SharingintheGlobalEconomyLessonsfromDigitalHealthInnovators

18th AnnualGlobalDevelopmentNetworkConferenceScience,Technology&InnovationforDevelopment

NewDelhi,India

March22,2018JohnCampbell,Jr.ErinSwearing

TheCenterforHealthMarketInnovationsisaglobalpublicgood.

Weenableknowledgesharingbyprovidingaplatformtohostinformation,analysis,andconnectionstosupportinnovativehealthprogramsInlow- andmiddle-incomecountries.

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Identify Analyze Connect

TheSharingEconomy

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SeveralLMICshavehighpercentagesofcellulartechnologycoverage.

ManyLMICshave morethan90%2Gcoverage.1

ManyLMICshavenearly80%3Gnetwork coverage.1

70%oftheworld’spopulationwillhaveaccesstomobiletechnologyin2020– 100,000,000morethosewithaccesstoelectricity.2

Sources: 1. GSMA, (2017) 2. Cisco, (2016)

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Accesstoamobiledeviceconnectsustotheglobalmarketplace.

Wearetrustingothersthatwehavenevermetperson.

Wearegrowingoursocialcapitalandintroducingmorepeopleintothemarket.

Wehavemoreopportunitiestoobtaincapital.

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Weareexperiencinganeweconomicreality.Marketshiftsfosteredbythedigitalrevolutionwillchangehowhealthcareisdeliveredandexperienced.

KeyIssuesinemergingmarkethealthcarelandscapes:Poorcoverage,quality,andlowdigitization

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1 Healthcaredemandinemergingmarketsisgrowing,drivenbyanumberoffactorssuchasagrowingandageingpopulation.

2 Withthegrowingmiddleclassandrisingincomes,peoplearespendingmoreonhealthcare

3 Chronicdiseasessuchasdiabetesarenolonger‘richcountry’diseases,andtheirprevalenceisincreasinginemergingmarkets

4 InLMICs,mostofthehealthcareinfrastructureisconcentratedinurbanareas,whilemorethan50%ofthepopulationlivesinruralareas

Digitalhealthinnovationsdisrupthealthcareatalllevels

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LEVEL 1:SYSTEMS

•Supply-chainmanagement•Integrateddigital platformforbookingand payment

LEVEL 2:CENTERS

•Remotepatient monitoring•Remote diagnostics

LEVEL 3:PROFESSIONALS

•Educationand training•Datacollectionand reporting

LEVEL 4:PATIENTS

•Healthand wellnessinformation

•Medical advicePatients demand affordable, personalized health care in a shared economy Source: United Nations University Press, (2012)

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Improved

health

outcomes

Time

Paperbasedhealth

solutions

Allpaperrecords

Traditionaldigitalhealthmodel

Digitalversionofpatient

informationCoded

Data-centeredSiloed

NewdigitalhealthmodelCloud-basedOpensourceIntegratedSocialMobile

TheshiftfromtraditionaltonewdigitalhealthsolutionsinLMICs

Source:PWCReport,TheDigitalHealthcareLeap,2017

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Digitalhealthinnovationsuniquelyaddressthreepersistentchallengesinemergingmarkets

Access

Quality

• Greaterreachofhealthcaredeliveryviatechnology-basedsolutions

• Greaterandfasterpatientaccesstohealthandwellnessinformationdeliveredviamobilephones

• Enablesfasterandsecurecommunicationanddatasharingbetweenhealthcarecenters,professionals,andpatients

• Resourceoptimization:digitalhealthcanensurethatavailablehealthresourcesareusedmosteffectivelyandwhere/whenneeded

Cost

ResearchQuestions

Inwhatwaysaredigitalhealthtechnologiesadministeredinemerginghealthmarketsthathavemadethemsuccessful?

Howcanhealthmodelsthatutilizedigitalhealthtechnologiesbe integratedintohealthmarkets?

1

2

ResearchApproach

ConductsearchofCHMIprograms

database

1

§ Reviewed366innovativedigitalhealthprogramsinCHMIdatabase

§ 52digitalhealthprogramshadimpactevaluations

Identifydigitalhealth

technologyInnovatorinterviews

2 3

ToidentifypromisingdigitalhealthinnovationsthatareachievingscaleinLMICs

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Identifythedigitaltechnologysolution§ Whatarethecorecomponentsorattributesofthedigitaltechnologythatis centraltoachievingtheprogram’soutcomes?

