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Public health entrepreneurship

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Public health entrepreneurship

  1. 1. PUBLIC HEALTH ENTREPRENEURSHIP Prepared By Nabaraj Paudel Masters of Public Health, Pokhara University 1
  2. 2. SCOPE AND STATUS OF PUBLIC HEALTH ENTREPRENEURSHIP AT NATIONAL AND GLOBAL CONTEXT Presented By Nabaraj Paudel Masters of Public Health Service Management Pokhara University 2
  3. 3. COURSE CONTENT Entrepreneurship in public health  Definition of Public Health Entrepreneurship  Public health entrepreneurial scope 3
  5. 5. AN EXAMPLE OF VALUE ADDING Apple in Mustang has very low value Wine made by the apple in Mustang has high value Apple Cider in the current market has the highest value. 5 Note: It is a negative example
  6. 6. AS A PUBLIC HEALTH PROFESSIONAL, WHAT DO YOU WANT TO BE? 6 1. Employer 2. Employee The terminology difference between employee and employer is small but the role of each is huge different.
  7. 7. BACKGROUND  The ILO estimates that some 88 million young women and men throughout the world are unemployed.  The scenario is even worse in the least developed countries like Nepal.  According to the report of Nepal Rastra Bank, remittance contributes about 25% to the country’s GDP.  According to the report of Department of Immigration of TIA about 1500 Nepali youths migrate abroad daily to foreign job market. (Source: Volunteer Initiative Nepal, available from 7
  8. 8. ENTREPRENEUR  Entrepreneur is the ability to take the factors of production or service-land, labor and capital and use them to produce new goods or services.  The entrepreneur perceives opportunities that other business executive do not see or do not care about.  Entrepreneur sees a need and then brings together the manpower, materials, and capital required to meet that need. [1] 8
  9. 9. ENTREPRENEURSHIP  Entrepreneurship involves initiating changes in production. [1,2]  The entrepreneurs always search for change, respond to it , and exploit it as an opportunity.  Need to shift resources from approaches that have produced low value into areas of higher productivity and yield.  Entrepreneurs create value. [1,2] 9
  10. 10. PUBLIC HEALTH ENTREPRENEURS ARE:  Change agent of population health,  Pioneer of innovations that benefits the wellbeing of humanity,  Offers sustained improvement in the health of populations in the face of need  Need to shift resources from approaches that have produced low value into areas of higher productivity and yield.  Social entrepreneur [2] 10
  11. 11. PUBLIC HEALTH ENTREPRENEURSHIP The opportunistic creation and implementation of catalytic innovations intended to offer sustained improvement in the health of populations in the face of need; without being limited by the resources currently in hand; involving collaboration with and accountability to the constituency served and the outcomes created. [2] 11
  12. 12. PUBLIC HEALTH INNOVATION Scott Frank 2007, 12 Public health Value Low High Cost Low Entrepreneurship opportunity Target ideal High Entrepreneurship opportunity Non Sustainable project
  13. 13. PUBLIC HEALTH ENTREPRENEURSHIP Success is measured by:  Improved health outcome  Change in social environment  Sustainable programming 13
  14. 14. PUBLIC HEALTH IS INHERENTLY ANTI-ENTREPRENEURIAL 1. No profit motive 2.Governmental stuck in the box (Clinical vs PH) 3.Slow moving relative to corporate world 4. “Products” are harder to sell (cigarette and alcohol VS milk) 5. Lack of accountability (individual level) 6.Stifled by funding restraints -best practice paradox 14
  15. 15. PUBLIC HEALTH IS INHERENTLY ANTI-ENTREPRENEURIAL 7.Brain drain-under trained work force, both in numbers and specialties 8.Hard to target an audience when we have no specific target audience (healthy population) 9.We don’t really know how we’re doing 10.Our focus is need and not just needs that will pay. [2] 15
  16. 16. PUBLIC HEALTH OFFERS INHERENT OPPORTUNITIES FOR ENTREPRENEURSHIP 1. Play on people’s fears!!! 2. They may not know it, but everybody needs us, and the market is wide open. 3. We are selling some fabulous things : decreased expenses, increased happy times 4. Small bites = big change 5. Passion abounds 16
  17. 17. PUBLIC HEALTH OFFERS INHERENT OPPORTUNITIES FOR ENTREPRENEURSHIP 6. The market is more receptive. The time to innovate is now!! 7. Timing is good for public health and medicine to play nice again 8. The nature of public health is responsive. 9. There is an inherent need for innovation because we have failed with things in the past. So something has to change! 10.Evaluation tools for outcome(improved health) [2] 17
  18. 18. THE SCOPE OF PUBLIC HEALTH ENTREPRENEURSHIP A. Life insurance companies B. Large scale companies/factories C. Public health insurance / benefits schemes D. Health product production establishment E. Public health consultancy agencies F. Fitness centers [3] 18
  20. 20. A. LIFE INSURANCE COMPANIES  Life Insurance companies are offering attractive options for consumers who want to protect their dependents.  Life insurance can protect the ones you love and be the foundation of your financial plan.  Since thinking about your own mortality is not pleasant, some people try to avoid contemplating thoughts of their own demise.  Force saving 20
  21. 21. A. LIFE INSURANCE COMPANIES Nepal  Growing faster in Nepal  Direct significance in Health  Do not protect from financial risk of disease India  Do not protect from financial risk of disease  More popular in India especially the female child USA  Do not protect from financial risk of disease  More emphasis health services coverage 21
  22. 22. BENEFITS OF LIFE INSURANCE  Financial risk protection  Saving (force saving )  Wealth creation  Tax saving 22
  23. 23. DISADVANTAGES 23  Suicide and Homicide  Life insurance company won't pay death benefits if the policyholder commits suicide within a specific period of time (2 years) after their policy takes effect.
