Healing the Gap: Rwanda Expands Access to Rheumatic Care Amid Specialist Shortage

Missouri's Transformation of Rural Community Health (ToRCH) pilot program is reimagining how rural hospitals serve communities by addressing social determinants of health. The program uses Medicaid waivers and a digital platform called Unite Us to coordinate referrals between hospitals and community organizations for non-medical needs like home repairs, utility assistance, and food security. In its first 18 months, the program generated nearly 3,000 referrals. The closed-loop referral system allows hospitals to track whether patients actually receive help, something that was impossible before.

In response to gaps in accessing psychiatric care, Cedar Oaks Clinic developed a team-based mental health care model that provides alternatives to psychiatric hospitalization through same-day crisis services, six-week intensive community programs, and collaborative care involving 30 specialized staff members. The clinic uses a holistic approach where providers from different specialties work together to create individualized treatment plans. So far, the clinic has served 3,000 patients, receiving hundreds of positive reviews.

Anambra State’s telemedicine program is closing the healthcare access gap in rural communities, making universal health coverage more possible. The program began in 2022 and has since hired and trained 42 doctors in providing remote healthcare. As more people use the telemedicine program, public trust in primary healthcare across the region is increasing.

RestoringVision addresses the global shortage of reading glasses by tackling supply and demand challenges. On the demand side, they partner with local NGOs and governments to provide vision screenings and free initial glasses, particularly for those in regions who either don’t know reading glasses are an option or don’t realize they’re losing their vision. On the supply side, they work to build retail networks and educate employers about productivity benefits, as workers receiving glasses show productivity increases up to 32%.

The Boresha afya ya mama na mtoto (improve the health of mother and child) program works to reduce maternal and infant mortality rates by connecting mothers with community health volunteers. These volunteers provide important education on topics like antenatal care and also help to increase access to immunization services. When the group formed in 2018, 531 women died during childbirth or pregnancy, but as of 2023, that number has dropped to 344 thanks to the program’s initiatives.

Boat clinics provide free mobile health care to those living in remote islands who typically struggle to access medical care. The clinics provide access to medicine, minor surgeries and testing and even set up camps off the boat in school buildings to make it easier for elderly locals to access care.

The Anambra state government’s Antenatal and Delivery Program mandates government-owned hospitals and Primary Healthcare Centers (PHCs) to offer free antenatal care and delivery services, to close the gap in care and curb maternal mortality rates. The program has helped strengthen the maternal care capacity at 329 PHCs throughout the state and has served over 60,000 women.

The leprosarium, run by the Evangelical Church Winning All (ECWA), provides free treatment, shelter, and support to those ostracized due to their leprosy diagnosis. Since forming, ECWA has helped 1,000 patients overcome the disease.

The Saving Mothers, Giving Life project aims to improve access to and the quality of maternal and infant healthcare to reduce maternal and newborn deaths. The project established a Maternal and Perinatal Death Surveillance and Response team and launched an interactive digital chat solution on WhatsApp to get important health information to pregnant women. Through these efforts, maternal and perinatal deaths in 25 private health facilities decreased by 60% and 16%, respectively.

Worker-owned home-care cooperatives are emerging as an alternative to the for-profit agencies that dominate America's direct-care sector. In these cooperatives, professional caregivers earn an average of $2 more per hour than the industry standard, share in business decision-making, and stay on the job at nearly double the rate of workers at traditional agencies. Patients also stay with co-op agencies twice as long, suggesting higher satisfaction and quality of care.