The municipality of Florianópolis and TopMed have innovated health care with the creation of Hello Health Floripa (Alô Saúde Floripa). The service is designed to fulfil the principle of universality, guaranteeing access to healthcare for 100% of the population. Using digital channels (phone or app), it connects any citizen to a health professional, 24 hours a day, without need of travelling. The innovation also organises access to health, generates savings and balance for public health. The proposal is disruptive in the relationship between citizens and health.
Innovation Summary
Innovation Overview
Alô Saúde Floripa is the first pre-clinical care service for users of the Brazilian Unified Health System, developed by TopMed in partnership with the City of Florianópolis. This model was adopted in other countries in Europe and the Northern Hemisphere and has served as a reference for TopMed. Remote care is divided into two levels: the first contact, called 'level 1', takes place via a smartphone app, tablets, computers, or by calling an 0800 service. The user is attended by a nursing professional who, with clinical algorithms, that is, a neural tree of questions and answers about the reported problem, provides the most appropriate referral; the 'level 2' service is under the responsibility of a nurse, and is offered when the patient presents symptoms. The service ranges from generating self-care guidelines to referring the patient to Health Units. The service is designed so that a user does not have to wait more than 60 seconds to have access to a health professional. Each service lasts, on average, 10 minutes for screening and another 5 minutes for health information. All appointments in which symptoms are identified are scheduled to reoccur so that a nurse can reassess the user's health status.
Data from the National Federation of Supplementary Health-FenaSaúde (Federação Nacional de Saúde Suplementar-FenaSaúd) estimates that 80% of these attendances could be resolved remotely. In addition, FenaSaúde and the National Supplementary Health Agency indicate that the average waiting time for patients in primary care units is at least two hours, but can multiply according to risk classification - aggravated by high exposure to other diseases in the hospital environment. Finally, the costs of face-to-face care and the impact of patient travel maximise the problems and dangers. Even though it is a Constitutional principle, universal access to health still has numerous barriers and, to overcome them, it is necessary to rethink the entire process. With the help of innovation, there is an evident organisation of health demands according to the necessary resources, placing the right patient in the right place, improving not only the quality of health care, but also communication with users, ensuring the availability of health professionals 24 hours a day, with quick and easy access. One of the most significant impacts of Alô Saúde Floripa is to guarantee access to health care for 100% of the population, using resources that a large proportion of the population in the city has: a conventional telephone, a smartphone, tablet or a computer with Internet access. In Florianópolis, this represents welcoming 593,588 people - the Unified Helath System (Sistema Único de Saúde - SUS) user base, 24 hours a day, 7 days a week and without limits on use.
Whether it's a headache, a heatstroke or a cold, the service is always available. Health is one of the most perverse faces of social inequalities in Brazil and the pandemic has aggravated this scenario, causing a drop in family income, and impacting access to health insurance by increasing the queues of those who depend on SUS. With the rapid expansion of the coronavirus, and uncertainties about assertive diagnoses, efficient treatments and distant vaccines, social confinement was inevitable. Travelling to health units (UPAs, clinics, emergency rooms and hospitals) posed a high-risk of contamination, especially for those with comorbidities, the elderly, etc. Alô Saúde Floripa welcomed all its users, without subjecting them to risks and allocating each case to its respective and appropriate resource for that moment. The service was responsible for more than 32% of the records of COVID-19 cases in the municipality of Florianópolis.
Research indicates that by 2023, there will be 50 billion devices connected to the internet, which allows countless ways to think about saving lives by taking advantage of it. For the future, new digitisation actions are being thought of, such as the use of teleconsultations with professionals like psychologists, nutritionists and physiotherapists. All the bureaucratic part can be computerised, offering transparency, control, agility and efficiency to the procedures for health care, increasing the integrality of care. In addition to strengthening actions for the use of the application, aiming to expand the culture of digital access. Telehealth breaks down physical, geographical and logistical barriers. The scalability of the solution benefits users, reduces costs and increases efficiency. By sharing technology, it can be expanded and replicated.
Innovation Description
What Makes Your Project Innovative?
The project offered users of the SUS 24 hour access to a digital gateway anywhere through telephone or internet. It began operating before the COVID-19 pandemic. It was an innovation tested in practice, in an extreme moment. The proposal is innovative due to the way it offers conditions to organise the demand for care and, consequently, provides effectiveness and resoluteness in care, guiding the patient to the right place, at the right time, without risks due to lack of timely care or crowds. It potentiated the Public Health Policy for the fulfilment and achievement of the SDG targets and the proposals of the New Urban Agenda, all while saving of public resources and optimising recruitment.
What is the current status of your innovation?
Alô Saúde Floripa welcomed users and was responsible for more than 32% of the records of COVID-19 cases in the municipality of Florianópolis. For the future, new digitisation actions are being thought of, such as the use of teleconsultations with professionals like psychologists, nutritionists and physiotherapists.
