In a part of project development study, the CHAs visited Rampal villages, met with the patients, community leaders face to face, and discussed the project objectives. This study compared main complaints, Medical Assistant feedback, and primary diagnosis. In this traditional face to face manner, the Medical Assistant was able to listen to a patient’s main complaints and inquire about relevant topics. The Medical Assistant then recorded the data in the project electronic system and verbally provided feedback and diagnosis to the patients or attendants, which the CHA also documented in their electronic medical record (EMR) system and sorted in their code book.

Feedback was organized into 3 categories: visit health care professionals directly, visit health care professionals for follow-up, or no additional visits needed. Diagnosis entailed the disease or illness that the MA believed the patient to have. Later, the MA received SAF profiles for the same patients and then provided feedback and diagnosis. When data collection concluded, the MA and CHA determined if main complaint, feedback, and diagnosis matched under various test conditions.

Diagnosis was determined to be the same if the same root cause or same disease were mentioned. Synonymous terms were accepted to be the same (e.g. hypertension and high blood pressure). This qualitative study was shared to local authorities (Upzila Nirbahi officer and Upzila Health Administrator). All 102 patients in this study gave their informed consent prior to participating in the study discussions.

This study supports the idea that Community Health Assistants, Medical Assistant, Medical Consultants as well as patients either from Rampal or from anywhere in similar setup can benefit from Store and Forward data sharing & telemedicine systems at the primary level. Such a system connects rural patients who otherwise may not have the resources to physically travel to the closest health care center.

Despite physical distance from the health care professionals, this study has proven that remote consultation with a Medical Assistant is able to yield the same advice as in-person visit in nearly 90% of the consultations. The Medical Assistants are able to remotely provide health advice of the same quality and reliability, saving travel time and expenditure for both Medical Assistant and patient. Furthermore, the presence of a Store and Forward system in previously inaccessible communities provides jobs for CHAs and also promotes task shifting and creating more jobs for MAs. Finally, a Store and Forward telemedicine system’s presence in local communities can act as a useful tool for community health workers. The biomedical devices that are integrated into the Amader Gram ‘Swasthya Sheba’ system inspire individuals to take an active interest in their health. Additionally, knowing community health statistics can allow CHAs and patients to better understand the importance of preventative health measures such as lowering sodium levels to prevent common and chronic conditions.

THIS IS HOW THE SOCIAL INNOVATION Swasthya Sheba MODEL EMERGED IN RAMPAL

The interacted idea research with Rampal community branded Amader Gram to ‘Swasthya Sheba’; this Networked Health Solutions emerged as a reliable store-and-forward telemedicine system that is able to provide both economic and social value to rural Bangladesh by connecting patients with remote primary health care. It is established that the Amader Gram Digital Health Services System’s intra-observer reliability rates correspond to those at established programs in the Western world. Medical Assistants are able to reliably provide rural patients with the same medical advice as if the patient had spent the resources to travel to meet a Medical Consultant for a traditional in-person consultation. Further the ‘Swasthya Sheba’ ensuring the continued reliability and accuracy of the telemedicine system will depend on methods of guaranteeing quality control among the teams.