PHC Research

Site Wise

PHC in Cambodia

Following the Millennium Development Goals 2001 to 2015, Sustainable Development Goals have called for reducing the maternal and child mortality and morbidity rates. These rates have shown measurable reduction. However, the incidence of preventable deaths remains high in low- and middle-income countries in Southeast Asia. One of the main reasons could be the inadequate uptake of care for mothers and newborns during the antenatal, delivery, and postnatal periods. In this context, the concept of “the continuum of care” has been promoted in the field of global health to improve the maternal and newborn’s health status. The concept calls for increasing the uptake of care for mothers and newborns successively from the antenatal to postnatal periods. However, in most remote areas, realizing the successive uptake of care faces such challenges as long distance and lack of transportation from the home to the health facilities. To address this problem, the Integrated Continuum of Care Project has been formed by Professor Junko Yasuoka of Tokyo University of Agriculture and Technology. The project was conducted in Ratanakiri, Cambodia in collaboration between National Center for Parasitology, Entomology and Malaria Control, Cambodia (CNM), Ratanakiri Provincial Health Department, Tokyo University of Agriculture and Technology, Kyushu University, and The University of Tokyo. The project aimed to realize the continuum of care in remote areas by designating village malaria workers the role of providing the health services to mothers and newborns using ICT. This ICT component was elaborated by Kyushu University and CNM. This study aimed to introduce the mechanism of this system and the challenges to promoting it as a standard monitoring system in Cambodia.

This Portable Health Clinic system could be considered as an effective system for remote areas where access to health facilities is limited. If the system is well organized, women and newborns could benefit from the stable health services, which could reduce the incidence of preventable maternal and newborn complications. However, to disseminate the system to many areas, some challenges need to be addressed. Efforts are required to ensure the stability and accessibility of the health services system to enhance the continuum of care among women and newborns. 

PHC in China

Partnership of PHC China started in September 2017 when a medical doctor from Guizhou provincial center for disease control and prevention (Guizhou CDC) visited at Kyushu University as Sakura Science Program for 3 weeks. In October 2019, six members of Guizhou CDC visited at Kyushu University as Sakura Science Program.  We have been collaborating in (1) publishing several book chapters related with PHC, (2) conducting joint seminars and meetings, and (3) sharing telemedicine and personal health record (PHR) related information.

Yuandong Hu

Institute of Chronic Disease, Guizhou Provincial CDC

PHC in India

Partnership of PHC China started in September 2017 when a medical doctor from Guizhou provincial center for disease control and prevention (Guizhou CDC) visited at Kyushu University as Sakura Science Program for 3 weeks. In October 2019, six members of Guizhou CDC visited at Kyushu University as Sakura Science Program.  We have been collaborating in (1) publishing several book chapters related with PHC, (2) conducting joint seminars and meetings, and (3) sharing telemedicine and personal health record (PHR) related information.

Manish Biyani

Director, Biyani Group of Colleges, India. President, BioSeeds Corporation, Japan. Professor (Visiting), JAIST and Kwansei Gakuin University, Japan.

PHC in Indonesia

PHC in Indonesia has not yet started. However, collaborative partnership was established with University of Gadja Madah (UGM), Department of Health Policy and Management (DHPM) when Kyushu University team had a meeting at Yogyakarta city, Indonesia in February 2020. DHPM has been doing a telemedicine research jointly with Indonesia National Health Insurance Agency and National Government.  Kyushu University team had an site visits at both rural village health center and urban health center at Yogyakarta and introduced a concept of PHC.

Lutfan Lazuardi, MD, Ph.D.

Associate Professor, Department of Health Policy and Management Indonesia
University of Gadjah Mada.

Nurholis Majid, MD

Perkumpulan SInergi Sehat

PHC in Malaysia

Initial face-to-face meeting on PHC in Malaysia was held in February 2020 at University of Malaysia, Sabah.  Due to COVID-19 pandemic, we had several online meetings and trainings to start our joint PHC project in two villages in Kota Kibabaru, Malaysia. We had already official joint research agreement and ethical approval to start our pilot project in September 2020.

Helen Benedict Lasimbang

Professor, Consultant Obstetrician and Gynaecologist.
Chief Executive Officer, Hospital Universiti Malaysia Sabah Universiti Malaysia Sabah, 88400 Kota Kinabalu.

Dr. Nicholas Pang Tze Ping

Acting Deputy Clinical Director
Hospital Universiti Malaysia Sabah (UMS).

PHC in Pakistan

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.

PHC in Thailand

Innovation, Job Creation and Healthcare Service Delivery: Enterprise Model for PHC

Dr. Faiz Shah

Director & President
Yunus Center Asian Institute of Technology, Thailand.

