ANDRéS FERNáNDEZ MARTíNEZ

Spain,

Andrés Martínez Fernández is improving the performance of rural healthcare systems in developing countries through creative, inexpensive telecommunication technologies and by engaging medical professionals and university faculty in new ways. The model he established has proven successful in over 170 centers and outposts in Peru, Cuba and Colombia, improving medical care for more than 150,000 people.

This profile below was prepared when Andrés Fernández Martínez was elected to the Ashoka Fellowship in 2008.

INTRODUCTION

Andrés Martínez Fernández is improving the performance of rural healthcare systems in developing countries through creative, inexpensive telecommunication technologies and by engaging medical professionals and university faculty in new ways. The model he established has proven successful in over 170 centers and outposts in Peru, Cuba and Colombia, improving medical care for more than 150,000 people.




THE NEW IDEA

Through systems improvements, Andrés is closing the communication gap between rural medical outposts staffed by paramedics that serve remote villages and larger, physician-run medical centers. By creating functional communication processes between these professionals, he allows them to save the valuable time normally spent traveling between locations for reports and consultations, thus improving their effectiveness as care providers. He is working with local medical staff and engineers to design and provide easy, cheap and sustainable technological solutions that can be used around the world to reduce public healthcare costs and increase efficiency.

The process improvements Andrés has implemented are releasing doctors and medical workers from having to make difficult decisions—often beyond their professional capacity—on their own. Now, they are can rely on each other through professional networks created through improved channels of communication. Through these networks, he has provided care providers with full access to the healthcare system’s resources including ongoing training, the ability to exchange medical and epidemiological information, and specialist consultation for individual cases. Ultimately, Andrés’s efforts enable these individuals to grow professionally, gain confidence, and overcome the feeling of isolation that generally accompanies working in remote villages. This way he is making a way for the public healthcare system to fully reach citizens no matter where they live.

Andrés also works to empower universities to play a bigger part in serving their communities and improving the healthcare system’s performance in rural areas. Through partnerships with telecommunication engineering and medical departments in local universities, he is engaging professors and students to take the lead in designing and launching these changes. Local University faculty is taking part in a completely new field of work: Technology applied to rural health, in which they are quickly becoming experts while also improving their rural reality. Andrés’s approach transforms professors from theoretical researchers to hands-on, multi-disciplinary leaders implementing innovative solutions to their communities’ problems. By making structures like Universities active resources in his initiative, Andrés places the stability and sustainability on a local level, avoiding full dependency on foreign aid.




THE PROBLEM

Healthcare in many developing countries is not effectively reaching significant portions of the population. Often, this is due more to infrastructure and communication problems than to a lack of monetary resources. In fact, in rural Peru, health outposts placed in villages are generally staffed by paramedics with little training, and are an average of 10.5 hours away from the closest health center where reference doctors work. Furthermore, in Peru, only 360 of 6,007 medical outposts have either a telephone connection or electricity. This hinders their ability to consult with an experienced physician, often leaving local staff to deal with all patients, regardless of the complexity of diagnosis or injury.

When difficult cases arrive (such as lung diseases, malaria symptoms or serious injuries), the majority of paramedics are forced to close their post to transport patients in need of an urgent intervention to their reference center to see a physician. Often, the doctor is away when they arrive, thus delaying interventions even further than the one to two days travel to the center. To add insult to injury, many of these urgent cases turn out to be simple issues that could have been resolved at a distance by the paramedic with basic instructions. This expensive process if paid for in great part by the patient.

The main hurdle in overcoming communication obstacles in rural areas is the lack of infrastructure and allocated resources to build them. Electricity and telephone service providers have little commercial interest in bringing their services to extremely poor, remote villages. Governments, on the other hand, lack the resources to build these infrastructures. International organizations have attempted to solve these problems, but generally focus on private healthcare centers and use expensive technological models that are not replicable or sustainable without foreign aid.

Another key issue affecting rural healthcare is the very high turnover rate among medical professionals in remote areas due to geographic isolation. In most cases, the people working at these outposts are graduating medical students undertaking their obligatory rural service, or paramedics with very little training. Many medical workers feel isolated in their job, and are eager to move to a city where they would have better communication and more chances of building a successful career. This feeling of abandonment and the lack of professional development makes serving in rural areas a task that very few doctors and health technicians are willing to undertake.

