Within this fast-moving yet selective healthcare delivery context, the GramHealth Portable Health Clinic (PHC) was chosen as the core component of a corporate pilot project.  Named SehatMobile, the project sought to mitigate health risks for seasonal migrant workers engaged in the collection and sorting of agricultural and non-agricultural waste that form the raw material for the company’s primary product.  Migrant agri-waste workers are a marginalized community that follows the sowing-cropping cycle along a well-defined geographical axis, yet typically subsists outside community-based social nets. Often ignored by the national welfare system, they are exposed to health hazards associated with “tuberculosis, asthma, cough, skin diseases, allergies and other contagious diseases.” The PHC fit the need for an out-of-the-box solution for the following rationale:

• Focus on preventive rather than curative care, so financial and opportunity cost of curative care is reduced
• Affordable access to qualified practitioners, so workers are less exposed to mal-practice and quackery
• Entrepreneurial model of service, so the budgetary burden on corporate resources is minimized
• Technology-driven triage that is independent of practitioner discretion, so quality of care is higher
• Integration of patient data across service delivery tiers, so healthcare outreach strategies can be optimized
• Real-time, remote, data-rich decision support for practitioners, so quality of care professional remains high
• Portability and scalability, so mobile fieldworkers to take preventive healthcare services to the very doorstep via ubiquitous mobile networks

For SehatMobile, PHC became a delivery system integrator, for an integrated service platform offering preventive care, clinical services, screening, referral and follow-up, with added elements for social empowerment through education on health & nutrition, reproductive rights, and citizenship.  Design criteria included service innovation, need-responsiveness, demonstrability, and value-for-money.  As the core technology platform for the SehatMobile outreach model, the PHC ties together a custom-built vehicle platform equipped with specialized modular service consoles to deliver:

1. Primary Care Ambulatory, Tertiary Referral & Follow up: Full-time SehatMobile staff conducting out-patient clinic supported by the PHC’s 16-parameter tele-medicine protocol, and triaging patients by color-coded results. Rita of specialist physicians designated by their host institute available online during agreed time-slots to backstop the outpatient clinic. Medical records centralized online to help referrals and followed up.
2. Health Education, Preventive Care & Occupational Safety: Specialists from collaborating partners conducting awareness and education in preventive medicine, nutrition, hygiene and sanitation practices, and occupational health. Awareness and behaviour change communication materials and staff provided by program partners to run sessions and demonstrate personal protective equipment (PPEs) and emergency response drills.
3. Rights & Citizenship Awareness & Community Organization: Collaborating community or citizens organizations using SehatMobile as platform for existing programs on citizenship awareness and community action for human rights, access to justice and community empowerment as part of the SehatMobile schedule.
4. Social Business Skilling & Entrepreneurship Training: Invited specialists offering training and pre-incubation, and community champions promoting independent and entrepreneurial thinking among migrant communities, motivating workers’ families and friends to organize into social businesses, such as recycling cooperatives, so that members claim social security benefits or workers’ compensation under existing law.

The pilot was designed for implementation at two distinct but integrated levels. The first phase included the design and fabrication of one SehatMobile vehicle installed with PHC and ancillary service delivery systems, training of project staff, induction of delivery partners and the establishment of a field-based clinicians’ referral network and handing over the tested SehatMobile to BSP.  The second phase included technical backstopping, over a 12-month pilot phase, and the implementation of a hand-over strategy towards a successor arrangement. The advantage of such a phased approach was that it the pilot was able to seamlessly integrate into future programs in response to emerging demand. The SehatMobile unit was delivered in mid-2017, and since the culmination of the backstopping phase is now fully rolled out.

The unit as designed, carries one primary care house physician, one nurse or medical auxiliary, one ICT data technician, and one driver-assistant.  There is room for up to two visiting specialists, contributed by program partners according to an agreed schedule, to provide consultations in medical specialties, screening & diagnostics, ambulatory procedures, as well as health education, reproductive health services or citizenship and mobilization.

The original design illustrates the PHC’s value beyond simply a mobile health technology platform.  The Pakistan experience indicates its utility as a hub for a variety of well-being initiatives. The piloted model demonstrates a ready interface with target populations, zero-cost mobilization and high-impact penetration of ideas, services and products through partnerships leveraging mutual benefit.  Delivery partners chosen for the pilot were a select few, but the potential for involving wider stakeholder participation makes SehatMobile a reliable coordinating hub for healthcare and wellbeing services at the doorstep to under-served communities.

The challenge specific to the SehatMobile vehicle platform is the high-cost of fabrication and maintenance.  However, the pilot confirmed that the PHC technology core lends itself to numerous adaptive uses, which can be tailored to fit a variety of terrain, and tighter budgets. The follow up being planned for Pakistan’s Balochistan province aims to apply learnings from the Kasur pilot into designing a need-responsive fee-for-service model that requires less start-up investment.

Within Pakistan’s context SehatMobile serves to address two challenges. First, it enables remote and under-privileged populations with poor access to healthcare and well-being services to be included in the national mainstream using expanding and ubiquitous technology. Second, online availability of healthcare providers, augmented with face-to-face engagement with key service providers, skill-teachers and opinion leaders empowers marginalized communities to expand horizons, integrate with the mainstream, acquire new insights and experience that enhances novel livelihood opportunities for more and more people.