As a mostly analogue system, especially in least and emerging developing nations, health care systems are traditionally ill equipped to cope with disruptive changes. Unlike other pandemics, Covid-19 has spread to every inhabitable continent within weeks, outpacing the health system’s ability to test, track, and treat people. In the next 10 years, healthcare sector will face major demographic changes that will dramatically impact which services are needed and how they will be delivered – millennials will exert more and more influence over healthcare delivery models.

While the current health care system is trying to manage largely through brick-and-mortar infrastructure, private sector investors and research institutions are leading the abrupt transition to accelerate a digital transformation within the health sector.

Urgent action is required to transform health care delivery and to scale up our systems by unleashing the convergence of technologies to:

  • penetration into under-served markets (digital innovation)
  • reduce lengthy and costly regulation (policy and govtech innovation)
  • increase supportive payment structures (fintech innovation)

Module Wise


1. Healthcare Service for NCDs’ based on Telemedicine:

The Portable Health Clinic (PHC) project endeavors to take healthcare facilities along with doctors’ consultancy to the doorsteps of people. In the developing countries like Bangladesh, rural areas hardly have any healthcare professional, hospital or diagnostic center. The PHC system has a handy briefcase which consists of a number of basic health checkup equipment. A trained-up Grameen Healthcare Entrepreneur (GHE) can carry it to the homes of her clients and conduct the necessary health checkups. The checkup results are instantly conveyed to the remote doctor over internet to be monitored. Depending on the health condition of the client, s/he is provided to consult with the remote doctor through video conference. Using the prescription module of the system, the doctor writes online prescription from his computer and it is delivered to the client printed immediately by the GHL using the printer in the briefcase. Thus, the necessity of having physical healthcare peripheries can be mitigated. On the other hand, patients can save their valuable time, effort and money required in travelling to distant hospitals. PHC promotes preventive healthcare by encouraging adults to take health checkups regularly so that possible diseases can be diagnosed at the very primary stage. Thus, diseases can be prevented as well as their severity can be mitigated leading to reduction on healthcare expenses for patients. Thereby the number of patients along with excessive workload on existing healthcare human resources can be minimized.

Another unique characteristic of PHC system is that it promotes preventive healthcare. Nowadays, the prevalence of non-communicable diseases (NCDs’) like Diabetes Mellitus and Hypertension has increased to a cautious extent. Bangladesh is also not an exception, and from our studies, we have learned that not only the urban people, but the people in rural and sub-urban areas are equally affected by these diseases. These diseases and the consecutive complications can be effectively prevented by taking cautions beforehand. Prevention is more important in countries like Bangladesh because of the limited ability of people to spend on health bills and the absence of provision from government. Preventing such diseases to occur or diagnosing it at early stage can help people to save a lot on medical bills. For this, regular screening of health status is important, which can be facilitated by PHC.

Checkup Package: The PHC box is equipped with the following checkup devices-

  • Body Temperature
  • Blood Pressure
  • Pulse Rate
  • Arrhythmia
  • Height, Weight and BMI
  • Waist, Hip and W/H Ratio
  • Oxygenation of Blood
  • Blood Glucose (random)
  • Urinary Sugar
  • Urinary Protein
  • Blood Cholesterol
  • Uric Acid in Blood
  • Hemoglobin
  • Blood Grouping
  • Online doctor consultation

One of the integral part of GramHealth is the PHC Application and Server System. The PHC system creates and maintains profile for each of the patient served. All the checkup taken at every point in time along with prescription (if any) and case history are stored under the system, so that the doctor can look at the patient’s previous records as reference while advising. It incorporates both web and android-based systems, so it is usable from any portable device. The system maintains smooth coordination among Gram Health Lady (GHL), doctor and patient.

2. Tele-Pathology:

We have a crisis of pathologists in rural areas. PHC became a popular & trustworthy tool for pathological report generation. A trained PHC healthcare worker (Diploma in Laboratory Technologist) collects samples of blood, urine, stool, cough and/or skin, and prepare glass slides for microscopic analysis. Then s/he produces 6-10 difference microscopic images from different view point and uploads to the PHC server. A PHC Pathologist in the urban area access to the images and produces a report. The report is preserved in the system and shared with the patients. So far, this system has produced 5,139 reports in 4 different healthcare centers in Barishal, Bogura, Manikgonj and Thakurgaon district since 2020. Majority of the tests are of blood and urine. This project was jointly funded by Grameen Kalyan and Grameen Healthcare Serviced Ltd.

The following tests are done through PHC Tele-Pathology services

  • Haematological Report
  • Biochemistry Report
  • Microbiology Report
  • Urine Report
  • Stool Analysis Report

3. Tele-EyeCare:

This is a service for the patients of any age. We target rural areas where ophthalmologists are not available. A healthcare worker takes retinal images of the critical patients using a digital camera in a prescribed format compatible in the software and uploads the images to the PHC server together with physical observation report. A registered ophthalmologist from distance accesses the server to check the images, talks to the patient over a video call and finally writes a prescription for the patient. The report is also sent back to the patient for further consultancy with other doctors if needed in the future. We have served about 3,919 services in Singra vision center within Natore district since 2020. The project has been funded by Grameen Healthcare Services Ltd.

