2. mHealth and E
H lth d Emerging Markets:
i M k t
Challenges and Possibilities
A Bangladesh Story
Kazi Islam
February 2011
3. Agenda
Bangladesh At a glance
Health in Bangladesh
g
mHealth Focus Areas
mHealth Services
mHealth Opportunities
Oppo t nities
4. Bangladesh | Demographics
Population Mobile Connections Small Enterprise
156M 66M 15000
Age group Mobile Internet
63% under 25
d 4M Medium Enterprise
IT Professional Fixed Broadband 10000
32000 2M
University Dial Up Internet Large Enterprise
1M 2000
82
5. Bangladesh | At a glance
Total Population: 156Mn Most women don’t Access to Information
have access to
information about
health and family
75Mn,
81Mn, planning from the
48%
52%
mass media
Male Female
Women’s lack of
access to Mass
Female 52%
F l
Media
Male 48%
Percentage of married
Physician 0.03% women are 15-49 who
Nurses
N 0.014%
0 014% have no regular access
to mass media
Total Male 75 Mn
Total Female 81 Mn
Fertility Rate (live births/woman): 2.65/ woman
Age 15 – 60 96 Mn Death Rate : 0.58%
Age 0 – 14 54 Mn Birth Rate : 2.34 %
Age 60+: 6 Mn
6. Bangladesh
Women Health at a Glance
Life Expectancy is 63 years of Age
p y y g
390 of every 1000 women die from birth
related complications
85% of births occur at home
- 24% get help from skill attendants
- 12% get help from doctors
th l f d t
Only 48% get antenatal care
Only 16% get postnatal care
Source WHO, CIA Factbook, UNICEF, ICCDRB
7. Bangladesh
Women Health at a Glance
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
of reproductive age is less than 18.5
f d ti i l th 18 5
Source WHO, CIA Factbook, UNICEF, ICCDRB
8. Bangladesh
Children 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 born
The remaining 60% die due to
malnutrition and from other
communicable diseases
Source WHO, CIA Factbook, UNICEF, ICCDRB
9. mHealth Stakeholders in Bangladesh
Patients /
Families
Health
Telco Workers
Govt Doctors
mHealth
Service
Labs
L b
Providers
Donors/ Healthcare
NGOs Institutes
Source DGHS 2010
10. Bangladesh Service Availability
Services per thousand population
400
357
350
Total Population 156 Mn
300
250
Total No of Hospitals 2903
Total No of beds 81,578
200
150
100 Total No of Physicians 51,993
Total No of Nurses 25,018
50 Total No of Midwives 23,472
0.20 0.53 0.33 0.16 0.15
0
Source DGHS 2010
11. mHealth Focus Areas
Education & Awareness
Remote Data Collection
Communication & Training
Disease & Outbreak Tracking
Diagnostic & Treatment Support
Remote Monitoring
12. mHealth Focus Area 1
Education & Awareness
Ghana India
East Africa
South Africa
Teach communities about nutrition, diseases & prevention
- Freedom HIV/AIDS Project, India
Primarily one-way communications to citizens via SMS to - Learning about Living, Nigeria
g g, g
provide critical information on public health issues and
id i i l i f i bli h l h i d - HIV/AIDS Video Distribution by Mobile Phone, Georgia
behavior change campaigns. Examples of programs using
- HIV Confidant, South Africa
SMS alerts are currently being used to promote maternal
- Project Masiluleke, South Africa
health and encourage HIV/AIDS testing.
- Text to Change (TTC) – HIV Prevention through SMS Quiz, Uganda
13. mHealth Focus Area 2
Remote Data Collection
India
Philippines
Peru East Africa
Brazil
South Africa
Assess community needs, plan treatment & services, determine impacts
- Cell-PREVEN, Peru
Remote Data Collection plays a critical role in bridging the
information gap regarding patient data by enabling the collection of - Community Health Information Tracking System (CHITS), Philippines
disease information and its analysis at the local, national, regional - EpiSurveyor, Kenya, Uganda, Zambia
i d bi
and global level. This allows public officials to gauge the - Integrated Healthcare Information Service through Mobile Telephony
effectiveness of Healthcare programs, identify and rapidly respond (IHISM), Botswana
to infectious disease outbreaks and adjust programs and policies - Mobile-Based Primary Healthcare Management System, India
accordingly.
