JUDITH K. BOND

M-HEALTH

EMPOWERING WOMEN WITH
AIDS
I N K E N YA

©6/25/2013

1
HIV/AIDS STATISTICS
K E N YA A N D A F R I C A

Judith K. Bond

2
HIV/AIDS- GIRLS AND WOMEN
GLOBAL RATE OF INFECTION= 40 M people worldwide live with aids –

GLOBAL MORBIDITY RATE: 69% of ...
AIDS ECONOMIC IMPACT, KENYA

6/28/2013

4
RELATIONSHIP BETWEEN FEMALE SEX WORKERS
AND HIV/AIDS IN AFRICA

5
CURRENT GLOBAL HIV/AIDS STRATEGY IN AFRICA
WHO – MDG- TARGET GOALS TO BE ACHIEVED BY 2015.
Goal 6. Combat HIV/AIDS
6a. Hav...
UNIQUE SELF-MANAGEMENT AND CHRONIC CARE
CHALLENGES FOR HIV/AIDS
US MODEL PROPOSED BY HEALTH RESOURCES AND SERVICES
ADMINIS...
AFRICA OFFERS HIGHEST ROI OF ANY
EMERGING MARKET- U. N. DATA
316 MILLION NEW TELECOM SUBSCRIBERS ADDED SINCE 2000
2008 Afr...
SOCIO-CULTURAL ENVIRONMENT
Population = 39,002,772
Size = 582646 K (approximately the size of Texas)
Language: English and...
ECONOMIC FREEDOM CHALLENGES

6/28/2013

10
ECONOMIC OPPORTUNITY THROUGH
MOBILE PAY TECHNOLOGY

M-Pesa mobile based money-transfer
Powered by Safaricom- leading Kenya...
MOBILE PHONE USE, KENYA

12
MOBIL PHONE MARKET IN KENYA
FINANCIAL GROWTH OPPORTUNTIES: MOBIL PHONE MARKET

¾ of the current 5.3 b mobile phones global...
ENVIRONMENTAL CONSIDERATIONS
KENYAN POLITICAL ENVIRONMENT
Newly elected President and deputy in 2013.President= Uhuru Keny...
CONTEXTUAL HEALTHCARE SYSTEMS
HEALTHCARE = COMPLEX ADAPTIVE OPEN SYSTEM

Comprised of people and activities that mutually ...
HEALTHCARE ACCESS CHALLENGES, KENYA
Health Worker Shortage –(2006) nurses 26,267- Doctors 3,855
Migration of doctors= 51 %...
M-HEALTH IN KENYA
CHALLENGES- MOBIL MARKET

Profit margins on phones may be lower than in US. Phones priced at $100-150 us...
PRIOR M-HEALTH TRIALS IN KENYA
SCALE CHALLENGES:
World Bank reports 500 m-health studies ,yet no knowledge of likely uptak...
INTERNATIONAL

DOMESTIC

MULTI-INDUSTRY

POTENTIAL SOLUTIONS
KENYA – M-HEALTH
I N T E R N AT I O N A L , M U LT I - I N D ...
CURRENT U.S. BASED M-HEALTH TECHNOLOGY
FDA APPROVED MOBIL APPS
BIOMEDICAL MONITORING DEVICES
BIOMEDICAL CARE DELIVERY DEVI...
POTENTIAL SUPPORT SERVICES
EDUCATION

SOCIAL SUPPORT

•
•
•
•

•
•
•
•

Health literacy
Self-management
Nutrition
Hygiene
...
BUSINESS MODEL

E-COMMERCE
M-HEALTH
LEAN STARTUP
VISION:
INCREASE CAPACITY FOR AUTONOMOUS, INDIGENOUS PROBLEM
SOLVING TO P...
CUSTOMER VALUE PROPOSITION
ACCESS TO CARE
SELF MANAGEMENT OPPORTUNITY

CONFIDENTIALITY
JOB CREATION – U.S. AND AFRICA
INCR...
SERVICE/PRODUCT DEVELOPMENT CYCLE

RESEARCH

ADJUST, MODIFY,
IMPROVE

SERVICE
HYPOTHESIS

MINIMUM
VIABLE
SERVICE

DATA
COL...
BUSINESS PROCESSES
AND CHANNELS
ARKETING:
INTERNET, WEB BASED VIA WEB SITE, SOCIAL MEDIA, ITUNES

ISTRIBUTION:
INTERNET, T...
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Empowering women with aids kenya revised

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A proposed e-commerce m-health business model to empower women with aids in Kenya

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Empowering women with aids kenya revised