The following eye tests/examinations are done through PHC Tele-Eyecare services.

  • Primary Investigation
  • Vision Test
  • Final Examination
  • Refraction
  • Glass Prescription
  • Eye Prescription

4. Maternal and Child Healthcare (MCH):

The aim of this project is to help the rural pregnant women and newborn babies where access to a Obs and Gynae doctor is difficult. We are following WHO guideline to monitor a pregnant woman from the beginning of her pregnancy up to 6 weeks of the child age. A total of 8 checkups are provided during this period with the help of PHC rural health workers followed by tele-consultancy by a gynecologist in the city. Besides, we are also monitoring all productive aged women between 15-49 years and provide basic health checkup by using PHC as preventive healthcare in the service area. The experiment started with a baseline survey in August 2018. We have started a pilot study from June 2019 for 439 subjects in 1 union of Shariatpur district. It will continue up to May 2021 at this phase. The project is funded by JSPS Bilateral Collaborations (Open Partnership) and Pfizer Health Research Foundation.

5. Virtual Blood Bank (VBB):

Blood is a very important biological fluid of human body and it is often deemed to be a lifesaving tool. So it is necessary to preserve blood in a scientific way so that it can be utilized further for next person who is in need of blood. But on the other hand, it is not easy to store blood and it requires good infrastructure. In Bangladesh, it is not always possible to store blood even in rural areas. Some organizations are storing blood only in big cities like Dhaka & Chattogram. Then what about the rural areas as blood equally important for them too. Keeping this limitations & demand in mind, Global Communication Center (GCC) thought to preserve blood donor information rather than storing blood since human body itself is the best place storing place for blood. Based on this concept, GCC developed an online portal and named it Virtual Blood Bank (VBB) where interested blood donors information will be stored only for the blood seeker. It was a joint initiative of Earth Identity Project (EIP) and GCC. VBB has been developed as a point of information storage for the blood donors and seekers in Bangladesh.

VBB started in the year of 2014 and till June-2020, we have the information of more than 36,000 blood donors in our database. To be a blood donor or receiver, a person must login to VBB website ( ) and then need to register as blood donor or receiver. After completing registration process putting some basic information, he/she can be able to find suitable blood donor/receiver nearby his/her location.

6. Children Health Care (CHC):

Seeing the upgrowing demand of PHC in different healthcare sectors have made us very optimistic and it indicates PHC could be used in versatile ways and in different magnitude. We transformed PHC in different shapes thus PHC system could be compatible with societal healthcare needs. We started to serve children (age between 3-14 years) under PHC Child Module in Ekhlaspur, Chandpur and in the year January-2020, 50 school going children have received healthcare services. It is still under piloting phase but soon we have plan to go commercial replication with this module.

7. COVID-19:

It is a new expansion of PHC system called “PHC for COVID-19”. This system has been developed for home quarantined COVID-19 positive patient follow-up and treatment from distance. It contains various self-checking medical sensors for patient`s health monitoring including a COVID-19 system application in a tablet PC for communication between patient and doctor for tele-consultancy maintaining a safe social distance. This system also uses a triage tool for identifying suspected COVID-19 cases at an early stage who will need PCR test and/or hospitalized. This will reduce the wastage of our valued medical resources in this pandemic.

Model Wise


In order to implement the model throughout the communities, we have been working to develop a sustainable business model.

1. Rural Model:

People with low income. Access to hospitals is not easy. Almost 70% of them do not have a health checkup in their lifetime. NCDs are becoming common. Recently people became aware of diabetes. It is expensive for them to control diabetes. PHC is providing diabetes monitoring at one-third of the cost of other service providers. PHC is trying to provide a basic health checkup service to give them an early wakeup as a preventive measure. From our experience, we assume that a healthcare worker can serve 200 patients per month as a home delivery service. In the best setup, she can save 150 USD per month after the cost what is equivalent to a standard salary in rural Bangladesh. However, promotional activity is required before she starts a business. She needs about 2,000 USD to start a PHC community business which can be ideally funded by Grameen Nobin Uddyokta (new entrepreneurship development) program.

The young people who have already completed a course to work as health workers (paramedics or nurses) can easily become an entrepreneur by taking the services of PHC to his/her community. They can take the PHC box along with the necessary devices, consumables and hands-on training on operating the devices and the PHC system. Besides, we ensure call center support with proficient doctors from Dhaka and provide necessary access to our system which enables them to run the services smoothly. We have estimated that a Healthcare Entrepreneur can run his/her business sustainably by serving at least 100 families in a community.

