Non- communicable diseases (NCDs) are responsible for 71% of all deaths globally in a year and the World Health organization estimates that deaths from NCDs are likely to increase by 17% over the next 10 years. Non-Communicable Diseases (NCDs) are increasingly contributing to the burden of disease and disability in Malawi. NCDs are the second leading cause of deaths in adults after HIV/AIDS in Malawi. They account for 16% of all deaths with 17% in males and 14% in females. With growing levels of hypertension at 32.9% in adults, high burden of cervical cancer which accounts for 9,000 DALYs per year in women, back pain was the third common cause of disability in 2017. 10 percent (1.8 million) of Malawians aged five years and older have at least one disability; 243 812 people have intellectual disabilities and 131 597 have problems with self-care.

Poor health seeking behaviour, unhealthy lifestyles among the population, inadequate human and financial resources, and poor infrastructure for chronic care clinics remain key challenges to the prevention, control and care of NCDs.

INTERVENTION

Online Clinic Yathu (Our Online Clinic) is an online platform that provides health services and care for a wide range of non-communicable diseases, chronic illness and general conditions through online (website, email) and mobile (WhatsApp) tools and a home-based care approach. The main services provided through OCLIYA: booking of home-based care especially for physiotherapy rehabilitation services, a directorate of medical and allied health professional across Malawi, online and mobile medical consultations and remote monitoring for general conditions.

Family members, care givers and patient visit the OCLIYA website, choose the service they want, get directed to WhatsApp, pay a weekly consultation fee of MK 2,244 ($ 3) compared to MK 8,976 ($12) daily fees charged by majority of clinics and are then referred to a relevant professional with whom they consult through WhatsApp or email, appointments for services such as physiotherapy are made and provided within the patient’s home.

The home-based care approach promotes patient’s, families and care givers agency as they are able to take control of their health within the comfort of their home. OCLIYA also provides linkages and referrals for children with cerebral palsy with rehabilitation therapists who provide comprehensive therapeutic home programmes, monitoring services and a peer support network for free.

Since November 2018 – February 2020, over 250 people have accessed health care from the comfort of their homes through homebased physiotherapy rehabilitation sessions, online consultation with the doctor and nurse placement for long term care. Reducing transportation costs to health facilities and physiotherapy rehabilitation costs.

The provision of home-based physiotherapy services has enabled the transferring of skills of care giving and maintenance of patient’s optimal health to family members especially for those recovering from stroke and with back pain. Additionally, family members have a better understanding of the causes of their patient’s chronic illness or disability and confidence in meeting their needs.

The platform has further reduced the amount of time patients spend in searching for and enhanced accessibility of health professionals and specialists through their listings/ directory accessed through mobile phones and computers.

CASE INSIGHTS

The Ocliya team has learnt the importance of adapting their approach iteratively based on their clients and ecosystem feedback in a health system built on face to face engagements, collaborating with others to enhance services provided and their credibility.

Two key learnings from the case study are:

Social enterprises in health and targeted interventions bridge the gap between a growing population and demands on healthcare services. They to extend services for NCDs and children with disability and their management complimenting existing approaches and government lead intervention on health promotion and education on NCDs. Creating a stronger support system and easing the burden of care NCDs and chronic illnesses at household level.

Young people can proactively create jobs for medical and allied health workers and other fields while offering critical solutions to health challenges. OCLIYA employs 8 staff and provides short term/ part-time employment to adverse health workers. Nurturing the skills, knowledge, technical and advisory support, a local fund and an enabling environment for startups and scaling up of mechanism ensures success for and in providing essential health services reducing the burden of provision of care the government system and increases point of care for all.