On the Edge of the Sahara, a New Research Study Flips Traditional Health Care on its Head
What if our health care found us? In a remote corner of the West African nation of Mali, a large research trial begins this month to answer this question. The results of the trial could inform and accelerate global efforts to provide care to vulnerable communities.
This randomized controlled trial (RCT), led by investigators at the University of Bamako, the University of California San Francisco, the University of California Berkeley, the London School of Tropical Medicine and Hygiene, the National Institutes of Health, the Malian Ministry of Health, and the global health organization Muso, will look at the impact of deploying health workers to search for patients proactively, through door-to-door home visits. The study will seek to determine if this proactive health care approach can connect patients with care earlier, reduce costs, and save more lives.
The study seeks a new way to save children’s lives, by taking aim at an unusual target: time. For the world’s poor, diseases like malaria, diarrhea, pneumonia, and newborn illnesses progress fast: these common ailments can become lethal within hours of symptom onset. Can finding and treating patients earlier save more lives?
In most of the world, health care is passive: doctors and health care providers wait for patients to come to them. But this doesn’t work for some of the world’s most vulnerable populations. Poor people face considerable financial, geographic, infrastructural, and social barriers to accessing care, and often access care not only infrequently but too late.
In 2014, 5.9 million children died globally before they could reach their fifth birthday, mainly of diseases that are curable, but progress rapidly.
With some of the world’s highest maternal and child mortality rates, Mali is at the epicenter of a global crisis. This research builds off of an earlier study by investigators at UCSF, Harvard, the Malian Government, and Muso, that documented a tenfold difference in child mortality in one area of Mali after the roll-out of a health system strengthening intervention that included proactive door-to-door visit. That study’s results were heralded as unprecedented, and lauded by institutions like USAID and the World Bank as a global best practice model.
Of that study’s results, Rob Yates, then a Senior Health Economist at the World Health Organization, said, “To my knowledge, this is the largest and fastest decrease in child mortality ever documented.”
The study did, however, have a couple of important limitations.
“In that study, we did not have a control group, so we cannot say that the proactive health care approach caused the difference in child mortality that we documented,” said Ari Johnson, who is a physician at the University of California San Francisco, an investigator on the study, and the co-founder of Muso. “The randomized controlled trial we are now launching will focus on one simple but powerful question: can searching for patients proactively, door-to-door, save children’s lives?”