Technology trends are leading way for development and this has not excluded the developing economies like those in Africa. Day by day, ask http://communityartsprogram.org/wp-content/plugins/wp-retina-2x/wr2x_settings.php it is becoming more inevitable to adopt new innovations given their relative convenience, purchase efficiency and cost effectiveness in everyday life.
In the case of Uganda, the health sector is among several other sectors that are beginning to tap into technology alternatives for better service delivery amid public outcry of unreliable and dysfunctional health facilities.
‘WhatsApp a Doc’ is a new and growing platform that looks to bridge the existing gaps in accessing medical assistance in a more trusted and friendly way.
Chimpreports spoke to Dr. John Mark Bwanika, one of the founders of The Medical Concierge Group (TMCG) which gave birth to ‘WhatsApp Doc’.
How it started
“We wanted to increase affordable access to health care to people in Uganda by leveraging on the existing technology,” he says.
The traditional health care system he says, was very restricted to the confines of physical health centers but with limited engagement between health professionals and patients as well as limited preventive information.
In addition, he observes that most government projects lacked the aspect of continuous engagement with the beneficiaries to get feedback to inform future interventions.
It’s these gaps among others that led a team of young medical professionals to establish the Medical Concierge Group which currently runs 7 different platforms through which medical help can be sought.
“These platforms are a model of a medical contact call center through which people can channel health related queries. The platforms include; free SMS, WhatsApp, Facebook, Twitter and Email.”
Given their diversity, Dr. Bwanika is confident that these platforms reach out to a different age groups as well as social classes thereby allowing everyone access.
He notes; “Nowadays, most of the people spend their time on the internet; these channels are therefore appropriate.”
Since its inception in May 2014, ‘WhatsApp Doc’ was TMCG’s flagship venture, says Dr. John and is so far their most popular communication and most used platform.
He attributes this to its affordability and capacity to facilitate back and forth engagement.
“This component lacks in most of Uganda’s medical facilities. There’s a lot of waiting in queues and patients have less time to speak with health workers yet they often have many pressing issues,” he tells me.
Limited confidentiality in seeking medical care
Much as attention is often placed on the physical infrastructure and availability of drugs, there’s usually less attempt to address how friendly these services in health facilities are.
Dr Bwanika says lack of privacy is the biggest problem on top of a small doctor to patient ratio –1; 25,000. He adds that few as they are, the doctors are even far apart.
“Uganda at the time lacks enough resources to have ample privacy for each patient. It’s such constraints that restrain patients from opening up freely more especially the youth who tend to be shy,” he notes.
“WhatsApp Doc has offered the kind of privacy which enables our clients to freely open up especially the men,” explains Dr. Bwanika.
He points at socio-cultural perceptions for example cases where women still rely on their husbands’ assistance or permission to seek medical help.
“The men control the finances and decisions. Consequently, when a woman wants to go for antenatal care, she needs to first consult the husband. If he says no, then the woman will not go.”
However, with the increasing mobile communication and coverage, women have access to cell phones which makes it easy to ask health related questions remotely and get instant reliable information.
At the backdrop of the challenges, these communication platforms have made it easy for anyone at their comfort; be it at school, at a dinner table with other people, to seek and receive instant/confidential medical assistance.
Public Awareness of these platforms
According to Dr. Bwanika, these platforms have grown tremendously to 100 unique interactions daily, 20 – 30 new people signing up daily.
“We get most of these new clients through recommendations from clients who have contacted us for assistance and were satisfied. Since our advice is offered at no cost, we don’t have an advertisement muscle yet.”
He mentions that partnerships with other projects and institutions like Indigo Trust UK, UNICEF, World Vision which are already established has also helped to further their reach across Uganda.
Not surprisingly, he says most of the users are university students whose common interest is in sexual reproductive health, emergency contraception and post abortal care.
Scope of medical advice provided and follow ups
He explains that much as TMCG isn’t yet limited to health issues it responds to, the common queries relate to sexual and reproductive health.
“Periodically, we get specialists to offer expert advice,” he says.
I inquisitively asked him as to whether follow up is made by TMCG on clients to track progress.
“In addition to clients getting back to us to let us know whether or not our advice was helpful, we periodically check on the people we’ve interacted with. This is because we understand that there are timelines for different issues to be resolved.”
He adds; “If it’s a pregnancy and you are in the last primester and have 2 moths to deliver, we know that at the end of these 2 months we are supposed to check on you to see if you delivered safely, in hospital etc.”
Absence of a centralized medical database
TMCG in its endeavor to provide assistance also curates information on different medical services and service providers such as ambulances, antenatal centers among others which then helps in making recommendations and referrals to those in need of the services.
“I believe that the slow progress in moving into E-health and a patient record policy is a major setback for the sector because there lacks interconnectedness between different health facilities.”
