Health is an information problem. Four hundred million people without access to healthcare need authoritative, trustworthy and actionable information as a priority. At the same time, millions of health workers in rural and urban communities need robust clinical support.

This growing ‘knowledge gap’ can only be addressed with a systemic approach driven by digital healthcare services like Your.MD, supported by trusted clinical authorities, for example the British Medical Journal and the British National Health Service (NHS).

Innovation in healthcare has focussed for decades on modern industrial societies, prioritised technically advanced hospitals and payment through traditional service models. Modern healthcare systems work ceasely to reassure the mother of a feverish child, the middle-aged man with heartburn and the declining pensioner.

Technology seldom considers how to alleviate the anguish of a Nigerian mother whose child is a day’s walk from a doctor or how to bring reassurance in Bangladesh where there is one doctor to care for every 10,000 souls.

Dr Margaret Chan, the former Director General of the World Health Organisation (WHO), in 2008 said: “We see a mother suffering complications of labour without access to qualified support, a child missing out on essential vaccinations, an inner-city slum dweller living in squalor. These and many other everyday realities of life personify the unacceptable and avoidable shortfalls in the performance of our health systems.”

At Your.MD we think the creation of a technically enabled Pre-Primary Care health sector can help to change this. In so doing, we aim to help the WHO deliver the four cornerstones of global health reform it identified in its report Primary Health Care – Now More than Ever, in 2008:

• Universal Coverage
• Service Delivery Reforms
• Leadership
• Public Policy Reforms

Table 1: How Your.MD contributes to the cornerstones of Global Health Reform

The Challenges

The WHO believes the world has been unable to mobilise the requisite resources and institutions to transform health. This has led to the gap between healthcare systems and the people they were designed to serve increasing instead of narrowing. This delta in provision contrasts with the WHO’s Declaration of Alma-Ata in 1978 that called for health equity, people-centred care and a central role for communities in health.

Table 2: How Pre-Primary Care closes the gap

 

Pre-Primary Care can deliver the Alma-Ata declaration by providing free healthcare assessment, information and access to trusted services for everyone, for ever. The catalyst for this new healthcare paradigm will be partnerships between Your.MD and organisation like the BMJ and the NHS. Pre-Primary Care’s goal will be providing global parity in health care assessment, knowledge and personalised care centred in the community.

Universal Coverage

By opening up every citizen’s personal health black-box with the assistance of

Artificial Intelligence, the global population can access a baseline of health knowledge and understanding via the mobile phone never before imagined. The training and knowledge usually associated with a medical degree can be universally delivered. This represents a step change akin to the mass adoption of mobile money transfer in Africa or the introduction of printing.

People are increasingly impatient with the inability of health services to deliver levels of national coverage that meet stated demands and changing needs, and with their failure to provide services in ways that correspond to their expectations. Few would disagree that health systems need to respond better – and faster – to the challenges of a changing world. Pre-Primary Care can do that. It can maximise equity and solidarity, give everyone the right to an attainable high-level of baseline health assessment, information, care and be responsive to people’s needs.

The WHO believes that it is clear that left to their own devices health systems do not gravitate naturally towards goals of health for all through primary healthcare as articulated in the Declaration of Alma-Ata. Health systems are developing in directions that contribute little to equity and social justice and fail to get the best health outcomes for their money.

Table 3: Common shortcomings of health systems and how they are helped by Pre-Primary Care

Putting People First

There is substantial evidence on the comparative advantages, in terms of effectiveness and efficiency, of people-centred care. Its characteristic features are: personalisation, comprehensiveness, integration, continuity and the participation of patients, families and communities.

Your.MD can provide all these characteristics and in collaboration with potential partners like the NHS and the British Medical Journal it can add authority and credibility. The evidence from numerous studies is that people are more willing and able to care for themselves if they are confident, reassured and certain of support. Studies from around the world demonstrate that close to 75% of all primary care consultations are appropriate for self-care and resulted in the health professionals providing little more than reassurance, information or over the counter drugs.

Data from WHO’s World Health Surveys, covering 18 low-income countries, show low coverage of the treatment of asthma, arthritis, angina, diabetes and depression, and of the screening for cervical and breast cancer: less than 15% in the lowest income quintile and less than 25% in the highest. Your.MD could significantly enhance people’s understanding of the probability and risk of all these conditions with its personalised and confidential approach.