Mathieu Lefevre

Backpack-equipped Health Care Workers Make a Difference in Rio: Added mobility helps monitor patients, manage diseases in favela

We were starkly reminded this summer, as Rio, São Paulo and Istanbul were shaken by some of the largest urban protests in decades, of the urgency of building more just and inclusive cities.

One of the main demands voiced by the protesters in Brazil is access to health care. Here at the New Cities Foundation, we chose to focus on this very topic in our Task Force on E-health. Led by our research arm, the Urban (co)LAB, we applied our methodology of using technology and cross-sector partnerships to develop replicable, scalable solutions to deliver better urban health care.

Partnering with the Municipal Health Secretariat of Rio de Janeiro, the State University of Rio, GE and Cisco, we launched our urban e-health pilot project in the favela of Santa Marta in 2011. Our aim was to test how state-of-the-art mobile and e-health technologies could improve primary health care services and lower health care costs for patients and the city.

E-health technology -– which the World Health Organization describes as “‘the transfer of health resources and health care by electronic means” – had previously been tested in remote, rural areas. Our project was the first major study looking at the impact of integrating e-health technology in low-resource, densely populated, urban settings.

One of the reasons we picked Santa Marta is that its health profile closely mirrors, and in fact foretells, the main health care concerns of other developing urban centers around the world. In these places, health care is hard to access due to geography. The population is dense and the citizens’ health profile is characterized by a major shift to chronic diseases like hypertension and obesity, and away from communicable ailments such as malaria and tuberculosis (though these remain very present in some cities in the developing world).

The questions we set for the task force were:

1) Can e-health technology reduce the unit cost of health care in an underserved urban community?

2) Can e-health overcome barriers to health care access in this type of community?

The main tool we used in this project was an “e-health backpack.” We equipped the local health clinic in Santa Marta with an easy-to-carry backpack containing state-of-the-art indicator measurement tools (see our full report for a complete list). Equipped with the backpack, health care workers were able to navigate the steep stairways and winding alleys of the community to access the most vulnerable patients who could not walk to the clinic due to illness or mobility constraints.

We focused on a sample of 100 patients, all older than 60. With a team of medical researchers and economists from the University of Rio, we studied the impact of the e-health backpack on the community and overall public health care system, including the clinic staff.

The results, released earlier this year, pointed to very significant potential economic, clinical and social benefits of this type of health care delivery process.

In terms of economic impact, the study showed that e-health technology enhances patient monitoring and leads to better management of diseases. Regular health monitoring of elderly patients, as well as timely diagnosis of chronic diseases, decreased the need for hospitalization for sufferers of certain diseases. This resulted in substantial savings for the public health care system.

In our study, cost savings through avoided clinical interventions for specific types of chronic disease ranged between U.S. $4,000 (heart failure) and $200,000 (kidney dysfunction) per 100 patients. Cost savings due to avoided hospitalizations of patients with cardiovascular diseases was around U.S. $136,000 per 1,000 patients.

The clinical and social gains are equally encouraging. Integration of the e-health backpack led to far speedier test results – sometimes reducing a two-week wait down to three minutes – and early diagnosis of chronic diseases.

We also documented far greater satisfaction among patients and health care workers. I visited the project several times over the course of the past two years and had the opportunity to tour Santa Marta with the nurses using the backpack. One thing that really struck me was how proud the nurses and patients were that this kind of state-of-the-art technology was being tested in their community and not in the fancier areas of Copacabana and Leblon, or in the U.S. or Europe. Empowering this community turned out to be one of the most positive outcomes of the project.

We are currently looking to dramatically extend the project with the city of Rio to cover most of the city’s favelas. I am convinced that urban e-health will play a big part in creating more equal, easy, efficient and cheaper urban health care in Rio in the future. We are hopeful that our project can start this process.

Mathieu Lefevre oversees the New Cities Foundation’s strategy and its day-to-day operations.

Health Care
healthcare technology, product design, public health