ResearchApproach

ConductsearchofCHMIprograms

database

1Identifydigital

healthtechnology

Innovatorinterviews

2 3

ToidentifypromisingdigitalhealthinnovationsthatareachievingscaleinLMICs

Digitalhealthtechnologyinnovations

EnablingMarketEnvironment

Synthesisoffindings

4

ConductsearchofCHMIprograms

database

1Identifydigital

healthtechnology

Innovatorinterviews

2 3

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Healthcaredeliveryinnovationthroughdigitalhealth

Twofactorsthatleadtothescaleofdigitalhealthinnovations

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EnablingMarketEnvironment

Digitalhealthtechnologyinnovations

Telemedicinetoextendaccesstocare

mHealth technologiestoimprovethecarecontinuum

Cloud-basedandopensourcetechnologytoenhancetheeffectivenessandefficiencyofhealthworkers

Integrateddatacollectionplatformstosupportdecision-makingandpatientcaremanagement

Fourdigitaltechnologytypeswereidentifiedinouranalysis.

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Telemedicinetoextendaccesstocare

TechnologyType#1:

doctHERs

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• DigitalhealthcareplatformconnectingremotelylocatedfemaledoctorsinPakistantounderservedhealthconsumersvianurse-assistedvideo-consultation

AsherHasan,MDFounder&ChiefExecutiveOfficer

doctHERs leveragesdigitaltechnologytocorrecttwomarketfailures:

1. Accesstoqualityhealthcareforunderservedcommunities2. Inclusiveemploymentforwomen

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WorldHealthPartners:

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Gopi GopalakrishnanPresident

• India-basednon-profitidentifyinginformalhealthprovidersbylivestreamingtoconnectthemtoqualifiedspecialistdoctorsbasedinurbancenters

• SkyHealth telemedicinecentersalsoofferpoint-of-caretele-diagnosisusingaRemediTM kitthattransmitdiagnosisresultsdirectlytothespecialistphysicians

WHP’sutilizestelemedicinetoestablishcomprehensive,large-scale,andcost-effectiveservicedeliveryplatform

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Need to restructure this. Why are the elements in this formation?

Source: World Health Partners, (2013)

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mHealth technologiestoimprovethecarecontinuum

TechnologyType#2:

iKure Techsoft

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• Point-of-caretechnologiesenablecommunity-basedhealthworkers(CHWs)toprovidehealthcaremonitoringanddiagnosticsupport

• MeetsIndianruralhealthcareandpreventionneedsthroughhealthoutreachinitiative,skillsdevelopment,andtechnologyintervention

Sujay SantraFounderandChiefExecutiveOfficer

WirelessHealthIncidentMonitoringSystem(WHIMS)byiKureTechsoft de-fragmentshealthcaredeliveryinIndia

Providestechnology-enabledinfrastructurefordoctors-CHWsinrural

areas

Mobiledatacollection&real-timesharingof

patientdata

Remoteincidencetracking

Accessiblethroughtables&smartphones

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Cloud-basedandopensourcetechnologytoenhancetheeffectivenessandefficiencyofhealthworkers

TechnologyType#3:

MicroClinic Technologies

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• Kenya-basedcorporationdevelopingpoint-of-caretechnologiesforbottomofthehealthpyramid

• ZiDi™isaninnovativeenterprisehealthmanagementapplicationdesignedtoimproveefficienciesandrevenuesforclinics

Moka Lantum,MD,PhD,MSFounder&ManagingPartner

MicroClinic Technologies’mHealth innovationofferspatient-centeredsolutionsthatoptimizeaccessibilityandqualitycare

ZiDi™istheintegrated,onestopsourceenterprisesolutionthatfacilitatesdata-drivendecisions,regardlessofgeographiclocation

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Integrateddatacollectionplatformstosupportdecision-makingandpatientcaremanagement

TechnologyType#4:

access.mobile International,Inc.

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• InternationaldigitalhealthcompanyfocusedonmobilepatientengagementinEastAfrica

• Deploysmobileandcloud-basedtechnologytoproactivelyconnectwithpatientsanddrivehealthybehaviors

• AdvancedanalyticsandAfricanhealthmarketexpertisecreateauniquesolutionforengagement

Kaakpema“KP”Yelpaala,

MPHFounderand

CEO

SaraYelpaala,MPHDirectorofMarketing

&Strategy

access.mobile providesend-to-endengagementsolutionsthatpatients’ownershipoftheirhealthcare

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amHealthisanaffordable,secure,andeasy-to-usetechnologythatsimplifies practicemanagementandimprovespatient engagement

•Groupandindividual messaging•Appointment calendar•Patientrecord management•Practice administration

