mHealth and Inclusive Innovation in India


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HealthCursor Consulting Group India- Distribution and Marketing- Mobile network operators in Africa have identified the growing demand for financial services and micro insurance . Airtel Africa has partnered with MicroEnsure for Mobile Micro Insurance. The range of Airtel-branded insurance products includes life, accident, health, agriculture, and other forms of cover.

Connecting intermediaries, customers and surveyors- ICICI Lombard India's mobile initiative started simply enough, with a set of basic applications that gave customers a consolidated view of all their policies, a reminder service to renew a policy, and a way to track the status of a claim. But as they matured with the mobile platform, they re-visited the paradigm and devised new ways to provide customers with more value-added and user-friendly features. This is however restricted to Auto insurance only.

Encryption, Transactions and handling customer grievance- Public sector general insurance company United India Insurance launched a mobile-based real-time fund transfer facility for payment of premium. M-Power enables customers to renew their policies and also remit the premium for approved proposals. To use this facility, one has to get an MMID (an identification number called - mobile money identifier) from his/her bank and enable one’s mobile with the application given by the bank. However, there are only 10 banks on board with this platform. This initiative follows the launch of its Internet-based sales, customer grievance portal and information-cum-sales kiosks.

Sales, awareness and providing access- Bima, a young Swedish microinsurance company, is using mobile phones to sell as many as three billion new insurance policies to the global poor. Bima, that has begun to access this untapped market, is now one of the largest mobile insurance platforms in the world. In just three years, Bima has acquired 4 million clients in Africa and Asia and is adding 400,000 new subscribers per month. Bima has been tackling many of the obstacles—education, pricing, premium collection—that prevent poor people from obtaining such benefits. For instance, Bima products such as life, accident and health insurance cost "as little as $0.20 to $6.00 a month. Last month, Leapfrog invested $4.25 million in Bima, which will allow the company to expand even further within Africa and Asia as well as reach into new markets in Latin America.

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mHealth and Inclusive Innovation in India

  1. 1. “Inclusive Innovation and Growth:-” Dr. Ruchi Dass HEALTHCURSOR CONSULTING GROUP 1
  2. 2. Table of Contents 1 Background 2 Innovation- As we define it in Healthcare 3 Turning Point- Opportunities & Market Readiness 4 Policy- FRAMEWORK for Inclusive growth 2
  3. 3. The Indian Healthcare Divide • India has 17% of the world's population • Poorest healthcare infrastructure among growing economies • Healthcare accounts for only ~5% of GDP • • • Healthcare Delivery Market in India ~ US$ 60 billion in 2010 • • Significant supply deficit Healthcare market expected to grow at CAGR of 15% Indian Healthcare Market Growth 15% CAGR Accessible, reliable and affordable healthcare continues to be a challenge Growing middle class with rising income levels , health awareness Indian Healthcare Capacity Shortfall (in mn) 8 6 3.7 3.6 4 1.9 1.8 1.3 0.9 0.7 1.5 Bed Doctors Nurses Existing Required (2010) 1.9 2 0 Source: Public Research 3 Required (2020) Source: Public Sources, Technopak Analysis
  4. 4. Health Services Utilization Ageing Population and Chronic Care management No. of Years Chronic Care Disease Patients Social Class Less than 7 Years More than 7 years Total High 24 12 36 Middle 18 11 29 Low 7 13 20 Very Low 12 12 24 TOTAL 61 48 109 Percentage (56%) (44%) Source: Health services utilisation in urban India: a study By C. A. K. Yesudian Out of pocket expenditure is more than 80% 4 Rising demand for medical services and timely medical intervention Need for measures to provide health specialists’ access anytime anywhere and not only at the point of care 4
  5. 5. Supply Problems Ageing Population and Chronic Care management Resource Constraints •There is 1 doctor per 1000 people in India. •Most of India’s estimated 1.2 billion people have to pay for medical treatment out of their own pockets (That is more than 80% of the total health expenditure as per 2011 stats). •Less than 15% of the population in India today has any kind of health-care cover, be it community insurance, employers’ expenditure, social insurance etc. •Over 72% (that would be over 620 million) of India’s population lives in its 638,588 villages. •It is hard to believe but in India, a common man is most indebted to healthcare after dowry. Call a Doctor/ Second Opinion 5 Patient education and Health Tips Home health and Remote monitoring Tele-Diagnosis and eprescription 5