  1. 1. JUDITH K. BOND M-HEALTH EMPOWERING WOMEN WITH AIDS I N K E N YA ©6/25/2013 1
  2. 2. HIV/AIDS STATISTICS K E N YA A N D A F R I C A Judith K. Bond 2
  3. 3. HIV/AIDS- GIRLS AND WOMEN GLOBAL RATE OF INFECTION= 40 M people worldwide live with aids – GLOBAL MORBIDITY RATE: 69% of GLOBAL deaths from aids occur in Africa GLOBAL GENDER RATE=more than 50% are women. In sub-Saharan Africa 57% of adults with HIV are women and women age 15-24 are more than 3 times as likely to be infected. Reasons – cultural/social = women have low social status, trade sex for survival, low financial autonomy, depend on partners for support, intimate partner violence. ART therapy makes AIDS both a chronic and an infectious disease – despite morbidity rate decrease , a growing population of active chronic infections creates potential to increase overall mortality rate, and adversely affect economies, well being, and health AIDS poses risks to health workers 2.5% of new infections are to health workers infected by blood exposure needle pricks and exposure. Most workers are female. African women likely to be caregivers for sick and dying as well as themselves ©6/28/2013 3
  4. 4. AIDS ECONOMIC IMPACT, KENYA 6/28/2013 4
  5. 5. RELATIONSHIP BETWEEN FEMALE SEX WORKERS AND HIV/AIDS IN AFRICA 5
  6. 6. CURRENT GLOBAL HIV/AIDS STRATEGY IN AFRICA WHO – MDG- TARGET GOALS TO BE ACHIEVED BY 2015. Goal 6. Combat HIV/AIDS 6a. Have Halted by 2015 and begun to reverse the spread of HIV/AIDS 6b. Achieve by 2010 universal access to treatment for HIV/AIDS for all those who need it. Progress 2011- reduction in % of newly infected- but increase of 2.5M Treatment = In 2011 more than 8 M people living with HIV receiving antiretroviral therapy (ART) in low and middle income countries. Another 7 M need 2 be enrolled in treatment to meet the target MDG of providing ART to 15 M people by 2015. Treatment suppresses symptoms – does not cure or prevent contagion of others Non-adherence to antiretroviral therapy – side effects, adverse events including death Testing = test reveals the presence or absence of antibodies to HIV in the blood. HIV may not b detectable for 3-6 weeks after contacting the virus. Is infectious immediately. Global burden of Disease www.who.int WHO Millennium Development goals (MDGs) Fact Sheet www.who.int 6
  7. 7. UNIQUE SELF-MANAGEMENT AND CHRONIC CARE CHALLENGES FOR HIV/AIDS US MODEL PROPOSED BY HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA) HIV/AIDS BUREAU 2006 ACKNOWLEDGES UNIQUE CHALLENGES* A. LOW ADHERENCE TO ART TREATMENT DUE TO RIGIDITY OF MEDICATION, DIET, RESTRICTIONS, AND SEVERITY OF SIDE EFFECTS B. DAILY SELF-MONITORING TESTS NOT AVAILABLE C. STIGMA AND GUILT AND SENSE OF RESPONSIBILITY FOR ACQUIRING THE DISEASE SELF MANAGEMENT MAY INCLUDE EMPLOYING MEASURES TO PREVENT INFECTION IN OTHERS SOCIO-CULTURAL PERCEPTIONS OF SELF-MANAGEMENT *Providing HIV/AIDS Care in a changing environment. (2006)HRSA http://hab.hrsa.gov/publications/march2006/ 7
  8. 8. AFRICA OFFERS HIGHEST ROI OF ANY EMERGING MARKET- U. N. DATA 316 MILLION NEW TELECOM SUBSCRIBERS ADDED SINCE 2000 2008 Africans spent $860b on goods and services-35% more than Indians KENYA M-HEALTH CURRENT MARKET ASSESSMENT A F R I C A C O N S I D E R E D O N E O F T H E M O S T R A P I D LY E X PA N D I N G G L O B A L E C O N O M I E S * *Chironga, Leke, Lund, & Wamelen(2013). Cracking the next growth market: Africa. Harvard Business review www.hbr.org ©6/28/2013 8
  9. 9. SOCIO-CULTURAL ENVIRONMENT Population = 39,002,772 Size = 582646 K (approximately the size of Texas) Language: English and Swahili Religion: Christian majority; Muslim (Sunni) minority; Animism Currency – Kenyan Shilling (KSH) 1$=70KSH Capital: Nairobi, Population 3-4 M, Main airport 7 major ethnic groups (tribes) -can be placed above the nation Transportation = 8,933km paved roads, 54,332km unpaved, 2,778km railways CHALLENGES: URBAN/RURAL, TRIBAL, RELIGIOUS DIFFERENCES Communicaid Group 2010 Doing Business in Kenya 9
