Global Health’s Digital Future
How mobile telecommunications and health technology are tackling global health
The challenges of resource poor settings
To the untrained eye, all healthcare systems are created equal. We can’t help but imagine that everyone has access to a decent quality primary care doctor. The reality is, nothing could be farther from the truth. Resource poor settings are “resource poor”. And when it comes to health care systems, resources do matter, especially the human and financial kind. It’s estimated that over 400m people lack access to basic essential services. That number is much higher when we think about those that don’t have access to quality, affordable primary care; the foundation of any comprehensive health care system (save the US perhaps).
Access, Quality and Cost
The last two decades has seen a big increase in investments for global health focussed around specific verticals and diseases driven mainly by the Millennium Development Goals (infectious diseases, maternal and child health, HIV/AIDS). Whilst there is still more to do here, developing countries are starting to confront the double burden of disease, with ageing populations, and the spread of lifestyle related risk factors driving up rates of non-communicable diseases (NCDs). By 2030, over 70% of deaths in Low and Middle Income countries (LMIC) will be from chronic diseases. Countries, already struggling to provide basic services to growing populations, will not be able to treat themselves out of this problem.
Take Bangladesh, for example. A LMIC with a population of 160m+. It has one of the most pluralistic healthcare systems in South Asia with a big NGO and private sector. Government spending on healthcare stands at approximately 3% GDP. Despite this it has made significant improvements towards the MDGs and though infectious diseases still accounts for a large proportion of disease burden especially in more rural areas, prevalence of NCDs and risk factors is growing rapidly.
1. Resources for health are in short supply. Only 3.5 doctors / 10,000 people (less than 1:1,000 is defined as a ‘critical workforce’ shortage) – and 80% work in urban cities (like Dhaka) where only 20% of the population lives. This leads to issues of access.
2. The rise of NCDs is putting huge pressure on systems not designed for chronic disease prevention or management. Diabetes affects over 8% of the adult population and surveys show 25% of adults have hypertension. 50% of men smoke. Health practices are out of date or non-existent. There is little if any coordination of care. This is an issue of quality.
3. Healthcare is expensive with over 65% of medical expenses borne out of pocket, the vast majority spent on medications and diagnostic tests, not to mention the burden of indirect costs due to health-care events (such as lost wages & transportation associated with caring for family members). This is about cost, or more precisely financial protection.
Across this unholy trinity there are great opportunities for digital health to find new solutions to these entrenched problems, but none as transformational as the potential to harness technology to reinvent primary care for the 21st Century.
Technology Enabled patient centered model of primary care
Primary care has promised many things over the years but none so powerful as the idea of health for all first put forth in the Alma Ata Declaration of 1978. Since those days a lot has changed. This new healthcare environment that we find ourselves in calls for a new model of Primary Care. One designed to take advantage of the powerful enablers to build a better system, not adapt a broken model to the new world. The ubiquity of mobile, especially the rise of smartphones and the potential it creates for connected devices, sensors and the proliferation of cloud computing and AI for healthcare provide the components to build these new models.
A mobile first healthcare system.
Mobile telecommunications have always offered exciting opportunities for improving health and the coming decade is poised to be the defining moment. As 3G (and soon 4G) coverage expands & smartphone prices continue to fall, penetration is growing rapidly in developing countries. According to the Ericsson Mobility Report, June 2017, by 2022, mobile broadband coverage will extend to over 95% of the population and the number of mobile internet subscribers, today at 3.2 billion will grow by an additional 2.6 billion. The represents 1m new mobile internet connections per day. The AI powered, mobile first future of tomorrow is here. Today.
In its recent report on “Scaling Digital Health in Developing Markets”, the GSMA highlighted the potential for mobile telecommunications and digital technologies to drive expanding access to affordable quality healthcare in developing countries. Compared to the developed world, most developing countries are at the very early stages of digitisation (see image) creating huge opportunities for telecommunications companies, healthcare technology players and service providers to build the ecosystem.
Those working in this space will be wise to learn the lessons that have plagued the proliferation of healthcare technology around the world. By adopting standards, building open inter-operable systems and drawing on the best of user centered design (for patient and providers alike), digital health has the potential to address many entrenched problems and contribute positively to the health & wealth of nations. Even broader than that is the possibility of so called ‘reverse innovation’ as new models, built specifically to address the challenges in mobile first countries flow back into healthcare systems around the world.
This is global health’s digital future.
Copyright © 2017 Galen Growth Asia