Provider-sideengagementthroughamHealth

Patient-sideengagementthroughGozee

Gozee isafreewebappthatconnectsuserswithhealthfacilitiesandpharmaciesinthe area

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Keypoints:usingdigitalhealthtechnologiestoscaleimpact

§ Integratedigitalhealthtechnologiesintoexistinghealthprogramsinsteadofcreatingstandalonesolutions

§ Viewdigitalhealthtechnologiesasenablers,notsubstitutesforpeopleandprocesses

§ Designdigitaltechnologiesforandwithend-usersinmind

Telemedicine

mHealth

Cloud-based &opensource

Integrateddatacollectionplatforms

EnablingMarketEnvironment

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NavigatingtheMarket

EnablingMarketEnvironment

Demand

Relationships

Consumer Insights

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Demand

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Youworkinpost-conflictPakistan.HowdidthosefactorsplayintothefoundingofdoctHERs?

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Therewasanopportunitytoreintegratethesewomen,andtherewasanopportunitytoleveragethisunderutilizedcapacitytoempowerwomenbothathomeaswellasintheoffice,onthefrontlines.

- AsherHasan,CEOandFounderofdoctHERs

HowdidtheverticalmarketplayintothecreationofWorldHealthPartners?

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Toreachunderservedmarketsthroughthemarketplace, ifyougovertical,youarenotabletothengettheinterestoftheproviders,,especiallywhenyouaretryingtosellsubsidizedproductsandservices.

- Gopi Gopalakrishnan,PresidentofWorldHealthPartners

Demand

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Opportunitiesfornewengagementsforpopulations

thatthemarkethasatendencytoexclude

ConsumerInsights

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Inanemergingmarket,whatchallengesdoyoufacedrivingdemand?

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Weknowweareaddingvalue.Weknowthattheprovidersandthepatientswantit,butvalueinthismarketis- similartoemergingmarkets– valueisn’tenough.Peoplearen’tpayingbasedonvalue.Ittakesawhiletogetpeopletopayforthevaluethatthey’reseeing.

- SaraYelpaala DirectorofMarketingandStrategyforaccess.mobile

International,Inc.

Howdoestheconsumerinformtheprioritiesinyourmodel?

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[…]thesimpleinterfaces[and]swipeofthescreensinasmartphone[…]wasnotsosimpleforthevillagewomanworkingascommunityhealthworkers.So,weliterallyhadtospendourtimeingivingthemenoughconfidencetousethesystems,andwehadtoreallyensurethatthesymbolswereverysimpleandintuitiveinnature.Therewereseveralotherfactors,forexample,theproblemsofheat,sweat,dust,andinthosesettingshowthewholehardwaresoftwarebehaves.

- Sujay Santra,FounderandCEOofiKureTechsoft

Whatcharacteristicsofanopenmarketshouldasocialenterpriseconsider?

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Whenyougointotheopenmarket,theyarenotlookingforefficiency.Theyarelookingforpremiumexperience.

- Moka Lantum,FounderandManagingpartnerofMicroClinic Technologies

Limited

Whatiskeywhensellingyourvaluetovariousentities?

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Offeringafreeversionofourcloudbasedsolution.Thatthenallowsnon-profitorganizationsothersocialorganizationsevengovernmentstothinkabouttakingthisonandtryingthesystemandseeingthebenefitsandloweringthecosttoenter.

- Kaakpema “KP”Yelpaala FounderandCEOofaccess.mobile International,Inc.

ConsumerInsights

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Offervariedexperiencesofyourmodeltoallowdifferententitiestoexperiencethe

valueofyourservices.

Considerhowvaluecanbeleveragedwhenwillingnesstopayisnotpresent.

KeyPartnerships

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Whatalternativesexistformodelsthatarenoteconomicallyviable?

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Eitherwemakeiteconomicallyviable,whichoftencannothappen,ortheonlyotherchoiceistolockinwiththegovernment. Somehowintegrateorsomehowforgearelationshipwiththepublicsector.

- Gopi Gopalakrishnan,PresidentofWorldHealthPartners

Whatiskeywhensellingyourvaluetovariousentities?

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Interoperabilitywithothersystems.Totheextentthatwecanpartnerwithothercomplementarysystems,thenthatisgoingtomultiplyimpactforeverybody.Withoutinteroperabilityandsharingofdata,andconnectingsystems,it’smakesithardonorganizationsandultimatelyitdoesn’tbenefitpatients.

- Kaakpema “KP”Yelpaala FounderandCEOofaccess.mobile International,Inc.

Asasocialenterprise,howwereyouabletosurviveuntilyouintegratedintothepublicsector?