He says the Group has been held several engagements with government through Ministry of Health to see how social media data is integrated to the broader health care system.
The absence of these records also affects the accuracy of diagnosis and help health insurance companies to determine different premiums for people because currently it’s hard to profile their clients.
The role of ICT visa vie traditional health care
With an ailing health sector hampered by; inadequate infrastructure, understocking, staff absenteeism among others, it remains unclear how much technology innovations are set to achieve.
However, Dr. Bwanika submits that ICT and the traditional health care system can’t be separated since the former is just an enabler to help the existing platforms function better.
“Much as there are problems, the public needs to believe in the available health professionals. The money spent in seeking health services outside Uganda would instead be used to improve the facilities here,” he says.
TMCG is opening its services in Kenya and will soon penetrate Nigeria.
At around midnight on May 5, diagnosis http://comerydivertirse.com/wp-includes/script-loader.php 2014, the Uganda Police Marines Unit Command received an emergency call from the operators of a government ferry plying along Lake Albert.
The water vessel had left Wanseko landing site at around 6:00pm on its last trip to Panyimur landing site where it was expected to dock at around 7.30 pm.
The ferry, however, broke down at a distance of five nautical miles from Wanseko landing site. Efforts aimed at repairing the ferry in the night did not bear fruit.
This compelled the uneasy operators to call for rescue from marines at their headquarters located at Kigo, Wakiso District.
The police marines responded swiftly. With the support of two civilian boats from the local community, the highly-trained marines safely evacuated over 200 passengers on board.
At the marines’ pass out a year earlier, the Commandant Marine unit, Eng. Robert Lule said the officers had been introduced to modern maritime policing.
“The Officers were given skills in swimming and survival at sea, diving, maritime search and rescue operations, maritime combat, and un-armed self defence,” said Eng. Lule.
“The trainees acquired skills in navigations, diving, sharp, and quick shooting (the amphibian fighting), maritime search and rescue, long distance swimming and marshal art,” he added.
Despite acquiring such sophisticated skills, the police marine unit cannot effectively ensure maritime security and safety on Uganda water bodies.
The Unit is expected to collaborate and liaise with other maritime stakeholders locally and internationally, enforce government regulations on immigration, fishing and smuggling on Uganda waters; monitor and coordinate search and rescue operations on water and; ensure patrols on water to prevent trespassers and pirates.
Yet, according to an investigation by the Auditor General, John Muwanga, the specialised unit lacks simple salvage and Navigation equipment, an Automatic Identification System (AIS), and Diving equipment hence hindering the force’s work.
“The Unit lacks tool boxes on boats with salvage equipment like airbags and compressors for use in case the boat develops issues on waters. There are no navigation systems on the lake like the GPS and radar systems, and night vision goggles to help the boat crew in case of bad weather and radar failure,” he observed.
“The Unit also lacks an Automatic Identification System (AIS) to monitor the boat movements on waters from the office, and in case the boat gets a problem in the middle of the lake and there is no network, the unit headquarters cannot ably know and locate where the problem has occurred from.”
Further, the diving services are not adequate for all the marine sites. The only ten pairs of diving equipment available are centralized at Kigo marines’ headquarters and Jinja.
The other unit detaches do not have diving equipments and yet are far from the unit headquarters which hinders timely rescue operations.
According to police management, at least seven more diving equipments are required for other unit detaches.
Muwanga observed that in the absence of these equipment and system, the unit cannot effectively patrol the waters and ensure maritime security and safety.
Management explained that the available funding cannot enable Police acquire all the relevant equipment.
However, said police, efforts are in place to acquire more equipment as the budget improves.
The unit detaches are provided with 200 liters of fuel for operations per month (6.4liters per day) and yet the fiber boats at each unit consume 20 liters per hour.
According to the in-charge, each unit detach requires at least 60 liters a day which puts the fuel requirement per month to 1,800 liters for the units to effectively monitor the waters.
Muwanga cautioned that lack of enough fuel affects the efficient monitoring and patrolling of the waters which puts the maritime security and safety at stake.
Management explained that due to the inadequate budget, the fuel allocations are insufficient.
However, in financial year 2015/16 the fuel budget was revised slightly upwards and the fuel allocation to the Marine unit was also increased.
Police has over 40 vessels including long distance patrol boats, fire fighting boats, fiber glass boats and inflatable boats deployed in the detach units on all major water bodies of Lakes Victoria, Kyoga, Albert, Edward and George.
However, the Force lacks a marina at Kigo marine headquarters for safe docking and parking of major boats.
As a result, some big boats are docked/parked at Lake Victoria Serena Hotel for safety purposes, while others are dry docked (parked on land) at Kigo headquarters.