Moreover, due to the lack of fluid communication, the public health system in rural areas has developed serious inefficiencies. It is nearly impossible to fully control inventory needs for the different centers and outposts, leaving many without essential medicine for extended periods of time. Also, the system for collecting epidemiological information to take preventive measures for regionally-specific infectious diseases and repetitive health problems is slow and the information is rarely dealt with quickly or systematically enough to influence any important changes in policies, medicine distribution and disease prevention. Often, when this information is collected and processed in the health center and finally sent to a research center, it is too late to deal with the health problems it intended to anticipate.




THE STRATEGY

Through his organization, Hispano American Health Link (EHAS), Andrés has shown that it is possible to save more lives while also improving healthcare efficiency and reducing public expenditures. One of the primary means by which he has achieved this is by improving the working conditions and capabilities of doctors and paramedics in rural outposts. After discovering that many individuals cited professional and personal isolation as the primary difficulties in their job, Andrés and his organization adapted inexpensive and simple wireless telecommunication technologies to connect outposts with each other as well as with reference healthcare centers, relying on solar energy rather than phone and electrical services. This change enabled centers to send and receive vital information concerning both difficult patient cases and epidemiological reports, as well as providing a means for doctors to supervise paramedics’ work in outposts more often than their standard monthly evaluation. Furthermore, this advancement also allows health workers to talk to family and friends from whom they were previously cut off for lengthy periods of time while serving remote areas.

Beyond merely quickening information exchanges, the local EHAS teams train doctors and health technicians in using these communication technologies to improve their practice. This includes taking online courses, accessing medical journals, and maintaining fluid communication with their colleagues and supervisors. Once in place, the technology opens a channel through which Andrés can introduce new services to improve specific medical needs, including long-distance stethoscopes to diagnose pneumonia and video microscopes to study patients’ blood samples.

Instead of depending on a single technological solution, Andrés’s objective is to involve his partners in constantly developing new technologies and adapt them to rural needs. This is best illustrated in the initial pilot testing process, in which Andrés found that VHF radio wave technology worked to transmit voice and data information in one area, but later on needed to be adapted in another area due to the high and heavy forests. There he and his local partners developed adapted wifi technology that had a 100 km projection range, compared to the standard 300 m range. This particular area now hosts the longest wifi network in the world, stretching over 300 km along the Napo River.

To support his plan, Andrés uses EHAS to launch projects in new countries, as well as oversee implementation and offer on-going support to national teams. Additionally, Global EHAS coordinates synergies and best practice sharing amongst its members. Locally, Andrés has created national EHAS entities in partnership with key University departments to work with the local medical staff and carry out the implementation of the technology as well as maintenance and improvements of micro-networks. Eventually Andrés plans to launch spin-off businesses from these local partnerships in order to deal with technical maintenance and massive implementation from a more agile structure.

In order to institutionalize his model and expand it to other countries and fields of work, Andrés is launching a series of training paths, including an official Master’s degree, accredited in five countries, that are designed to give professors and students the skills to focus their career goals on developing real solutions in underdeveloped communities. Having proved that research in these kinds of technologies can give one equal prestige as working on cutting edge technology, Andrés is also affecting other areas of work by raising awareness on the important role Universities play in improving systems for developing countries. Thinking towards expansion to countries in Africa and Asia with similar rural situations, Andrés is partnering with two Universities in Europe to implement training programs in English (for countries in Africa and Asia) and Portuguese (for Brazil and Portuguese-speaking Africa). He plans to work with them to share the model with new countries and engage local partners.

Beyond health, Andrés has already attracted a few partners to use the micro networks he has set up to deliver improvements to other areas of rural life such as education and participation in local governance. His next steps are centered on finding integral ways of measuring the real impact that these changes have brought about in rural areas, and this way influence future research and problem solving.




THE PERSON

Upon returning from his first trip to Peru, Andrés began to explore ways to apply the ideas he developed regarding the transformation of public health systems in rural areas. Convinced that joining an international citizen organization was the way to go, he began to share his idea with different entities working in developing countries. However, their interests didn’t match the objectives of his organizations. During this time, he also began a part-time job at the university, from where he carried out many of his technological innovations in the process making them applicable to rural needs such as those he had become aware of in Peru.

While working at the university, Andrés discovered the huge potential these institutions had in bringing about change, and he began recruiting experts to work with him in rural areas. Without any major funding, he began developing his model locally through the organization Engineers Without Frontiers along with the Polytechnic University of Madrid, and partnerships with Peruvian and Nicaraguan Universities to implement pilot tests in their rural areas. The success of these initial projects helped him to convince colleagues and funders to invest in the creation of his own organization (EHAS) with a global focus and reach.

In the last eight years, Andrés has already spread his concept to three different countries, and is now working on partnerships to launch projects in two new countries.




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