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Synesis mHealth service is a 24/7 mobile based medial counselling and health information dissemination service that targets every resident in Bangladesh, primarily those residing in rural areas. In accordance with the plans of the Health, Population and Nutrition Sector Development Program (HPNSDP), set forward by the Ministry of Health and Family Welfare (MOHFW), Government of Peoples Republic of Bangladesh, mHealth attempts to alleviate the issues of those people who have relatively low access to health services and live in areas that are prevalent to health issues pertaining to common diseases, maternal health, childcare etc. Through the use of cellphones, mHealth provide health related information and medical counselling service 24/7, by specially trained registered physicians.

Bangladesh is home to an estimated 156.6 million people. Given that nearly 67% of the total population is impoverished, a relatively large portion of the people is inhibited from proper health facilities.

Recent statistics indicate only 1 doctor is available per 5000 people in Bangladesh. However these ratios are further exacerbated to 1 doctor every 50000 people, when focused primarily on rural areas as nearly 80% of all doctors' practice in metropolitan and urban areas. The large gap in ratio between the number of doctors available to the general populace and the number of people they could treat can't be reduced overnight, it requires time and thus an alternative solution must be devised to help cope with this issue before it is solved.

As such, the Ministry of Health and Family Welfare (MOHFW), Government of Peoples Republic of Bangladesh to implement the Health, Population and Nutrition Sector Development Program (HPNSDP) for a period of five years from July 2011 to June 2016, with the goal of ensuring quality and equitable health care for all citizens of Bangladesh by improving access to and utilization of health, population and nutrition services through effective alternatives. An effective means of information transfer and retention thus needed to be devised.

An effective means of information transfer does not only require focus on the speed of information transfer but also must focus on the range of information transfer. Bangladesh is home to nearly 120.35 million mobile subscribers, which is more than 75% of the total population of Bangladesh. Furthermore, an estimated 97% of all families in Bangladesh own a cellphone, which makes the cellphone the best method of information transfer to the masses. These problems and the proper solution to such an information gap were already identified by Synesis IT back in 2008, which led to the inception of mHealth.

The diagram below briefly describes the model of the service being offered:

Since its' inception, in 2008, a total of 8 million calls have been served. Currently attending around 9,000 calls every day and sending health information content to around 250,000 subscribers every day, mHealth is widely known, popular and admired service that has played a significant role in helping Bangladesh achieve some of the Millennium Development Goals. Furthermore mHealth sends. Currently

As expected, implementing such a service in a developing country such as Bangladesh would lead to the emergence of certain challenges and obstacles that must be dealt with:

  • Awareness Buildup: Patients were too accustomed to traditional forms of medical counseling involving meeting up with doctors in person and were thus unaware of the availability of such a service through the cellphone. This was subverted through use of television commercials (TVCs), newspaper advertisements, flyers and further campaigning, which helped attain a widespread response and approval.
  • Aligning Doctors: Since doctors were not used to providing advice on the telephone, they had to be provided specialized training as well as being taught the Standard Operating Procedure for information delivery and retention, before they could be deployed to ensure they can work efficiently.
  • Creating a Standard Operating Procedure: Being the first mobile health information and consultation provider in Bangladesh, mHealth had to innovate its' own Standard Operating Procedure based on the model of similar health information and consultancy providers in South Asia while taking into account the local culture and practices.
  • Building Trust: Information security was an issue initially as many patients would express highly confidential information, ailments and concerns. This was subverted by ensuring that physicians are incapable of seeing the caller's number and the recorded call would be highly restricted. Synesis IT is developing on better information security in the form of automated, unique caller ID generation and also automatic deletion of patient history, when it is over a year.
  • Low Mobile Penetration:During the initial phases of implementation the mobile penetration was not much high as the telecom operators were still trying to expand their network coverage. This was alleviated over time, and now with a relatively good network coverage the service is performing up to its' potential.

To the people

  • Accurate Information delivery by registered physicians relying primarily on proper diet, lifestyle and similar forms of home treatment methods, which is primary advice and treatment.
  • An alternative, low cost health service.
  • Health Service that would disseminate relevant and often life-saving information to those who have access to relatively low health service.
  • Feedback call by physicians to ensure the efficiency of the service provided and further advice, if required.
  • Formation of patient history (previous advice given, ailments, symptoms etc.) that is automatically brought up to the physicians screen upon return call but deleted after one year to ensure patient security.
  • Patient Security is maintained by ensuring that the physicians can never view the patient's number thus ensuring doctor-patient confidentiality and also allowing the caller to talk freely about culturally taboo issues such as STDs.
  • Video Doctor Service adds another depth of clarity to the diagnosis process by helping the physician provide the patient with a more studied diagnosis and thus more effective advice.
  • Training the physicians on how to deal with patients over the phone has helped ensure that patients are satisfied upon receiving the service.
  • BDHealth.com, health information repository is a massive database that contains all forms of information pertaining to numbers and locations of hospitals, specialists, physicians, blood banks, ambulance information etc.
  • State of the art call center technology assists in performing a number of advanced features that ensures better service delivery such as call forwarding, call conference, call history, call referencing etc.
  • As the service relies upon the use of cellphones, the effectiveness of delivering information is considerably higher than other forms of information dissipation such as the internet.
  • Overcoming barriers of health services as well as poverty & lack of knowledge, literacy etc.
  • Increased awareness regarding leading a proper lifestyle and having a proper diet to prevent prevalent diseases or ailments.

To the stakeholders

  • Information exchange- The primary focus of the service has always been information exchange in a variety of ways:
    • Delivery through helpline- Advice and primary consultancy would be provided promptly by registered physicians to those who call the helpline.
    • Daily Health Tips- Providing health content for those who want to attain more knowledge and thus improve their standard of living or help cure an ailment through proper home treatment.
    • Retention of information- The service helped identify the ailments that pester the masses most and thus the diseases that should be most focused upon.
      • The entire service of information delivery and retention is completely automated with negligible dependency on paperwork.
      • Adaptability, can be adapted into similar communities with relative ease.

Through collaboration with the major telecom operators in Bangladesh and also the Ministry of Health and Family Welfare (MOHFW), international organizations such as MAMA as well as numerous healthcare professionals and other healthcare service, mHealth has been able to provide a reliable, timely, high quality and relatively low cost health information system, which relies a standard operating and training procedure for physicians while respecting the citizens' right to privacy through high restriction of caller information. Through the employment of registered physicians, callers are provided with access to highly accurate medical information and advice that rely on locally-relevant content resources to help prevent STDs and other diseases as well as promote better sexual and reproductive health. As sexual health could be a very sensitive matter in Bangladesh, hiding the callers' phone number would encourage people to seek knowledge and advice instead of inhibiting them. An internationally researched and developed standard operating procedure, employing state of the art call center technology and a massive repository of health related information pertaining to Bangladesh are all factors that have helped cement mHealth as a premium telehealth services delivery system in Bangladesh. Furthermore, as information regarding common ailments would be retained from callers, the data can be used to gauge prevalent ailments and thus focus on providing information to relieve those, controlling and monitoring the spread of communicable diseases. Furthermore, the callers could be provided with information regarding such diseases, alerting them about the spread and how to prevent from contracting such them.