  10. 10. ECONOMIC FREEDOM CHALLENGES 6/28/2013 10
  11. 11. ECONOMIC OPPORTUNITY THROUGH MOBILE PAY TECHNOLOGY M-Pesa mobile based money-transfer Powered by Safaricom- leading Kenyan Operator 2/3 of Kenya’s financial transactions by phone- $8.6b in first half of 2013 10/27/2013 11
  12. 12. MOBILE PHONE USE, KENYA 12
  13. 13. MOBIL PHONE MARKET IN KENYA FINANCIAL GROWTH OPPORTUNTIES: MOBIL PHONE MARKET ¾ of the current 5.3 b mobile phones globally are in the developing world Kenya-6 M internet users in the country - 4 M access thru mobile phones Kenya’s telecom market expected to generate $2.2B in 2017 up from $1.7B in 2012 Currently 4 Local telecom operators- U.S. firms preparing for entry Mobile voice - primary operator with 63% of market share. Prepaid phones = Currently 99 % Revenue= $1.1 B Yolo – new device from Safaricom- smartphone $125 . More affordable. New phone models- local and U.S. developed- with multi-functional features ©6/25/2013 13
  14. 14. ENVIRONMENTAL CONSIDERATIONS KENYAN POLITICAL ENVIRONMENT Newly elected President and deputy in 2013.President= Uhuru Kenyatta son of Kenya’s first President Deputy = William Ruto. Both men charged under the International Criminal Court with creating violence in 2007 elections. Creates instability and challenges . Global Business Environment Constant change -disruptive technology- no longer can employ statistics to predict outcomes . Read: Outliers, Black Swan. Businesses must be agile, resilient, flexible adaptable to new technology and environmental, economic, political and socio/cultural forces. Muti-national trends Emerging markets are becoming lead markets as well as talent pools Kumar, N and Puranam, P. (2013) Have you restructured for global success? Harvard Business Review Summer2013 www.hbr.org originally published in Oct 2011 ©6/25/2013 14
  15. 15. CONTEXTUAL HEALTHCARE SYSTEMS HEALTHCARE = COMPLEX ADAPTIVE OPEN SYSTEM Comprised of people and activities that mutually influence one another in complex ways with often unpredictable outcomes. The system evolves as it interacts over time. World Bank report 2012 sees m-health ecosystems as complex with multiple interests of government, health care systems, technology, and finance. Kenyan fragmentation and system complexity exacerbated by multiple multi-national players with private interests, including NGO’s, donors, and Kenyan government operating in silos. No universal healthcare delivery or funding system, minimal interaction of players M-Health business models developed in isolation aimed at solving specific problems in narrow areas of the health system. Lack of coordination between donors, NGO’s multi-national companies and government lacks system wide solution development. 15
  16. 16. HEALTHCARE ACCESS CHALLENGES, KENYA Health Worker Shortage –(2006) nurses 26,267- Doctors 3,855 Migration of doctors= 51 % 1.5 million needed in Africa Hospital bed Shortage= Beds per 1000 (2006) 1.4 . Four major hospitals all located in Nairobi with rural limited access clinics— HIV/AIDS clinics primarily NGO funded and operated Socio-Cultural Stigma=individuals known to have aids shunned, socially isolated, fearful of being tested, low literacy rates Under financed system=Out of pocket % of health expenditure (2007) 44% Poverty -40% unemployment Health inequities = Contraceptive use =by wealth, 17% lowest quintile to 48% upper quintile. Education = 12% lowest quintile to 52% upper quintile Births by skilled health professional – educational level =19% lowest 72% highest- wealth = 20% lowest and 81% highest. World Health Statistics 2013 www.who.int. © 6/25/2013 16
