H lth d E i M k tmHealth and Emerging Markets:Challenges and Possibilities

A Bangladesh Story

Kazi IslamFebruary 2011

Agenda

Bangladesh At a glance

Health in Bangladeshg

mHealth Focus AreasmHealth Focus Areas

mHealth ServicesmHealth Services

mHealth Oppo t nitiesmHealth Opportunities

Bangladesh | Demographics

PopulationPopulation Mobile ConnectionsMobile Connections Small Enterprise156M

Age group63% d 25

156MAge group

63% d 25

66MMobile Internet

4M

66MMobile Internet

4M

15000

Medium Enterprise63% under 25IT Professional

32000

63% under 25IT Professional

32000

4MFixed Broadband

2M

4MFixed Broadband

2M

Medium Enterprise10000

University82

University82

Dial Up Internet 1M

Dial Up Internet 1M

Large Enterprise 2000

Bangladesh | At a glance

Total Population: 156Mn Access to InformationMost women don’t have access to

information about

75Mn, 48%

81Mn, 52%

information about health and family planning from the

mass media

Male Female

F l 52%

Women’s lack of access to Mass

Female 52%Male 48%

Physician 0.03%N 0 014%

MediaPercentage of married women are 15-49 who have no regular access

Total Male 75 MnTotal Female 81 Mn

Nurses 0.014% have no regular access to mass media

Total Female 81 Mn

Age 15 – 60 96 Mn Age 0 – 14 54 MnAge 60+: 6 Mn

Fertility Rate (live births/woman): 2.65/ womanDeath Rate : 0.58%Birth Rate : 2.34 %

Age 60+: 6 Mn

BangladeshWomen Health at a GlanceWomen Health at a Glance

Life Expectancy is 63 years of Agep y y g

390 of every 1000 women die from birth 390 of every 1000 women die from birth related complications

85% of births occur at home- 24% get help from skill attendants

12% t h l f d t- 12% get help from doctors

Only 48% get antenatal careOnly 16% get postnatal care

Source WHO, CIA Factbook, UNICEF, ICCDRB

BangladeshWomen Health at a GlanceWomen Health at a Glance

58% of deaths in females aged 15 to 17 is 58% of deaths in females aged 15 to 17 is from suicide (due to mental health)

75% of women aged 15 to 24 have never heard of STI

Body Mass Index (BMI) of 52% females f d ti i l th 18 5of reproductive age is less than 18.5

Source WHO, CIA Factbook, UNICEF, ICCDRB

BangladeshChildren Health at a GlanceChildren Health at a Glance

Annual Birth Rate 2.34 %

Infant Mortality Rate 5.25%

46% of children below 5 are underweight

40% of deaths for under 5’s occur in the first month of being bornin the first month of being born

The remaining 60% die due to The remaining 60% die due to malnutrition and from other

communicable diseases

Source WHO, CIA Factbook, UNICEF, ICCDRB

mHealth Stakeholders in Bangladesh

Patients / Families

Health WorkersTelco

mHealthDoctorsGovt

L bService Labs

HealthcareDonors/

Service Providers

Healthcare InstitutesNGOs

Source DGHS 2010

Bangladesh Service Availability

400

357

Services per thousand population

300

350Total Population 156 Mn

200

250Total No of Hospitals 2903Total No of beds 81,578

100

150

Total No of Physicians 51,993

0

50

0.20 0.53 0.33 0.16 0.15

Total No of Physicians 51,993Total No of Nurses 25,018Total No of Midwives 23,472

0

Source DGHS 2010

mHealth Focus Areas

Education & Awareness

Remote Data Collection

Communication & Training

Disease & Outbreak Tracking

Diagnostic & Treatment Support

Remote Monitoring

mHealth Focus Area 1Education & AwarenessEducation & Awareness

IndiaGhana

South Africa

East Africa

Teach communities about nutrition, diseases & prevention

Primarily one-way communications to citizens via SMS to id i i l i f i bli h l h i d

- Freedom HIV/AIDS Project, India- Learning about Living, Nigeria

provide critical information on public health issues and behavior change campaigns. Examples of programs using SMS alerts are currently being used to promote maternal

health and encourage HIV/AIDS testing.

g g, g- HIV/AIDS Video Distribution by Mobile Phone, Georgia- HIV Confidant, South Africa- Project Masiluleke, South Africa- Text to Change (TTC) – HIV Prevention through SMS Quiz, Uganda

mHealth Focus Area 2Remote Data CollectionRemote Data Collection

Philippines

India

Peru East Africa

South AfricaBrazil

Assess community needs, plan treatment & services, determine impacts

Remote Data Collection plays a critical role in bridging the information gap regarding patient data by enabling the collection of

- Cell-PREVEN, Peru- Community Health Information Tracking System (CHITS), Philippines

i d bidisease information and its analysis at the local, national, regional and global level. This allows public officials to gauge the

effectiveness of Healthcare programs, identify and rapidly respond to infectious disease outbreaks and adjust programs and policies

accordingly.

