Biggeri, Mario; Fedi, Claudio; Graci, Carmela; Mauro, Vincenzo; Melniker, Larry; Neri, Davide; Neri, Luca; Pazeli, Jose; Spreafico, Alberta M.C. (2014). 'Access to health services for capabilities expansion: The Global Ultrasound for Human Development Program – the role of innovative technologies and protocols' Paper presented at the annual conference of the HDCA, 2-5 September 2014, Athens, Greece.

As stated by the Nobel Laureate Amartya Sen 'The Capability Approach provides the intellectual foundation for human development. This approach considers human well-being, participation and freedom to be central economic and social objectives.' Sen and other human development scholars view development as the 'expansion of capabilities' or 'positive freedoms' (Sen, 1999). This is why 'the capability approach proposes a change – a serious departure – from concentrating on the means of living to the actual opportunities of living in itself' (Sen, 2009: 17). Resources are indeed important for promoting the functionings and capabilities of persons but only as instrumental means for human flourishing. The opportunity to have access to health is, together with education, one of the most relevant capability for its intrinsic and instrumental role (Ruger, 2007). In developing and developed countries the universal access to health is strongly debated in the literature. However, the debate of universal access vs universal coverage do not take enough into account the potential related to new technologies and  protocols.

The aim of this paper is to analyze the potential role of innovative technologies and organizational, clinical and training models grounded in the Capability Approach on health accessibility. In particular, we focus on the quality and accessibility to primary and emergency care resource scarce and remote areas.

The paper is structured into four sections. In the first section the role of technologies and new models is analyzed using the capability approach as a grounding framework. In the second section the case study of the Global Ultrasound for Human Development (GLOBUS4HD) 'Ecos dos Gerais' Project carried out by the World Interactive Network Focused on Critical UltraSound (WINFOCUS) in partnership with the Secretariat of Health of the State of Minas Gerais (SES/MG) in the Northern meso-region of Minas Gerais and Belo Horizonte is presented. The Project was developed to train medical doctors and regional health coordinators of the Brazilian State of Minas Gerais Health System on Point-of-care Led Ultrasound (PLUS) and Tele-Sonography technologies, as well as on the adaptation of the protocols to these new technologies and on enhancing the overall regional Human Development.

In the fourth section, the main results are reported. According to our findings the GLOBUS4HD 'Ecos dos Gerais' Project has developed strategies and processes that fostered individual and collective capabilities following the Sustainable Human Development paradigm and Amartya Sen's capability approach (1999).  In fact, the GLOBUS4HD approach impacted the outcomes at the pre-hospital and intra-hospital levels of the emergency medicine system. In order to reach this goal, the integration of technology and interdisciplinary protocols does not seem sufficient, so that education takes a fundamental role in improving and enhancing the regional and national healthcare system. On the other hand, the new paradigm positively affected the information system (rapid and immediate diagnostic information) and, so, the coordination between all hospitals and health centers and the healthcare organizational models. The new approach may lead, more in general, to an increase of the capacity of coordination in patient referrals.

Moreover we found that the GLOBUS4HD 'Ecos dos Gerais' Project has a relevant role for the expansion of the individual health capability – in particular opportunity to access quality ultrasound exams through the public healthcare system (at no out-of-pocket cost)_– has an impact on individual health as final outcome, generating positive feedback loops in terms of wellbeing (including income i.e. access to other goods and services), higher agency, and individual conversion factors (such as better health personal conditions). Moreover, on the societal side, the actions of the Project have an impact both on the governance of the healthcare system and the hospital service delivery capacity and management. The positive feedback loops increase social empowerment which may affect social and environmental conversion factors as well as better goods and services for the population.

In the last section the elements for future researches are indicated and some conclusions are reported.