The Healthcare Entrepreneur in a rural or sub-urban area can deliver the services in two approaches. The first one is to go home to home and visit patients on pre-scheduled times or on instant calls. Another approach is to set a service point, preferably, in the local drug stores, sit there on specified times and serve patients coming there. The Gram Health Entrepreneur (GHE) can make a balanced mix of two approaches depending on the needs of the community.

2. Urban Model:

Although the primary target of PHC was the low-income rural communities, we have found a good client segment in the urban ageing community as well. The urban ageing community has the same characteristics as developed countries. The rich urban patients are knowledgeable and most of them have their own blood pressure, diabetes test equipment, etc. However, sometimes it is not easy for them to take the checkup by themselves accurately and regularly as required for NCD patients. Besides, when they need to consult with a doctor, they need to visit a hospital through traffic-congested areas and stay in a long queue what is very hectic for an aged person. Now a PHC urban health worker visits registered patients at home at per preset schedule, conducts health checkup professionally and if needed, connect to our call center doctor for a consultancy from patient`s home. This low-cost service saves time, labor and money of the ageing clients. So far we have approached to 31 urban apartments with 2,602 patients. We provide free health checkup first and then register to make them regular customers. The project was funded by Toyota Motor Corporation.

3. Community Health Camp Service:

We also send health teams to villages from time to time and hold Health Checkup Campaigns usually of 5-7 days. We offer the basic health checkup service to people aged 25 years or above and provide online consultancy by expert doctors for the patients at health risk. We usually arrange the camps in Union Parishad office or in the schools, so that people can easily gather and access the service.

4. Corporate Service:

This community includes female employees mostly working at garments industries, and male workers working in the construction industries. Occupational health service is rare at Small & Medium Enterprise (SMEs). We carried out health checkups. The project was funded by FIRST (2013 to 2015). Developing a business model for this sector is not easy. The employers can understand the necessity of such service to enhance the productivity of their employees but are not interested spending money for the preventive healthcare service. Fortunately, we found a third party to pay from the buyer community for maintaining compliance as a requirement in the factories.

For the corporate companies and factories, who want to provide a basic annual health checkup to their employees/workers, we have the facility to send health teams at their workplace and conduct health checkups program. The corporate groups can also take the health checkup service as their CSR activity to the communities they are working in.

5. Pharmacy Based Service Model:

We have millions of pharmacy/drug store across the country and people have easy access of these if they need any medicine. And more importantly, people can get medicine without showing any prescription to drug seller and even drug seller do not even ask for the prescriptions.

In a study it has been observed that irrational drug usage, insufficient access to essential drugs, wrong prescribing are major hitches affecting the overall health care scheme of Bangladesh. The National Drug Policy (NDP)-2016 has been constructed to ensure better healthcare by ensuring affordability, availability and rational use of medicine. However, lacks of knowledge and awareness among the dispensers and general people have suppressed the effective implementation of the NDP-2016. It has been found that 75% of dispensers of the country know that selling, dispensing and distribution of drugs should be conducted under the supervision of a registered pharmacist but only 5% of A grade pharmacist, 4% of B grade pharmacists and 15% of C grade pharmacists were found in the medicines shops to dispense drugs.

To STOP this malpractice, GCC thought to develop PHC service delivery model in pharmacy. Some pharmacy owner have completed short course on healthcare but they are not adopting healthcare service delivery as profession rather they are selling drugs from their pharmacies and pretend to be a doctor in his locality. On the other hand, people are also buying medicines from him. GCC piloted Pharmacy Based PHC in 2 districts of the country; i.e Kalihati of Tangail and Bhederganj of Shariatpur. In this model, pharmacy owner will provide healthcare service to the community using PHC system. He/s will deliver service from his pharmacy and this would be considered as ONE STOP SERVICE POINT for the customer. People can avail the opportunity to talk to the doctors as in rural areas we still do not have available doctors 7 days in a week. After finishing some basic health checkups and using online video conferencing tool of PHC, rural people can get appropriate medical treatment from a MBBS doctor.

After piloting this model, it has been perceived that this model is a win-win situation for both pharmacy owner and for rural people. Now people are receiving proper treatment and on the other hand, income of pharmacy owner also been increased further as he can healthcare service sitting over his drug store and people are buying medicines from his pharmacy prescribed by online doctors.

6. PHC for Garment Workers:

Our Garment industry is also realizing the growing importance of starting healthcare services to their workforce to comply with buyers demand. And as we all know, there are huge shortage of doctors till now in Bangladesh; so it is almost impossible to ensure physical presence of doctor in every garment factory 24/7. Thus PHC could be another realistic source for our garment industry. Hence PHC has been supporting in healthcare sector for Epyllion Group and PRIMARK and as of now 12,523 garment workers have received healthcare services through PHC.