  6. 6. Empowerment Ageing Population and Chronic Care management Resource Constraints Patient Empowerment With increasing Internet and mobile broadband access, available in-depth information on medical conditions and their treatment has enhanced patients’ knowledge, generating an increasingly consumerist attitude toward medicine and higher expectations regarding treatment. 6 6
  7. 7. Integrated care Ageing Population and Chronic Care management • • Resource Constraints Patient Empowerment Integrated Care In the face of the enormous challenges of managing chronic diseases, delivery innovations appear to have the most impact when multiple parties (e.g., physicians, nurses, payors) interact seamlessly to provide the best possible patient care over an extended period of time. Such integrated models have the potential to reduce costs dramatically, while increasing patient satisfaction and clinical quality. 7 7
  8. 8. Health Innovation ecosystem in INDIA Healthcare Providers Government / Regulators ... are regulated and funded by ... ..several others…. ... provide access to ... .. fund and regulate ... Implemented remote monitoring solution Sharing of medical images Medical data management Digitization of health records … provide platform to and partner with … Operators/Distributors Solution Providers Remote monitoring solution 8
  9. 9. Opportunities 9
  10. 10. Technology Vs Usability Innovation 10 Source: PSFK
  11. 11. Episodic care Vs Continuum of care 11 Source: PSFK
  12. 12. Healthcare & surveillance 12 Source: PSFK
  13. 13. Table of Contents 1 Background 2 Innovation- As we define it in Healthcare 3 Turning Point- Opportunities & Market Readiness 4 Policy- FRAMEWORK for Inclusive growth 13
  14. 14. Innovation Strategy Innovation Strategy- From the Books Platform Inclusion Ecosystem Drivers Innovation Strategy- From the Ground Creation Protection Exploitation Innovation Defined- For a Country like India Meaningful= Design Driven 14 Disruptive = Technology driven Incremental= User Centric = Market driven Discourse
  15. 15. Design Driven Innovation 15
  16. 16. Design Driven Innovation 16
  17. 17. Innovation Budgets Innovation budgets of the main government departments and agencies 17
  18. 18. Innovation brings economic growth “India is an entrepreneurial country, but its entrepreneurs have had to struggle to create and grow their business ventures. There is, however, a growing group of first-generation Indian entrepreneurs – the founders of companies such as HCL, Cognizant, Infosys, Bharti and others that have generated large scale employment and significant wealth. They and others such as IndiaBulls, Makemytrip and Naukri have also demonstrated value creation through a public listing. These successes have encouraged a new breed of entrepreneurs especially in the internet and ecommerce space. India has the potential to build about 2,500 highly scalable businesses in the next 10 years – and given the probability of entrepreneurial success that means 10,000 start-ups will need to be spawned to get to 2,500 large-scale businesses. These businesses could generate revenues of Rs10 lakh crore ($200 billion)” Moreover, entrepreneurship tends to be innovation-driven and will also help generate solutions to India’s myriad social problems including high-quality education, affordable health care, clean energy and waste management, and financial inclusion. Entrepreneurship-led economic growth is also more inclusive and typically does not involve exploitation of natural resources. 18
  19. 19. Table of Contents 1 Background 2 Innovation- As we define it in Healthcare 3 Turning Point- Opportunities & Market Readiness 4 Policy- FRAMEWORK for Inclusive growth 19
  20. 20. Application of usable innovation Health Awareness and Education- Existing health content could be aggregated, filtered and indexed, under the guidance of global domain experts and made available on IVR, mobile devices and tablets like “Aakash”. Said innovation will help achieve &: 1. Assist India with meeting the MDGs by providing support to the social sectors; WHO says that India will fail to achieve some of the most important Millennium Development Goal (MDG) targets like reduction in maternal and child deaths, and increase in child immunization rates by 2015. 2. Solve the economic implications related to the burden of NCDs in the country- In 2004, 4.8 million (59.4 percent) of the estimated 8.1 million Indian deaths were due to NCDs. A 2011 study shows that about 25% of families with a member with CVD and 50% with cancer experience catastrophic expenditure and 10% and 25%, respectively, are driven to poverty. 3. Help ASHA/ Aanganbadi workers stay connected to useful resources at the time of need.- The information challenges facing health workers include lack of routine systems for seeking and sharing information, lack of high-quality and current health information, and lack of locally relevant materials and tools. Without such basic information, the provision of quality services by health workers, the effective management of programs, and the use of evidence to formulate health policy all suffer. This information deficit contributes to poor health outcomes, including increased morbidity and mortality. 20