  24. 24. B. LARGE SCALE COMPANIES/FACTORIES Industries and entrepreneurship projects related to public health include  Design and development of healthy homes  Sustainable approaches to water, energy  Food production, healthy food stores  Health and recreational institutions  Behavior change institutes  Information and communication  Smoking/tobacco cessation reality TV programs [4] 24
  26. 26. B. LARGE SCALE COMPANIES/FACTORIES 26  Design and development of healthy homes  Sustainable approaches to water, energy and food production  Healthy food stores  Tobacco cessation projects  Health and recreational institutions  Behavior change institutes  Unplanned urbanization  Improper food storage and handling  Weak food inspection and regulation  Problem in effective implementation of UNFCTC Developed countries Developing countries
  27. 27. C. PUBLIC HEALTH INSURANCE / SOCIAL HEALTH INSURANCE  Social Health Insurance (SHI) is a prioritize government program based on comprehensive social contributory scheme with government subsidies for the poor. Objectives of Social health insurance  Ensure access to quality health  Protect from financial hardship and reduce out-of pocket payments. [5] 27
  28. 28. C. PUBLIC HEALTH INSURANCE / SOCIAL HEALTH INSURANCE  This program is expected to play an important role in achieving Sustainable Development Goals by 2030 by propelling the country towards Universal Health Coverage. [5] 28
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  32. 32. TOTAL NO OF ENROLLMENT (JAN 2017) 32
  33. 33. C. SOCIAL HEALTH INSURANCE IN NEPAL  Health insurance Vs disease insurance  Gradual change in the number of acceptors of SHI in Nepal.  Implemented in 25 districts 33
  34. 34. C. SOCIAL HEALTH INSURANCE IN GLOBAL CONTEXT Private insurance model  Predominately private insurance and funding  Predominately private providers  Medicare/Medicaid Ex: USA 34
  35. 35. C. SOCIAL HEALTH INSURANCE IN GLOBAL CONTEXT Beveridge model (Public)  Taxation is the source of funding  Universal scope to all citizens  Not related to income  Public providers and governmental ownership  Complete coverage with basic health benefits and free access to all citizens. Ex: UK, Norway, Denmark, Portugal 35
  36. 36. C. SOCIAL HEALTH INSURANCE IN GLOBAL CONTEXT Bismark model : Public Private Mixed  Related to income  Compulsory health insurance premiums paid by employ and employers  Selective scope Ex: Japan, Holland, Austria, Switzerland 36
  37. 37. D. HEALTH PRODUCT PRODUCTION ESTABLISHMENT Medical products  Nepal CRS Company is a key driver in the growth of Nepal’s private health sector and pioneer social marketing company in Nepal started its operation in 1978 with the launch of its first condom brand. [1]  It continues to distribute low-cost family planning (FP), maternal child health (MCH) and other health products through its innovative social marketing initiatives.  CRS contributes approximately 25% to the overall national FP achievements on reversible methods. (NDHS 2011). 37
  38. 38. D. HEALTH PRODUCT PRODUCTION ESTABLISHMENT Vaccines  Bill and Melinda Gates foundation supported in vaccination.  Goal of Bill and Melinda Gates foundation is to prevent more than 11 million deaths, 3.9 million disabilities, and 264 million illnesses by 2020 through high, equitable, and sustainable vaccine coverage and support for polio eradication. 38
  39. 39. D. HEALTH PRODUCT PRODUCTION ESTABLISHMENT Technology  Special attention should be given to GMP  MHM-Sanitary pads,  Diabetes: food manufacturing, BP checker, …  IPD: Vaccines,  Malnutrition: super floor, balanced diet restaurant 39
  40. 40. D. HEALTH PRODUCT PRODUCTION ESTABLISHMENT Technology  You tube series on public health  Online newspapers on Health (swastha Khabar Patrika)  Journals  Blogs 40
  41. 41. D. HEALTH PRODUCT PRODUCTION ESTABLISHMENT  Temp Traq offers a patch-like smart device, which monitors body temperature 24/7.  It continuously senses, records, and sends temperature data to mobile devices so caregivers can keep track without unnecessarily disturbing the child. 41
  42. 42. D. HEALTH PRODUCT PRODUCTION ESTABLISHMENT  QardioCore promises a discrete as well as easily usable heart monitor without patches and wires.  The FDA-approved, medical-grade wearable uses sensors to record clinically accurate continuous ECG, heart rate, heart rate variability, respiratory rate, skin temperature, and activity data. 42
