In India, a hospitalized patient is typically accompanied by a handful of family members who take days, sometimes weeks off to be of help to their relative, particularly if they move to another city for treatment. And yet, they are committed to waiting in the corridors or lounging on benches in the hospital’s outdoors. Walks to the pharmacy to purchase medicines for the patient and taking regular updates from the attending physician are some paltry tasks that interrupt their waiting routine.
So, Shahed Alam and Edith Elliott, co-founders of the nonprofit Noora Health, had an idea: What if a patient’s family’s good intentions, concern and time at the hospital could be put to good use? They devised a simple training, to both help families assist their sick relative in the hospital and ease the transition to home care after discharge. At the same time, it would reduce familial anxiety about caring for the patient.
In the seven years since its founding, Noora’s intervention has been scaled up massively in collaboration with state governments and is now operating in 156 hospitals in India and four in Bangladesh.
Created with the expertise of health and content experts, Noora’s Care Companion Program (CCP) trains nurses to deliver 30 to 60 minutes of actionable health information about caring for a recovering patient to cohorts of families during their relative’s hospital stay. Palatable formats such as videos, audios, animations, pictures and slogans are used to communicate the information in the local languages.
The need Noora aims to fill is huge. In India — which has 1.7 nurses per 1,000 people, compared to the world Health Organization’s recommendation of 2.5 — each nurse attends to eight to 10 patients per day on average. That means that patients have an extremely short window of time — on average 2.5 minutes — to learn about critical preventative care upon discharge. Studies show that about 40 to 80 percent of the medical information provided by a health care practitioner is forgotten immediately by the relatives and what is retained is often inaccurate or incomplete.
That’s where Noora’s training comes in.
Take the case of Seethamma from the southern Indian village of Rattihalli. When her daughter-in-law passed away during childbirth, and she was in hospital with her prematurely born grandchild for a month, she attended Noora’s sessions several times. The information alleviated her anxiety and gave her the agency and confidence to raise her prematurely born granddaughter by herself, years after her own children had grown up.
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Simple but critical activities such as washing hands before picking the baby, burping her properly after a feed and giving kangaroo mother care — critical skin-to-skin-care for a prematurely born child — were disseminated by a nurse using engaging content.
“Earlier, I didn’t even bother to wash my hands before eating,” Seethamma says in a video interview by Noora. But Noora’s team kept in touch with her family on WhatsApp for reminders of adherence and support for a long time. Seethamma shares her lessons with families around her. “Everyone should get to learn what I was taught.”
A study — still under peer review — looking at 11 Indian district hospitals shows that after Noora’s CCP intervention, skin-to-skin care increased by 78 percent and newborn readmissions reduced by 56 percent.
Apart from maternal and newborn care, Noora’s CCP extends to oncology, cardiology, general medical and surgical care, where studies show similar results: patients in CCP-trained families show a 71 percent decline in post-discharge complications after 30 days of cardio-thoracic surgery, for instance.
“Noora’s program is kickstarting a cycle of health awareness and positive health behavior change that can last well beyond the doors of a hospital and has the potential to permeate several generations of a family,” says Rebecca Weintraub, an assistant professor of global health at Harvard Medical School and a former director at Noora.
Alam says that since CCP is not a community level intervention, its reach is limited to supporting people when they are seeking care, and needs a basic health infrastructure to operate.
According to Weintraub, Noora’s is a simple and cost-effective model that works to everyone’s advantage, from public health administrators to nurses, and families. She also believes the program could be implemented anywhere in the world. “The program can be taken across geographies,” she says. “While cultures and habits vary across the world, the feelings of worry, anxiety, love and care for one’s family are universal.”