  21. 21. Case Study- INDIA Case Study 1: Health Awareness and Education- Existing health content could be aggregated, filtered and indexed, under the guidance of global domain experts and made available on IVR, mobile devices and tablets like “Aakash” Mediphone 1 4 Regulators 2 Solution Provider Process 5 Mobile IVR System Decision support Tele-Triage system Healthcare Providers 6 3 Patient Profile Technology Providers 7 Airtel Subscribers 8 Success Factors 21 Medical Organizations Patients • Call helpline •Ask questions on health-related problems •Describe an ailment Community workers •Visit families periodically •Are on call for serious ailments •Connect villagers with call center •Promote awareness •Educate •Deliver medications Call center agents Receive incoming calls and triage to – Physicians – Nurses – Educators – Field workers Place outgoing calls to – Follow up on patients – Monitor community worker performance Physicians in call centers •Speak with patients •Conduct interviews; use images and videos if required •Make a diagnosis •Recommend treatment including medications, educational advice •Refer to agent to coordinate medication delivery and follow-up Mediphone has the capability to scale up on several platforms and can work seamlessly on Landline, Mobile and Internet. The service can be provided in regional languages as well. Mediphone can also be supplemented with a health classifieds service that will further enhance the call flow. Mediphone will also act as a platform to browse and buy Health related packages from several providers. Currently Mediphone is handling more than 1500 calls per day and will soon start Hospitals referrals, Appointment scheduling and emergency management 24X7.
  22. 22. Application of usable Innovation Crowd-sourcing Healthcare- provide an opportunity for scientists, doctors, technocrats, students and others with diverse expertise to work for a common cause. Said innovation will help achieve &: 1. Drug Discovery- Crowd-sourcing will help assist India with controlling morbidity of Tropical diseases by providing a global platform where the best minds can collaborate & collectively endeavour to solve the complex problems associated with discovering novel therapies for neglected tropical diseases like Malaria, Tuberculosis, Leshmaniasis, etc. Drug discovery can be made successful by pulling together informaticians, wet lab scientists, contract research organizations, clinicians, hospitals and others who are willing to adhere to the affordable healthcare philosophy. 2. Best Practices- Sharing best practices in solving some of the most complex issues around NCDs and related complications in the country. Take an example of Multiple sclerosis- It is very difficult to prognosticate effectively for MS patients. Some individuals have a very benign course and/or respond well to treatment, whereas others become rapidly disabled within several years of diagnosis. Sharing of best practices related to treatment, prognosis and follow up can hence lead to success. 3. Clinical Trials- Governments and public funded institutions in the countries with high burden of disease has a responsibility to contribute to the drug development. The cost of trials can therefore be brought down considerably on a platform which is crowd-sourced and open. 22
  23. 23. Case Study- Hungary Case Study 2: The Webicina- "Webicina," a site where medicine combines with social media to allow physicians within the country as well as across the world to communicate their findings easily, quickly and effectively. Webicina 1 4 Social Media 2 Components 5 System Integrated PlatformMobile App/ Web 2.0 Personalized Search Drug Discovery Second Opinion Healthcare Providers 6 3 Patient Profile Medical Resources Medical Organizations 7 8 Empowered Patients and providers Webicina has the capability to scale up on several platforms and can work seamlessly on KPO/IVR, Landline, Mobile and Internet. The service can be provided in regional languages as well. Success Factors 23
