Cheaper by the dozen - The Answer to Mass screening in Healthcare
The expression ‘less is more’ is not always true. In healthcare, where the output is directly related to the input, the idea that one can yield a greater output with less input is both unreasonable and illogical. In this case, ‘more is more’. But what if we flipped the script and proposed the phrase ‘more is less’. This idea, commonly known as the economies of scales, dates back to the 1700s. This principle explains the advantages obtained when goods are purchased in large quantities and forms the basis of health care solutions for the masses.
On the surface, it would seem that a simple solution to the struggles faced by the healthcare sector would be to produce more professionals, allocate more financial aid and ensure the implementation of solid strategy. But as we know, qualified healthcare professionals are scarce, and money doesn’t grow on trees. Because of this many public healthcare institutions are expected to do more than is feasible with very little. Financial aid and government assistance is limited and is a major contributing factor to why healthcare service delivery isn’t where it should be today. Doctors, nurses and other healthcare professionals are left to “make do” which results in poor healthcare service delivery, reduced quality of care and a backlog of patients who are in dire need of help.
Universal health coverage is a major concern. Millions are still without access to fundamental healthcare services which, in our view, is a violation of basic human rights. It is also a contributing factor to millions losing their lives due to preventable illnesses and leaves the healthcare industry scrambling to band-aid and cover up an open wound.
‘Prevention is better than cure’,
Preventative health care should be the core of all healthcare strategies and presents an opportunity to resolve many of the issues currently faced within healthcare. While reactive healthcare is both inevitable and necessary, more emphasis and resources need to be channeled towards preventative strategies that provide proactive health care solutions for the benefit of all.
WHO regularly releases statistics on the occurrence and prevention of disabilities and diseases. Particularly alarming are the statistics related to hearing loss.
WHO 2018 stats reveal that about 466 million people worldwide suffer from disabling hearing loss and a staggering 34 million of these are children. The very children who are the future of tomorrow are suffering from disabling hearing loss. A large portion of which may have been prevented as an astounding 60% of childhood hearing loss is preventable. To make an already complex scenario more complicated, many of these children are incorrectly diagnosed with ADHD/ADD; they are labelled as mischievous and experience learning and developmental delays.
How is it then that effective measures are not employed to combat this silent epidemic? The operative word there is “effective”. Many schools and institutions put measures in place simply to comply with the law. The efficacy of which usually goes unquestioned.
In South Africa, the Integrated School Health Policy (ISHP), states that the hearing of scholars should be screened once every 3 years. Regrettably, this is not a reality in many schools in South Africa and around the globe. With preventative measures being bypassed, it is obvious why we are facing such an epidemic in the first place.
In 2010, the South African basic education system comprised more than 12 million scholars, meaning that an approximate 3 million scholars would need to be tested each year. With only about 200 school days per year, excluding holidays and exam periods, this would mean that roughly 15 000 scholars would need to be tested every single day to meet the demand.
The traditional methodology would be to employ a nurse to screen the scholars, complete a report and refer any child who happens to fail the test to a primary health care clinic. On the face of it, it sounds simple but, the reality is rather daunting. This means that more than 400 additional nurses would be needed to supply the demand of the ISHP. With traditional technology, a single nurse could test approximately 60 children each day. One in every 3 to 6 of those children are likely to fail their hearing test due to the nature of screening. Screening tests provide a pass or fail result without indication of course, urgency or treatment path. At these volumes, this would mean that a staggering 3,750 scholars would be referred every day.
But, without any indiction of the correct referral path, where do these referrals go?
Primary healthcare clinics are the current referral path, these clinics have neither the staff, nor the equipment to handle the influx.
At these volumes, referrals would simply crash an already overburdened health system.
But it doesn’t have to be this way. Successful pilot studies have been carried out by the team at eMoyo proving that mass school hearing tests are not only feasible but necessary. The team created and employed new methodology which maximises screening efficiency, enables early diagnosis and correct path of referral. Thus providing a credible healthcare service solution fit for the masses.
The paradigm shift
The conventional way of doing things undoubtedly needs revision. The act of screening one scholar at a time is a good place to start. The team at eMoyo, successfully proved that with additional equipment and a small team, children in groups of 12 could be tested simultaneously. Proving that school and mass testing (including diagnosis) is indeed cheaper by the dozen.
The illustration below shows a step by step model, that not only saves time and money, but effectively reduces the number of referrals thus relieving the burden placed on primary healthcare clinics. Traditional methodology only determines a pass or a fail and leads to higher referral rates (1:3/6) than what the actual incidence is (1:12). The use of KUDUwave Booth-free audiometry in these programs alleviated the noise level related issues found in the school environment which are too loud for standard headsets to test accurately without a sound booth.
The Cheaper by the Dozen approach can effectively screen 144 scholars per hour, which is about 720 children per day. Only 1:12 of those patients will fail the test as compared to the 1:3/6 encountered by the conventional system. Diagnostic tests help to eliminate unnecessary and costly referrals. Eliminating unnecessary referrals, saves not only the cost and resource burden to the healthcare system but to parents and guardians who would have to ensure that their child receives further care. This also minimizes disruption in the classroom by ensuring that all children are tested in a single day. Moreover, only one nurse and 4 trained facilitators/technicians are needed per team. This creates efficient units able to perform testing at scale while creating jobs for less qualified individuals.
Government departments, entrepreneurs and other stakeholders could stand to benefit from spearheading high quality healthcare projects like these.
So why are models like these not actively in place?
High quality audiological equipment suited for mass screenings isn’t the hindrance. The technology exists, and has already eliminated the issues related to noise and reduced the capital investment requirement as well as the burden of false referrals. KUDUwave™ technology is readily available and can easily form the basis of this model.
Occupational health checks are mandatory health screening checks primarily put in place to prevent work-related injuries and disease. In many cases, these tests are performed by external service providers and are time-consuming. As such, they reduce productivity and increase the time that employees need take off work to receive treatment. This is further exacerbated by the cost of unnecessary referrals due to standard “screening” methodology. These costs are often simply transferred on to the patient. Mass screening solutions could provide convenient, time and money saving services that benefit all involved.
Occupational health clinics would also be able to take their services to their patients instead of the patients leaving work to come to them, often travelling great distances to reach a destination where a soundbooth has been placed.
In all cases, healthcare providers, in their many forms can expand their business offerings and include mass health services by augmenting their technology base to reach more patients in less time and at a reduced cost to all.
If this isn’t the way to take preventative healthcare to the next level, then I don’t know what is.
We all have a social responsibility to act in the benefit of society at large. This is a call to entrepreneurs and other entities to partner together and help take healthcare to humanity.