title: The Maniapure Program--lessons learned from a rural experience: two decades delivering primary healthcare through telemedicine.
abstract: OBJECTIVE
  Latin American healthcare has a common characteristic in the way countries provide assistance to the majority of their population, often represented by limitations in investment and most frequently by assigning funds to the wrong sectors of the system, which will never reach the neediest segments of the society. We want to share some lessons learned in nearly two decades serving the poorest segments of the society, despite limited funding, through the use of communication and information technologies.
  
  
  METHODS
  The data analyzed come from the accumulated experience in a remote rural center in southern Venezuela (La Milagrosa Health Center in Maniapure, Bolivar State) and further experience in over 20 similar rural clinics replicated from that case. The methodology has been a retrospective evaluation of results with a constantly maturing and dynamic practice at three levels of care: (1) remote (basic clinic), (2) a virtual triage center, and (3) a specialty level.
  
  
  RESULTS
  We analyzed qualitative results on access to specialty care of previously excluded communities (populations) and the significant cost reduction (social and financial) by avoiding unnecessary travel for the majority of consulting patients. In cases needing subspecialty care that require travel, the effectiveness of such activity is optimized in time and service.
  
  
  CONCLUSIONS
  Communication and information technologies can provide significant savings to society and improve healthcare with the use of common and relatively inexpensive consumer-level devices if used in a basic, coordinated system of services with adequate training and follow-up.
authors: Cardiology, Centro Medico de Caracas Hospital, San Bernardino, Caracas, Venezuela. tomasanab@gmail.com
authors: Tomas J
authors: TJ
authors: Sanabria
authors: Morel
authors: M
authors: Orta
mesh_terms: D002309:Cardiology / Q000458:organization & administration; D006801:Humans; D019982:Organizational Case Studies; D011204:Poverty Areas; D011320:Primary Health Care; D012189:Retrospective Studies; D019035:Rural Health Services / Q000458:organization & administration*; D017216:Telemedicine / Q000458:organization & administration*; D014687:Venezuela