- PDAs for Malaria Monitoring, Mozambique
g, q
14. mHealth Focus Area 3
Communication & Training
UK
Pakistan
The Caribbean
Guatemala
G t l Uganda
Learn & develop through Health programs for remotely based medical
staff
- Enhancing Nurses Access for Care Quality and Knowledge through
Connecting health workers with sources of information via Technology (ENACQKT), the Caribbean
mobile technology is a strong basis for empowerment, as it - HealthLine, Pakistan
provides the support they need to perform their functions - Mobile HIV/AIDS Support, Uganda
effectively and self-sufficiently. - Primary Healthcare Nursing Promotion Program, Guatemala
- Uganda Health Information Network (UHIN), Uganda
15. mHealth Focus Area 4
Disease & Outbreak Tracking
India
Vietnam
Peru
Tracking to quickly capture & report outbreaks and assist with control
- Acute Encephalitis Syndrome Surveillance Information System
(AESSIMS), India
Deployment of mobile devices, with their ability to
p y , y - Alerta DISAMAR Peru
DISAMAR,
quickly capture and transmit data on disease incidence, - FrontlineSMS, Worldwide
can be decisive in the prevention and containment of - Handhelds for Health, India
outbreaks. - Remote Interaction, Consultation, and Epidemiology (RICE), Vietnam
-Tamil Nadu Health Watch, India
16. mHealth Focus Area 5
Diagnostic & Treatment Support
India
Vietnam
Philippines
pp
Mozambique
Indonesia
South Africa
Argentina
A ti
Access to trained medical staff & allows for remote information exchange
- Digital Inclusion Kit in Health and Higher Education, Argentina
- M-DOK: Mobile Telehealth and Information Resource System for Community Health
Workers, Philippines
With mHealth-enabled diagnostics and treatment support,
g pp ,
- Mobile Telemedicine System, Indonesia
patients are able to receive treatment in their villages and - Teledoc - Jiva Healthcare Project, Nacer, Ericsson & Apollo, India
homes, averting the need for expensive hospital visits, - Remote Interaction, Consultation, and Epidemiology (RICE), Vietnam
which are beyond reach for many.. - HIV Mobile Decision Support, South Africa
- Cell Phone Applications for Clinical Diagnostic Therapeutic and Public Health Use by
Front Line Healthcare Workers, Mozambique
17. mHealth Focus Area 6
Remote Monitoring
UK
China
Trinidad &
Tobago
Peru
Brazil
South Africa
Monitor health conditions through scheduling or medication adherence
- Chinese Aged Diabetic Assistant (CADA), China
Monitor health conditions, maintain caregiver - Colecta-PALM, Peru
appointments, or ensure medication regimen adherence.
i t t di ti i dh - MediNet Healthcare Management System, Trinidad and Tobago
Some applications may also include inpatient and out-
- Mobile Phones for Health Monitoring, India and the United Kingdom
patient monitoring sensors for the monitoring of multiple
- Phoned Pill Reminders for TB Treatment, Thailand
conditions (such as diabetes, vital signs or cardiac).
- Virtual Health Pet, Brazil
18. Current mHealth Initiatives in Bangladesh
• Remote Monitoring:
Clinics are able to follow up on patients not
keeping referrals or appointments by matching
paper receipts with an electronic receipt sent to
the clinic via a mobile phone.
• Remote Data Collection:
Equipping Child Healthcare Workers with mobile
phones to gather patient information which allows
for prioritized visits and assessment of p
p patients at
risk.
• Diagnostic & Treatment Support:
Telemedicine with physicians available on the
phone 24/7 with connections to 250 diagnostic
centers, 800 hospitals and over 8000 doctors.
19. Potential Services through mHealth
• Registration • Education
Education, • Registration • Registration • Education &
Patients
s
Health Workers
s
Doctors
s
titutions
s
ernment
t
• Appointment Training & • Patient • Patients Awareness
• Admission Re-Training Appointment Appointment • Notification
• Reports • Telemedicine • Notification • Doctors • Remote Data
• Search for
Sea c o W • Teleconferen for Schedule collection
P
Gove
ce medication
di i
Inst
hospitals, • Notification • Remote
doctors, • Share etc for Monitoring
medicines knowledge • Patients medication, • Training
etc • Remote Data Records campaign • Disease &
• Telemedicine Collection • Share etc Epidemic
• Notification • Remote knowledge • Teleconferen Outbreak
for Pill, etc.. monitoring • Remote ce Tracking
• Buy/Pay monitoring • Share • Search for
service thru • Remote data knowledge hospitals,
mobile collection • Remote doctors,
• Education monitoring medicines
and • Remote data etc
Awareness collection
on Basic • Search for
Health hospitals,
hospitals
doctors,
medicines
etc