Innovation Development
Collaborations & Partnerships
Florianópolis government representatives were the leaders of the process, dedicated to seeking alternatives, building the work plan and thinking about the necessary results. TopMed, in turn, was responsible for sourcing foreign technologies, improving them with Brazilian epidemiology, transforming them into a clear and efficient language for public policy, and operationalising the project.
Users, Stakeholders & Beneficiaries
Citizens received 24-hour health care centered around safety and equitably. Patients were guided to the correct place for timely care. The municipality was prepared for the arrival of the pandemic and showed resilience and strength in conducting the work. Its work was recognised nationally for the results, especially public funds' saving on new hires and health centres. TopMed has evolved, improved technologies, expanded to other governments and, above all, contributed to expanding and democratising access to health.
Innovation Reflections
Results, Outcomes & Impacts
By September 2022 a total of 596,914 users have registered and 354,115 users have been attended, the majority being women- 60.61%, with an NPS (net promoter score) of 93 points, and a resolution rate of 95%. The main reasons for attendance were Covid-19, respiratory system problems, digestive system problems, nervous system problems and musculoskeletal system problems. Attendances are recorded and made available to the Municipality's management through dashboards for real-time monitoring and measurement of results. For the future, the telemedicine service should be expanded to specialised care, reaching specialised consultations where today the lack of professionals or the capacity to accommodate users limits care, generating queues for diagnoses or treatments. In addition, the monitoring of chronic patients should be included in this process, avoiding aggravations in diseases already diagnosed and improving the quality of life of patients.
Challenges and Failures
The innovation process was put to the test with the arrival of the pandemic, when there were no clinical protocols for the public authorities to guide the population, making everything unusual and challenging. The high demand for the service also tested the capacity for quick and effective reception, which proved to be a challenge when hiring new teams. It is also worth considering issues related to the lack of access to telephony in some areas of the municipality, which can be overcome with the use of the internet application and the arrival of 5G. The street population, in turn, still remains unattended due to lack of access to telephone or other digital means. The agility of communication between the municipality's face-to-face teams is also an offline factor that eventually emerges as a challenge for the rapid advancement of innovation.
Conditions for Success
- Infrastructure and support services
- 5G available for all cities with more than 30 thousand inhabitants
- Policy and norms - Regulation of Telehealth and Telemedicine in Brazil, which was overcome by the Ministry of Health and the Federal Council of Medicine
- Leadership and orientation - Understanding by the next public managers that the project must be bigger than the government, or its management, because it is for the population
- Human and financial resources
- Improved communication between the face-to-face teams and between the face-to-face teams and the tele-service team
- Personal values and motivation
- Constant search for innovation, flexibility, humanisation and care for people.
Replication
With the success of Alô Saúde Floripa, other public bodies sought similar partnerships. We are working for growth in other local governments, such as the municipalities of: Lages , Rio do Sul, Benedito Novo, Correia Pinto and Pinheiro Preto.
In each of these governments a personalised result is obtained, since the number of inhabitants, cultural characteristics, availability of telephone and internet directly reflect on the services, but in all of them we have achieved good references of improvements in health policy assistance. In the future, innovation will be connected to other systems, new care networks, which will allow for the synchronisation of information between basic services and urgent and emergency care, overcoming difficulties in care, locomotion, crowding of patients, sequelae or delay in returning to work due to lack of adequate care which lead to loss of productivity, and reducing costs due to inefficiency.
Lessons Learned
Always aspire to respect and care for the local knowledge and culture of each health work team. Prioritise following the local process and the customs of each government and community to personalise the delivery of innovation so that it is adapted to the custom and habits of its referenced population and can be increasingly effective. The organisation of Healthcare Networks in Brazil is still a process under construction and development, which impacts the implementation of innovations, requiring flexibility and constant adaptation of the planned with the executed to keep the focus on the result. Build resilience to face the challenges of municipal management, both budgetary and in terms of the crises that arise on a daily basis. It is important to focus on daily improvement of communication, technology and service processes, aiming to offer the best in protocols, flows and agility to the Municipality and users of the Unified Health System.
Anything Else?
In Brazil, the largest public health policy is the Unified Health System (SUS), one of the largest in the world and which guarantees, by constitutional force, access and assistance to all. However, since its creation in 1988, this structure has not yet solved all the barriers to its success, especially due to geographical and budgetary issues. Brazil has an uneven territorial population distribution, which is evident when comparing the demographic density of the Southeast - 87 inhabitants/km² - with the North and Centre-West, which accumulate 4.1 inhabitants/km² and 8.7 inhabitants/km2 respectively. This disparity is reflected in specialised labour and, consequently, in the difficulty of hiring and maintaining doctors, specialists and technologies for the care of the population, especially in places far from the major centres, forcing users to travel for days to access general and specialised care, absenting themselves from family, work and their routine.
Project Pitch
Supporting Videos
Status:
- Implementation - making the innovation happen
- Diffusing Lessons - using what was learnt to inform other projects and understanding how the innovation can be applied in other ways
Innovation provided by:
Files:
Date Published:
21 July 2023