The health services in Bangladesh (like many elsewhere) can't get enough doctors. Training more doctors is not an answer. Those who do qualify tend to leave for higher rates of pay elsewhere. So, given the desperate need for trained medical staff in rural areas (for example, to curb child mortality rates), what are the health workers to do?
The more qualified a doctor is, the more likely he is to take a flight. The district hospital in Matlab, Bangladesh, boasts an operating table, lamp, oxygen cylinder, and anesthetic machine, all carrying the EU's gift tag. They gleam, partly because they are unused. Several surgeons and anesthetists have been trained, but none so far have been retained. "Other than holding a gun to their head, doctors do not stay here.", comments Shams Arifeen, a researcher in the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR, B). Doubling their pay is not the answer because they can earn five or ten times as much in private practice. Besides, specialists want to educate their children in the capital Dhaka, not in Bangladesh's backwaters.
Imagine that you were standing in that clinic without medical training, when a mother asks you to look at her sick child. What will you do? The solution that the Bangladesh health workers came up with was IMCI or Integrated Management of Childhood Illness. IMCI takes the knowledge in a doctor's head and writes it down as a set of rules that health workers can follow. When a sick child is brought into the remote clinic, the health worker is able to follow the simple step-by-step instructions to make quite a sophisticated diagnosis.
The following figure shows IMCI:
Look at the boxes in the above diagram—it's a set of medical rules. (Source, World Health Organisation, http://whqlibdoc.who.int/publications/2005/9241546441.pdf.) Using these rules a health care worker can quickly come to the following conclusions:
When the child is under two years of age, then refer to doctor immediately
When the child's skin does not bounce back when pinched, then the child is dehydrated
When the child is dehydrated then give rehydration salts
This is a real life example of business rules. Although it is paper-based and useful to the medical profession, it's a good example of business rules all the same.
Rules are 'when something is present, then do this'. And not just single rules, but many of them. Together, loads of simple rules allow you to come up with quite a sophisticated diagnosis.
Ruleflow and Workflow allow you to group your rules and decide which should fire first. If you're a health worker with a sick child, you want to do the most important checks first. Depending on the outcome, you then apply the next set of medical rules.
Everybody, including the doctors, is happy that his or her knowledge has been translated into rules. The doctors are happy because they can (guiltlessly) move to better-paying jobs. The medical workers using the system are happy because they can help the sick children that they see every day. The children gain because the better availability of medical knowledge is literally the difference between life and death.
Note
If you've used a computer language before, you might find the above example strange. 'Traditional' computer languages are more like a set of instructions: Do step 1, do step 2, repeat 5 times, and so on. Rules are different; they allow you to make many individual statements of what you know to be true and then let the computer decide if these rules apply (or not) to the current situation. This is similar to the way in which the human mind works.
Look again at the example. We don't specify any order for our rules. All of them, one of them, or none of them might apply in a given situation. A child under two who was dehydrated potentially could be referred to a doctor and given rehydration salts on the way in. This could be the outcome we want, or we may wish to rewrite our rules to be more precise—but always in the "when (something is true) then (do this)" format.
For more information on this real life example, read The Economist magazine's online article at: http://www.economist.com/research/articlesBySubject/PrinterFriendly.cfm?story_id=9440765.