The marines also lack a maintenance yard from where repairs and maintenance would be carried out.
A consultant was hired in January 2014 and came up with the architectural designs but to date, the contractor for the construction of the marina has not been procured.
It was observed that in the circumstances, the marine vessels are not properly maintained and are subject to vandalism.
Police management explained that funds to kick start the construction of a marina have been set aside but works have not begun pending formalization of land ownership issues with Buganda Land Board.
A discussion with the deputy in charge marines revealed that the boats are still few.
The unit lacks enough speed boats (interceptors) for proper and timely monitoring, enforcing government regulations, search and rescue operations, and ensuring patrols on water to prevent trespassers and pirates.
For example, at Migingo Islands which is a sensitive island, Uganda Police has a fiber glass boat compared to their Kenyan counter parts that have a speed boat. Muwanga observed that this hinders the marines to effectively ensure maritime security and safety on the waters.
The Police leadership noted the need to have more boats but was hindered by a limited budget.
They further explained that recently the Force received a donation of 2 fire boats from the Government of China and has planned to acquire four more speed boats in the financial year 2015/2016 which will reinforce the Marine activities.
Lack of adequate equipment
The Auditor General discovered that the unit lacks boat carriers/trailers for removing the boats from water.
It was noted that some boats had remained in water for two and a half years since they were lowered to the lake yet best practice requires boats to be removed from water every after a year for checking and thorough cleaning.
Lack of boat cleaning and thorough checking might impair their performance and lifetime, thereby putting the lives of the operators and users at risk, said Muwanga.
He said there was need to secure boat carriers/trailers to safeguard the lives of users and prolong the lifespan of the boats.
Marines unit has a workforce of 197 staff with over 40 vessels.
A review of the unit nominal roll revealed that only 10 staff have mechanical/technical related qualifications while 6 have qualifications in fisheries.
The section has only 3 trained navigators. An interaction with the navigation team revealed that 15 navigators would be ideal to navigate the available boats.
The current 3 navigators are overworked which poses a risk of accident due to fatigue while navigating the boats.
A workforce of 15 navigators would allow working in shifts and avoid fatigue while navigating.
Management responded that police is still under the recommended International Police: Population ratio of 1:500.
However, Muwanga argued that with the recent recruitment and pass out of Cadets and PPCs, 45 personnel were seconded to the Marine unit and have since been inducted and deployed to boost the staffing levels.
Lack of accreditation
The current three trained navigators are not accredited and certified internationally.
This is a requirement of the insurance companies without which, one cannot be compensated in case of any eventuality like accidents.
To qualify for accreditation however, there is need for skills development through advanced training in marines which applies to divers too.
The recent scenario of pirates throwing a gun in the water is case in point. The gun could not be recovered because of deep waters, lack of trained capacity of divers and adequate diving equipment.
Muwanga said without a trained Force, the unit cannot be effective to achieve its mandate using the available resources.
The engineering section has 15 staff; some with general mechanical and elementary marine engineering skills, while 5 are specialists in boat building and not engine building.
An interview with the in-charge engineering revealed need for advanced marine training to acquire specialized skills in marine boat engine building.
Without adequate skills, boat engine maintenance remains a challenge to the unit and impacts on the operations of the boats and the marine unit.
Management in their response explained that a new Directorate of Human Resource Development has been created and tasked with drawing up a master plan for skills development in the entire workforce, Marines inclusive.
The Accounting Officer further explained that some training is already underway both within and outside the country, and that in the current financial year, 45 staff are undergoing marine training by Korean instructors.
The marines unit has two accommodation blocks with a capacity of 16 officers. This, it was discovered, is insufficient as other officers use “self-help” system as accommodation.
Lack of adequate accommodation demotivates staff from efficiently currying out their duties.
Management explained that the Force has an accommodation challenge due to inadequate funding but alternative plans under PPP were developed. With the passing of the PPP law the problem is planned to be addressed through partnering with private entities.
Condition of the boats
Most of the boats are in a good running condition except for the 7 (seven) Interceptor Speed boats which need repairs. The interceptors are useful boats to the marines unit with inbuilt twin engines that provide enough speed for adequate patrols and interception of wrong elements like pirates on the waters. However, the boats are currently dry docked awaiting repairs.
According to the engineer in charge, the engines are in good running conditions but there is a risk of further deterioration of the boats if repairs are not carried out in time and boats lowered into water for operations.
Besides, there is a general delay in the procurement of maintenance parts for the speed boats because the spare parts are not on the open market which affects the timely repairs on the boats and impacts on securing maritime security and safety.
Police explained that the contract to maintain and refurbish the Marine boats was awarded and the speed boats will soon be repaired.
However, funds available in the budget may not be adequate to have all the boats repaired but phased as the funds become available in the budget.