Health and Technology“A Ugandan Experience”

Dr.John B. Niwagaba(MbChB,Mmed)

Mobile Health Care Ltd

Uganda

Uganda at a glance

• Land locked,found in E.Africa• Area-241,038km2,(85% Land,15%water)• Ethnic groups-52 tribes• Languages-English ,Kiswahili,Luganda etc• Population estimate-35 million (2014 UBOS)• History:British Protectorate,got independence in 1962• Religion-84%christian• Tourism :Game parks (Giraffes,Mountain

Gorillas,birds,lions) Source of R. Nile,The Uganda Martyrs….

Uganda`s Health Indicators*

• Doctor Patient Ratio 1:20,000• Child mortality:128/1000 live birth (under5 years)• Maternal mortality:432/100,000 live births.• Life Expectancy: 49(men),51 (Women)• Literacy %age:52-57 (total),83.5 (youth)• Delivery by skilled health worker-33%• HIV Prevalence-6.5%• Diabetes, Hypertension and other NCD-5%

*Data from multiple sources

Health is a state of complete physical, social and psychological wellbeing of the body ,not mere

absence of disease or infirmity (WHO)

Medical information: Consult the Gods… Speak To the

oracle… HIV KILLS…Use a Condom

Safe Blood saves lives TB is curable

The Information era

E-Health E-Medicine

Telemedicine Telehealth

Mobile Health Mhealth

Mobile Health/Mhealth

• Use of a phone for health related services. Simple Advanced

Call a doctor Mobile apps for

Text for health monitoringAdvice glucose

What has been done locally….?GoogleSMS SMSDoctor

TXT 2 Change 999

NDA UMDPC

Hotlines for Domestic violence,rape.etc… VERDICT: Insignificant!

Why: More Technology, less human !

MTN at a glance…

• MTN subscriber base-7 million• Value added services (Mobile Money

>1Million subscribers)• “Another first from MTN!”

Innovation distinguishes between a leader and a follower (Steve Jobs)

Mobile Heath Care Ltd

Vision Bringing health care to the people

Mission To create a reliable, timely and cost effective health information interface between the community and the health sector

The Medical Call..

Facts• Patients always call friends and relatives when sick• 60% outpatient consultations need information

only(UDHS 2006)

• “The Golden 4 Minutes”• 70% diagnosis is from history(Hutchinsons Clinical Methods 21st

Edition)

• Estimated 80% Ugandans speak either English,Kiswahili,Runyakitara,Luo or Luganda(Ethinologue)

Models

Single call model/Call extension model

Caller Call Centre

Remote doctor/service

provider

The Single Call Model• Tag line: Hello Doctor• Service No:0902900800 (MTN only)• Call cost:Sh.600 per minute.• Revenue share: 60%(MTN),40% (MHCL)• Extensions:5 active channels (30 channel PBX hybrid system)• Staffing:24 hour cover by 4 health workers• Database : >6000 health care providers (hospitals,clinics,pharmacies) and

20000 health care workers• Information: Basic consultation, location and cost of health services +counseling• Languages:English,Luganda,Runyakitara and Kiswahili (soon)• Call density :0-5 calls per day• Advertising: Information leaflets, radio shows,articles,clinic royalty program, SMS

doctor…• Expenditure: Full office, full time doctors/clinical officers

The Extended Call Model• Tag line: Hello Doctor• Service No:0902900800 (MTN only)• Call cost:Sh.600 per minute. Extension-Sh100• Revenue share: 60%(MTN),40% (MHCL)• Extensions:50• Staffing:25 doctors (10 gyn,10 paed,5 general)• Database : direct consultation with doctors• Call density :20-100 calls per day• Advertising: Strip in Red Pepper daily, social media• Expenditure: Minimal(little rent and small stipend to doctors)

Benefits

• Cheaper than physical consultation (UGX5000-50000)• Off the counter medicine buyers more certain what to buy and

pricing• Saves time and money commuting too and from facilities• Saves on appointment fixing, waiting and queuing.• Enhance competitiveness in public and private sector• Reduces quack practices• Increase uptake of emergency and first aid services• Cost of medication and health insurance to drop• Another value added service-using your phone to do MORE!

Challenges

• Reduce the doctor patient contact• Mistrust, unsure of doctor on line• Delays,unneccesary questions, increase cost• Double payment if sent to doctor physically.• Language barrier and communication hitches• Medico-legal issues in case of bad/misleading

or fatal information.

The future: A holistic healthcare product

Funding the call• Out of pocket: The caller• Health insurance packages: Member subscription,

Mobile Money based • Heath Providers: Subscription(extension)• Mobile Network(MTN)-Royalty program e.g.

Simcard registration• Government/Development Partners: Social

service

The doctor of the future will give no medicine, but will interest her or his patients in the care of the human frame, in a proper diet, and in the cause and prevention of disease. Thomas A. Edison US inventor (1847 - 1931)