patients and reduce the need to access big medical centers for minor problems. The entire process is digitalized and there is a medical management platform that integrates all the data and helps ensure good collaboration between GPs, specialists and local authorities. It also allows for follow-up and monitoring of the assessed patients, as well as health data analysis and research purposes, including community health needs assessments.

There is also a prioritization of the main health topics (main pathologies + main community health needs) covered by the caravans, according to the specific epidemiological picture:

- general/internal medicine caravans (covering chronic diseases such as cardiovascular diseases)

- paediatric caravans;

- gynaecology and maternal health caravans

The Doctors' Caravan Association has a vast experience in organizing  caravans.The program started in 2014 and now has a national coverage, having formed branches is 7 major cities and having organized over 180 caravans from which tens of thousands of patients have benefited.

The program was so successful that we proposed a legislative bill - The Mobile Healthcare Act - which passed in march 2022 and has now become the foundation through which any medical professional can offer medical   services in caravans.

The model of hybrid health services we deliver and the main features of our solution are briefly described below:

Service scope:

• Preventive consultations;
• Medical investigations (blood tests, ECG, Spirometry, Ultrasound etc);
• Follow up consultations for chronic diseases;
• “Medic chat”;
• Patient health education (including access and use of medical services);
• Patient navigation;
• Questionnaire/study (eg study for access to health services)

Who delivers the service:

• Medical specialists (eg. Medical specialists working in outpatient clinics – once per week in the field)
• Nurses

How:

• Medical caravans (mobile health);
• Virtual care (including call center, telemedicine, wearables etc)

Costs: similar to the costs of delivering the medical services in the clinic

Number of beneficiaries covered so far: 30.000 patients in rural areas from > 180 communities covering > 50% of Romania;

Over 30.000 patients in rural areas from > 180 communities covering > 50% of Romania.

I am applying because it is our desire to scale up our solution so that is  becomes an international model for improving healthcare in rural and remote areas. We require funding to improve our digital platform and analysis protocols in order to correctly identify the medical needs of the population.

Our solution is innovative because it combines a novel approach to delivering healthcare. Through mobile caravans, you can bring a team of doctors that can perform screening and diagnostic tests and improve the healthcare of a population that lacks access to basic medical services. The digital system that we have employed helps GPs identify medical needs and allowed them to request the services (through caravans) that would improve the health of the population. Our platform also helps identify patients that are in need of further investigations or follow-up and assists in providing solutions (proximity clinics, reminders, etc).

Moreover, the rural caravans provide the patients with a high "dose" of  empathy and enthusiasm coming from the young students and doctors, fundamental for a creating a proper relationship between doctors and patients and trust among the beneficiaries. It is a win-win solution, as the young students and doctors have the unique opportunity to see and examine patients, in the middle of their community, and understand the whole picture of their determinants of health.

Our solution covers the following areas:

- Provide improved measurement methods that are low cost, ?t-for-purpose, shareable across information systems, and streamlined for data collectors;

- Provide actionable, accountable, and accessible insights for health care providers, administrators, and/or funders that can be used to optimize the performance of primary health care;

- Balance the opportunity for frontline health workers to participate in performance improvement e?orts with their primary responsibility as care providers.

The solution addresses the following challenges:

- Lack of comprehensive vision and purpose for data collection: the Caravans program is carefully designed done in collaboration with Public Health and Medical Experts;

-Poor quality or impractical data, inconsistent connectivity and adoption of real-time digital tools: the processes and data collection are digitalized using a fully customized software platform;

-Systems lack feedback mechanisms for data collectors themselves: feedback sessions are performed on a regular basis together with the Public Health Experts.

We have recently achieved a major goal by passing The Mobile Healthcare Act and our plan is to promote the deliverance of medical services through medical caravans. We hope more professionals / institutions will adopt this solution, and thus contribute to lowering the poor access to medical services for rural and remote areas.

This effective program can also be scaled-up by designing a community based model where various stakeholders are involved in order to offer better support and more regular access to healthcare services.

Plans for the next year:

 We plan to offer free medical services to 10.000 patients from over 40 communities. We al so plan to expand our solution to a second country (Republic of Moldova)

Plans for the following 5 years:

• Extend legislative framework (Norms) for the Mobile Healthcare Act;
• Increase number of mobile health services offered (including preventive services);
• Cover part of the services through the Public Health Insurance Fund.

We measure our progress through the total number of population that has benefited from our health services and through the number of patients that have been treated and have consequently enrolled in our electronic medical platform to be followed-up and counseled so that they can receive quality  healthcare. We also see a huge enthusiasm from the volunteers who organize the caravans, which are constantly growing.

Our solution changes the way healthcare is delivered. Instead of the patient coming to the clinic (which can constitute a problem for some categories of the population), we promote the concept of mobile healthcare. Through this concept, a team of doctors periodically visits rural and remote areas and offers medical services. This changes the paradigm that a patient only has to see a doctor when he has a medical problem / an ailment. Our proactive approach not only improves access to healthcare in remote areas, but also improves the general well being of the population through routine screening and prevention programs.

We envisage to change through this approach the behavior of the local population from passive seekers of medical support to proactive citizens seeking for preventive health services and maintaining their health.

The technology that powers our program is a medical management program that allow all the involved parties (patients, GPs, medical specialists, clinics, local authorities) to be connected, to identify the medical needs of the population and to help provide it afterwards. The solution is currently a web based platform that is mobile friendly and that uses advanced security protocols to ensure that all the medical information is protected.

We support and encourage diversity and equity within our Association. These actions can be seen by the large and diverse number of volunteers that have joined our group, comprised of medical students, medical residents and specialist doctors, but also nurses, midwives, community assistant and any other specialist that is connected to the field of healthcare. Moreover, the scope for which we started and developed this project was to provide medical care to the most distant and disadvantaged communities, regardless of gender or race.

So far, we have obtained financial donations / support from numerous companies that either had active projects in the health sector, or had CSR programs and wanted to get involved in our project. In the future, we plan to involve the  National Health Insurance House and multiple stakeholders that have an interest in investing in the health of the local community.

One of the next objectives after passing the Mobile Healthcare Act is to regulate the framework for funding these services by the National Health Insurance House. We also plan to involve multiple stakeholders that have an interest in investing in the health of the local community (City hall, GP,s community nurses, territorial clinics and county hospitals, pharmacies, private companies).

So far we have received numerous grants from CSR projects and have won several funding projects from companies that organize funding contests. Through the private funding that we have raised we were able to organize over 130 caravans and provide medical services to more than 20.000 patients. Moreover, we have expanded into branches in 6 other cities and  have been able to acquire medical equipment (i.e EKG devices, abdominal  and cardiac ultrasound devices, colposcopy units). Also, we have recently    acquired a medical trailer which has been equipped with POC blood tests and ultrasound device.