Structure profile of telemedicine in communities isolated by exclusion in health in rural area, Paraguay. A case study

INTRODUCTION: Paraguay addresses the epidemiological surveillance with information and communication technologies (ICT). Information support is useful for improving health outcomes related to the disease. The ICT can help in providing such assistance and support. The objectives were to develop a system of community and ICT-based surveillance in rural isolated populations with access problems.

METHODS: Location: Tte. Irala F. in the Paraguayan Chaco (400km from the capital city). Baseline surveys on analysis of health status and use of ICTs, where villagers voluntarily participated, were performed. The BONIS telemedicine system with cell phone calls according to syndrome was used. The system can record, classify and prioritize automatically through an IVR (Interactive Voice Response) febrile cases to provide community notification. A public access portal (web.www.vigisalud.gov.py) with general information was incorporated as well as a notification service that identified the areas of diarrheal, acute and chronic respiratory, acute febrile and eruptive syndromes.

RESULTS:  400 surveys identified health problems such as tuberculosis, malnutrition, gastrointestinal diseases, hypertension, inadequate medical care, teenage pregnancy and alcoholism. The use of ICT in the community: 40.2 % have access to electricity, 88.6 % have a radio, 73.2% have a cell phone, availability of TV only 23 %, 2 % own a computer, 0.9 % internet service at home and 3% at work. Weekly calls to the Bonis system were made by community workers in a pilot study where according to epidemiological week these cases were reported: diarrhea (174), influenza (713) and respiratory symptoms (266). On warning, the notified numbers were: diarrhea (100), influenza (48), acute febrile (41) and exanthematic febrile (45).

CONCLUSIONS: The operation of the BONIS system has been adapted to promoters and community workers who are the community leaders. The collected information shows the coexistence of transmissible and non-transmissible diseases and the functionality of the Bonis system and cell phone calls, the compliance of days and the syndromes identification is highlighted. The notification system is intended for local doctors, the Direction of Surveillance of the Ministry (MSPBS in Spanish) and the referral hospitals. To support surveillance, the use of ICT of the inhabitants has been investigated in a rural village in the Paraguayan Chaco, where there is high exclusion in health and a vulnerable population with a high proportion of aboriginal people with low education levels and high poverty. Furthermore, it is important to present the lessons learned from the evaluation of a complete telehealth project about the success factors and evaluation methodology for this type of projects