  17. 17. M-HEALTH IN KENYA CHALLENGES- MOBIL MARKET Profit margins on phones may be lower than in US. Phones priced at $100-150 usd have a 6-8% profit margin in Kenya compared to 30% gross margins from Apple Pricing: of phones in Kenya has been above the average consumer= sh30,000 (Kenyan Sheckels, though new lower priced models are now being introduced to consumers. GLOBAL BARRIERS TO ENTRY The WHO forum on data standards for e-health identified the following barriers : panoply of proliferating standards, some that include high barriers in some areas; technical complexity of systems and standards and language. Fragmentation of systems that cannot talk to one another. Governing regs e.g. HL7- rules that govern how healthcare systems exchange info and SNOMED CT coded taxonomy used to define diseases- Neither of these r available 4 use. ©6/25/2013 17
  18. 18. PRIOR M-HEALTH TRIALS IN KENYA SCALE CHALLENGES: World Bank reports 500 m-health studies ,yet no knowledge of likely uptake or best practices for engagement, efficacy or effectiveness. Lacks a foundation of evidence. In Uganda 23 of 36 initiatives did not move beyond the pilot stage. SCOPE CHALLENGES Most current trials employ text messaging reminders to improve attendance at appointments. Trials were NOT done in resource limited settings . Evidence indicates text message alone not effective. Must employ theories of behavior change. Messages must be personally tailored and content relevant. Scaling up mHealth: Where is the evidence? Plos Medicine Feb 2013 Vol10(2) www.plosmedicine.org--more barriers/obstacles SUSTAINABILITY CHALLENGES: REPLICABILITY Need good outcome measures and data. Data should include qualitative as well as quantitative data and theoretical bases & understand why, what and under what conditions it works. Evidence should be broad not just controlled studies. PLOS Medicine www.plosmedicine.org Feb 2013 vol 10(2) A reality checkpoint for mobile health: three challenges to overcome ©6/25/2013 18
  19. 19. INTERNATIONAL DOMESTIC MULTI-INDUSTRY POTENTIAL SOLUTIONS KENYA – M-HEALTH I N T E R N AT I O N A L , M U LT I - I N D U S T RY / S E C T O R C O L L A B O R AT I O N S , PA RT N E R S H I P S A N D C O A L I T I O N S 6/27/2013 19
  20. 20. CURRENT U.S. BASED M-HEALTH TECHNOLOGY FDA APPROVED MOBIL APPS BIOMEDICAL MONITORING DEVICES BIOMEDICAL CARE DELIVERY DEVICES DIAGNOSTIC AND TESTING HEALTH COACHING REMOTE PRIMARY CARE CHALLENGE: INTEROPERABILITY PRIVACY AND SECURITY PROTOCOLS OPEN STANDARDS- DEVELOPED USING A CONSENSUS PROCESS ©6/27/2013 20
  21. 21. POTENTIAL SUPPORT SERVICES EDUCATION SOCIAL SUPPORT • • • • • • • • Health literacy Self-management Nutrition Hygiene PATIENT ADVOCATES     CHAT ROOMS WEB SITES SOCIAL NETWORKING PATIENT/CAREGIVER TRAINING RESOURCES INFORMATION CARE COORDINATION PERSONALIZE EXPERIENCE     ©6/27/2013 TECHNOLOGY CARE GIVER HEALTH WORKER AGRICULTURE 21
  22. 22. BUSINESS MODEL E-COMMERCE M-HEALTH LEAN STARTUP VISION: INCREASE CAPACITY FOR AUTONOMOUS, INDIGENOUS PROBLEM SOLVING TO PROMOTE SOCIAL CHANGE, HEALTH, AND WELL BEING ©6/28/2013 22
  23. 23. CUSTOMER VALUE PROPOSITION ACCESS TO CARE SELF MANAGEMENT OPPORTUNITY CONFIDENTIALITY JOB CREATION – U.S. AND AFRICA INCREASE AWARENESS, REDUCE STIGMA REDUCE NEED FOR HEALTH WORKER TRAVEL AND EXPOSURE AUTONOMOUS, CULTURALLY SPECIFIC, INDIVIDUALIZED SOLUTIONS NOT IMPOSED BY OUTSIDE NGO’S OR GOVERNMENTS OR BUSINESSES PERSONALIZED EXPERIENCE ENCOURAGE PREVENTION STRATEGY DEVELOPMENT ©6/28/2013 23
  24. 24. SERVICE/PRODUCT DEVELOPMENT CYCLE RESEARCH ADJUST, MODIFY, IMPROVE SERVICE HYPOTHESIS MINIMUM VIABLE SERVICE DATA COLLECTION & ANALYSIS ©6/28/2013 24
  25. 25. BUSINESS PROCESSES AND CHANNELS ARKETING: INTERNET, WEB BASED VIA WEB SITE, SOCIAL MEDIA, ITUNES ISTRIBUTION: INTERNET, TRAINED LOCALS, PARTNERS (PRIVATE, NGO,GOV) ONEY: M-PESA MOBILE MONEY PLATFORM, PAY PAL, WEB SITE SHOPPING CART ©6/28/2013 25

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