  24. 24. Major Players Players Definition Regulators Medical regulatory authorities such as FDA, HIPAA etc Healthcare Providers Individuals or institution s providing health care services Fitness Providers General fitness providers and diet clinics Application Developers Data Management Independent medical / mobile Software developers Medical information providers Health Device Manufactures Manufacturers of sensors that interface with application on mobile phones Medical Organizations Medical education & research institutions, publishers, pharmaceutical companies and pharmacies Network Providers Mobile Manufacturers 24 Wireless data network providers Smartphone and feature phone manufacturers Examples
  25. 25. Table of Contents 1 Background 2 Innovation- As we define it in Healthcare 3 Turning Point- Opportunities & Market Readiness 4 Policy- FRAMEWORK for Inclusive growth 25
  26. 26. Areas of Policy making 26
  27. 27. Innovation 27
  28. 28. Digital Health Efforts- Collaboration areas Health Information systemsCHIS- India will also put in place a Citizen Health Information System (CHIS) - a biometric based health information system which will constantly update health record of every citizen-family. The system will incorporate registration of births, deaths and cause of death. Surveillance- Maternal and infant death reviews, nutrition surveillance, particularly among under-six children and women, service delivery in the public health system, hospital information service besides improving access of public to their own health information and medical records would be the primary function of this effort. Placed on a GIS platform, it can identify geographic concentration of disease. Medical Records- The system will also provide hospital information service to improve the quality of care to patients through electronic medical records, to lower response time in emergency and improve hospital administration. It will support emergency response systems and referral transport arrangements, the organ retrieval and transplantation programme. Resource Mobilisation- The system will also support financial management -- from resource allocation, resource transfers, accounting and utilization to financial services like making of payments to facilities, providers and beneficiaries. It will provide a platform for continuing medical education and support regulatory functions of the state by creating a nation-wide registration of clinical establishments, manufacturing units, drug testing laboratories, licensing of drugs, approval of clinical trials 28
  29. 29. Approach and Innovation The major part of public investment in information technology in health care would go to institutional capacity building for understanding and use of information. Incurring large expenditures on hardware and software without making a matching input in capacity development and institutionalization can be an error. Every state should have the skilled human resources needed at state and district level. This would require a mix of those with IT skills and public health informatics skills. State centres for health information, either standalone, or embedded in existing institutions would be essential and district teams of three to five persons for managing information flows and interpreting information would also be essential. 29
  30. 30. Lessons learned •The future of Healthcare innovation requires accessing and managing distributed networks of knowledge providers. •Health/Biomedical research infrastructures need to be accessible, high quality and sustainably financed. •The intellectual property landscape should evolve to better leverage strategic intangible assets. •New research and business models are needed to meet economic and public health objectives. •Intellectual Asset Valuation could facilitate trade in the under –exploited knowledge assets of the Healthcare/Biomedical sector. •Regulatory evolution, in consultation with industry, is critical to ensure the development and diffusion of breakthrough biomedical technologies and the innovative use of existing technologies. •End users of new biomedical technologies have an increasingly strong impact on innovators and public policy. 30
  31. 31. Challenges Development Delivery Uptake 31 There remain a number of outstanding questions with reference to the development, delivery, and uptake of health innovations where further research might be pursued in order to help inform policymaking. The thematic areas for possible future work include: 1. Progress in governance and the regulatory system. 2. Open innovation models in health. 3. Commercialisation of innovation derived from research and health infrastructures. 4. Financing models for health innovation. 5. Intellectual asset management. 6. Patient needs and demands. 7. Metrics and indicators of health innovation. 8. Policy challenges of disruptive technologies.