In March 2020, Trinidad and Tobago implemented its first public health measures to mitigate the spread of the COVID-19 pandemic by instituting a nationwide lockdown. This included closing the country’s borders and limiting movements of citizens within the country. To ensure that the health care system was not overburdened, the government took a series of measures to manage COVID-19 cases.
However, even as these steps were taken, Trinidad and Tobago still sought mechanisms to continue to provide health services to the population without unduly exposing clients and health workers to the coronavirus. The nationwide curtailment of movement and services led to limitations on the delivery of health services, and there was a risk that overwhelmed health systems would leave patients without important physical and mental health services.
Towards a Solution
Recognizing the importance of continuing to provide physical and mental health services, the government focused on how to maintain access to healthcare while reducing the workload of frontline workers and their risk of infection through the High and Low Technology (HALT) Project, of which one output is the introduction of health service robots.
The HALT Project is complementary to the Government of the Republic of Trinidad and Tobago’s efforts to address the pandemic and has four outputs: 1) a telemedicine service deployed; 2) eight mobile healthcare robots deployed; 3) 55,000 washable masks distributed; and 4) 50 accessible hand hygiene stations set up.
The HALT Project aims to minimize the impact and challenges of COVID-19 by using technology to increase access to physical and mental healthcare, reduce transmission through more-available personal protective equipment and hygiene facilities and lowering the risk of infection through public education. The HALT Project contributes to the achievement of the Sustainable Development Goals (SDG) by working toward the good health and well-being of the population (SDG 3), while encouraging the development of industry, innovation and infrastructure (SDG 9), as the country strives to reduce inequalities (SDG 10).
The HALT Project is funded by the India-United Nations Development Partnership Fund, managed by the United Nations Office for South-South Cooperation (UNOSSC), totaling US$1 million. It aims to facilitate partnerships among developing countries to advance human-centric sustainable development around the world, with a priority on small island developing states affected by disaster.
Project partners and contributors are the Pan American Health Organization/World Health Organization (PAHO/WHO) in Trinidad and Tobago and the United Nations Country Team in Trinidad and Tobago who helped facilitate the exchange of best practices, challenges and benefits that were part of the Rwanda process. Representatives from the Ministries of Health of Rwanda (the Rwanda Biomedical Team) and Trinidad and Tobago and the University of Trinidad and Tobago participated in the meeting.
To understand the operation of health service robots, the Trinidad and Tobago team examined a model presented by Rwanda, which had successfully introduced heath service robots into their health system in 2020 with United Nations support. Exploratory research was done to understand the local context and to define a baseline of how health service robots could be used in Trinidad and Tobago. The University of Trinidad and Tobago undertook two critical needs assessments, one on the global use of health service robots, particularly during a pandemic, and the second on local stakeholder engagement, including a case study on the Rwanda experience.
Some of the critical information provided during the meeting included the importance of high-level support and advocacy and having a strong communication and change management strategy. This aims to minimize resistance and increase knowledge of how health service robots support and enrich health service delivery. A unique piece of information was the concept of giving the robots culturally appropriate names to make them more relatable to the public. Also, patients shared their stories with their communities and thus, through word-of-mouth, the robots became more acceptable to the general public.
The development of a “pandemic policy” by Rwanda was another tool that assisted in the fast-tracking of decisions and actions, allowing the procurement and distribution of the health service robots. Building Rwandan health personnel capacities to maintain and programme the robots was also crucial. In Rwanda, the health service robots were used for temperature screening, recording vital signs, delivering video messages, mask detection and collecting data. Rwanda also procured robots to perform decontamination services in health facilities and at the Kigali International Airport. Rwanda reported that the robots played a valuable role in the fight against COVID-19 and that their operation in the most infectious wards reduced the exposure of medical staffs by allowing them to avoid direct contact with patients.
The Trinidad and Tobago Team identified the importance of developing a change management approach, including a communication plan to achieve the acceptance of the health service robots by the community. The needs assessments carried out by the University of Trinidad and Tobago for PAHO/WHO identified preferred services for the health service robots to undertake in the local health facilities and recommended for their use. The best practices of Rwanda are being adapted to the local context. It is fully expected that collaboration with Rwanda will continue during the implementation of the project.
To aid in moving the country closer toward implementation of the health service robot portion of the HALT Project, the University of Trinidad and Tobago formulated a costed implementation plan and identified a cross section of stakeholders that need to be involved in the process to ensure the institutionalization of their use. Capacity building for healthcare workers and the local universities, including the critical technology transfer component, are essential parts of execution and sustainability of the initiative.
It is anticipated that the introduction of health service robots will be the start of the technological transformation of the health sector in Trinidad and Tobago, which can lead to wider opportunities for the country to be a repository for the development and production of health service robots for countries across the Caribbean region.