- EpiSurveyor, Kenya, Uganda, Zambia- Integrated Healthcare Information Service through Mobile Telephony (IHISM), Botswana- Mobile-Based Primary Healthcare Management System, India- PDAs for Malaria Monitoring, Mozambiqueg, q

mHealth Focus Area 3Communication & Training

UK

Communication & Training

G t l

The Caribbean

Pakistan

Guatemala Uganda

Learn & develop through Health programs for remotely based medical Learn & develop through Health programs for remotely based medical staff

Connecting health workers with sources of information via- Enhancing Nurses Access for Care Quality and Knowledge through Technology (ENACQKT), the CaribbeanConnecting health workers with sources of information via

mobile technology is a strong basis for empowerment, as it provides the support they need to perform their functions

effectively and self-sufficiently.

- HealthLine, Pakistan- Mobile HIV/AIDS Support, Uganda- Primary Healthcare Nursing Promotion Program, Guatemala- Uganda Health Information Network (UHIN), Uganda

mHealth Focus Area 4Disease & Outbreak TrackingDisease & Outbreak Tracking

IndiaVietnam

Peru

Tracking to quickly capture & report outbreaks and assist with control

Deployment of mobile devices, with their ability to

- Acute Encephalitis Syndrome Surveillance Information System (AESSIMS), India- Alerta DISAMAR Perup y , y

quickly capture and transmit data on disease incidence, can be decisive in the prevention and containment of

outbreaks.

Alerta DISAMAR, Peru- FrontlineSMS, Worldwide- Handhelds for Health, India- Remote Interaction, Consultation, and Epidemiology (RICE), Vietnam-Tamil Nadu Health Watch, India

mHealth Focus Area 5Diagnostic & Treatment SupportDiagnostic & Treatment Support

IndiaVietnam

Philippines

A ti

ppIndonesia

South Africa

Mozambique

Argentina

Access to trained medical staff & allows for remote information exchange

With mHealth-enabled diagnostics and treatment support,

- Digital Inclusion Kit in Health and Higher Education, Argentina- M-DOK: Mobile Telehealth and Information Resource System for Community Health Workers, Philippinesg pp ,

patients are able to receive treatment in their villages and homes, averting the need for expensive hospital visits,

which are beyond reach for many..

- Mobile Telemedicine System, Indonesia- Teledoc - Jiva Healthcare Project, Nacer, Ericsson & Apollo, India- Remote Interaction, Consultation, and Epidemiology (RICE), Vietnam- HIV Mobile Decision Support, South Africa- Cell Phone Applications for Clinical Diagnostic Therapeutic and Public Health Use by Front Line Healthcare Workers, MozambiqueFront Line Healthcare Workers, Mozambique

mHealth Focus Area 6Remote Monitoring

UK

Remote Monitoring

Trinidad & Tobago

China

Peru

South AfricaBrazil

Monitor health conditions through scheduling or medication adherence

Monitor health conditions, maintain caregiver i t t di ti i dh

- Chinese Aged Diabetic Assistant (CADA), China- Colecta-PALM, Peru

appointments, or ensure medication regimen adherence. Some applications may also include inpatient and out-

patient monitoring sensors for the monitoring of multiple conditions (such as diabetes, vital signs or cardiac).

- MediNet Healthcare Management System, Trinidad and Tobago- Mobile Phones for Health Monitoring, India and the United Kingdom- Phoned Pill Reminders for TB Treatment, Thailand- Virtual Health Pet, Brazil

Current mHealth Initiatives in Bangladesh

•Remote Monitoring: Clinics are able to follow up on patients not keeping referrals or appointments by matching keeping referrals or appointments by matching paper receipts with an electronic receipt sent to the clinic via a mobile phone.

•Remote Data Collection:•Remote Data Collection:Equipping Child Healthcare Workers with mobile phones to gather patient information which allows for prioritized visits and assessment of patients at p prisk.

•Diagnostic & Treatment Support:

Telemedicine with physicians available on the phone 24/7 with connections to 250 diagnostic centers, 800 hospitals and over 8000 doctors.

Potential Services through mHealths Registration s Education s Registration s Registration t Education &

Pati

en

ts • Registration• Appointment• Admission• Reports• Search for W

ork

ers • Education,

Training & Re-Training

• Telemedicine• Teleconferen D

oct

ors • Registration

• Patient Appointment

• Notification for

di i titu

tio

ns • Registration

• Patients Appointment

• Doctors Schedule e

rnm

en

t • Education & Awareness

• Notification• Remote Data

collectionP Sea c ohospitals, doctors, medicines etc

• Telemedicine Healt

hW ce

• Share knowledge

• Remote Data Collection

medication etc

• Patients Records

• Share

Inst • Notification

for medication, campaign etc

Go

ve • Remote

Monitoring• Training• Disease &

Epidemic Telemedicine• Notification

for Pill, etc..• Buy/Pay

service thru mobile

• Remote monitoring

knowledge• Remote

monitoring• Remote data

collection

• Teleconference

• Share knowledge

• Remote

Epidemic Outbreak Tracking

• Search for hospitals, doctors, mobile

• Education and Awareness on Basic Health

collection Remote monitoring

• Remote data collection

• Search for hospitals

doctors, medicines etc

Health hospitals, doctors, medicines etc

ComeCome

See

Build

S lScale

Sustain

Think People, First!

Thank you!