The Last MileIHIG @Stanford, 2008

Nap Hosang, MD, MPH, MBA

UC Berkeley School of Public Health

3/1/08

Today’s topic

• What can we do on our campuses• to improve the delivery of health care• in difficult to reach places

• “designing strategies to cross the last mile”

Important Questions

• What’s our goal?• Why? (Whose interests are being served?)• Does scale matter?• Define our target population?– Young, old, women, men, children, your church

Important Questions

• How will we know that we are successful?

• What is the difference between ‘health’ and ‘health care’

Perspectives

• Smart delivery of health care with technology: telemedicine, robotics, cameras

• Reduce premature deaths and illness burden in hard to reach places.

Health Care access

• Even with the best prevention, people do get sick.

• So what’s on the list of core essential services that still need to be provided?-seek audience input here!

Essentials

• Drugs• Ability to treat:

- appendicitis- safe delivery- post miscarriage (post-abortion) care.

- vaginal bleeding- optical needs/cataracts- pregnancy prevention

Essentials continued

• Ability to treat:- Dental infections/dental caries- communicable diseases (immunization)- chronic diseases (diabetes,hypertension)- gallstones-urinary tract infections- common ailments

Essentials continued

• How does one make these essential services accessible and affordable to the rural poor?

• What can we do on our campuses to make a difference?

Barrier

• Current economic model does not work.

Tasks

• Bring technology to the people.

• Bring people to the technology.

• Figure out an economic model that is sustainable, without sig. external inputs.

The last mile

• Now you have decided what can be offered,

- how do you deliver it?

What can we on our respective campuses to facilitate this process?

What can our campuses do to facilitate this process?

• 1• 2• 3• 4• 5• 6• 7

Let’s open it up for discussion:with your ideas!

Gavin Yamey PLoS Med. 2007 Oct 23;4 (10):e303 17958464 (P,S,E,B) Which Single Intervention Would Do the Most to Improve the Health of Those Living on Less Than $1 Per Day?