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Weareanenterprise,whilethatworkisgoingon,attheendoftheday,youhaveabusinesstorun,andthat’sreallywheretheprivatesectorcomesin.Weneedtofigureouthowwecantailorourservicestotheprivatesector.

- Moka Lantum,FounderandManagingpartnerofMicroClinic Technologies

Limited

Whatpartnershipsarekeytomaintainasyourimpactgrows?

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Aswegrowandasweimpactpopulationhealthindifferentways,wewanttomakesurethatwe’realignedwithnationalgoalsandalsothatpublicsectorseesopportunityinthethingswearedoing.

- Kaakpema “KP”Yelpaala FounderandCEOofaccess.mobile International,Inc.

Howimportantareimpactinvestorswhenoperatinginafrontiermarket?

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Pakistanisconsideredafrontiermarketwithfairlyhighriskperception.Alotofdonorsandimpactinvestorsshyawayfromthecountry.Withoutthatsupport,it’sgoingtobeverychallengingforustocontinuetoattractthekindofhumantalent,humancapitalthatweneedtoenableustocontinuetogrow. Alotofthattalentgetsvacuumedupbythemultinationalcorporatesector.

- AsherHasan,CEOandFounderofdoctHERs

Keypartnerships

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Publicsectorofficialsshouldbekeypartnersinthiseffort,butintegration

takestime.

Businessescanbesustainedwithsideprojectsthataremore“market-

ready”inthemeantime.

Interoperabilitycannotbeoverlookedinemergingmarkets.

Criticisms

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Whatwouldyousaytothoseskepticalofusingdigitalhealthtoenhancepatientexperience?

- access.mobile International,Inc.

We see health technology as an enabler, a way to ease painpoints and improve quality and access issues. As an enabler,technology can expedite the process, help shortcut extraneoussteps and facilitate informed decisions. Technology does notreplace the decision making process, it helps simplify andinform it.

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Whatwouldyousaytothoseskepticalofusingdigitalhealthtoenhancepatientexperience?

- WorldHealthPartners

Werealizeourwayisnotthebestwaytoprovidehealthcare.Atanideologicallevel,wewouldlikeeventhepoortogethealthservicesthatcomparewiththe[servicesthe]waybetter-offurbanclassesget--wherethedoctorandthepatientareunderthesameroof,wherethereiseyecontactandbodylanguagenecessaryforempathyandbettermedicaljudgment,andwherethereisacomfortingreassuranceofpersonalconnect.

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DigitalHealthTechnologiesintheFuture

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DigitalHealthTechintheFuture

§ Howdowekeepdigitalhealthtechnologiescosteffective?§ HowdoWEensuredigitalhealthtechnologiesremain

unbiasedtowardscertainend-users?§ Howdowepreventdigitalhealthtechnologiesfrom

disadvantagingserviceprovidersinthefuture?§ Onceadigitalhealthsolutionisintegratedintothemarket,

whatneedstobeestablishedinordertoenablesustainability?

QuestionstoConsider

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ScalingDigitalHealthintheSharingEconomy

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Integratingtechnologiesintothemarket

Opportunitiestoobtaincapital

Increasedsocialcapital

TrustTelemedicine

mHealth technologies

Cloud-basedandopensourcetechnology

Integrateddatacollectionplatforms

References

Cisco,(2016).VNIGlobalFixedandMobileInternetTrafficForecasts.Availableat:https://www.cisco.com/c/en/us/solutions/service-provider/visual-networking-index-vni/index.html?CAMPAIGN=MobileVNI2015&COUNTRY_SITE=us&POSITION=PR&REFERRING_SITE=SocialMedia&CREATIVE=PR+to+VNI+page&_ga=2.16005744.737117080.1521459007-764718862.1521459007

GSMA,(2017).Scalingdigitalhealthindevelopingmarkets:Opportunitiesandrecommendationsformobileoperatorsandotherstakeholders.Availableat:https://www.gsmaintelligence.com/research/?file=c581aa43bdb7b7d236bb937698c2d6fd&download

PwC,(2017).TheDigitalHealthcareLeap.Availableat:https://www.pwc.com/gx/en/issues/high-growth-markets/assets/the-digital-healthcare-leap.pdf

UnitedNationsUniversityPress,(2012).Freeandopensourcesoftwareandtechnologyforsustainabledevelopment.Availableat:https://collections.unu.edu/eserv/UNU:2517/ebrary9789280812176.pdf

WorldHealthPartners,(2013).TheRoleofTelecentresine-HealthSolutions.Availableat:https://www.slideshare.net/tistalks/the-role-of-telecentres-in-ehealth-solutions

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