  43. 43. E. PUBLIC HEALTH CONSULTANCY AGENCIES 1. Consultancies for health research  Tool development,  Intervention design,  Monitoring and Evaluation  Baseline and End line survey  Data analysis  Proposal development and technical assistance Eg. New ERA (NGO) 2. Establishment of health promotion centre. 43
  44. 44. E. PUBLIC HEALTH CONSULTANCY AGENCIES Health Consultancy for technical assistance (TA) on different areas  Nutrition, Meat inspection/food inspection  Reproductive health, Family planning,  Safe motherhood  Occupational health and safety  Environmental health management  Monitoring water quality  Monitoring drug quality  Quality of care 44
  45. 45. E. PUBLIC HEALTH CONSULTANCY AGENCIES Information centre  Public Health Information Centre (PHIC) Training institution  Technical assistance,  Formal training course/ informal training course 45
  46. 46. F. FITNESS CENTERS 46
  47. 47. F. FITNESS CENTERS  Fitness services is defined as “the overall intangible activities based on physical activities that create value for individuals by offering them physical, psychological, social and economic benefits”. 47
  48. 48. F. FITNESS CENTERS  Limited motion lifestyle that today’s consumers face due to mechanization and automation, has led significant consumer interest in fitness center (FC) offerings as a way to compensate the lost physical activities. 48
  49. 49. F. FITNESS CENTERS  There have been continuous increases in the number of participants of the FCs in the US and Nepal where FCs has been rapidly proliferating around the globe.  Recent economic successes and increases in the national income of Turkish consumers along with the effective marketing efforts of sports and physical activity services might also be contributing to this trend. [6] 49
  50. 50. F. FITNESS CENTERS 50
  51. 51. F. FITNESS CENTERS 51
  52. 52. OTHERS Waste management  Diffetent Pvt. Ltd is managing health care waste and municipal solid waste. Water Supply  Promotion of filters/ water purifiers Eg. Environmental and public health organization of Nepal (ENPHO)working in WASH sector and emphasis in water filtration. 52
  53. 53. OTHERS Health education materials production  Training manuals development  Message mapping  Designing and development hoarding board, poster, pamphlet, flip chart related to health Electronic health -Mobile apps (SMS, APPS) -Electronic health records (BMI) - Telemedicine 53
  54. 54. BENEFITS OF PUBLIC HEALTH ENTREPRENEURSHIP  Economic Growth  Productivity  New technologies, products and services  Marketplace change Improved health status and wellbeing 54
  55. 55. QUESTIONS FOR DISCUSSION  Why the status of Public Health Entrepreneurship is very low in Nepal?  What are the barriers of Public Health Entrepreneurship in Nepal? 55
  56. 56. SOCIAL MARKETING  It is a marketing strategy modeled after corporate marketing, used by health professionals to develop successful health messages.  Many different definitions of social marketing exist, but most have these common components:  The adoption of strategies used by commercial marketers.  A goal of promoting voluntary behavior change (not just improved knowledge or awareness).  An end goal of improving personal or societal welfare.  The use of pro-health messages. Eg. ORS, Iodized salt 56
  57. 57. SOCIAL ENTREPRENEURS: SOME EXAMPLES Social entrepreneurs work for society. Monetary benefits is not subject of priority. For examples:  Mahabir Pun, pioneer of wireless technologies to develop remote areas of the himalayas.  Anuradha Koirala, founder of Maiti Nepal, provides shelter to the sexually violated, trafficked and helpless women.  Sanduk Ruit provides eye surgery facility in low cost to thousands of poor cataract patients across the globe. 57
  58. 58. CONCLUSION  Entrepreneurship involves initiating changes in production and finally entrepreneurs create value  Success is measured by improved health outcome, change in social environment, and sustainable programming.  Debate on Public Health Entrepreneurship inherently anti entrepreneurial vs. offers opportunities for entrepreneurship.  Bring positive change to achieve improved health status 58
  59. 59. RECOMMENDATION  For beginners of public health entrepreneurship, it is recommended to review the Public Health Innovation matrix. 59
  60. 60. REFERENCES 1. Dahal A, A textbook of Health Management.Bhotahity Kathmandu:vidyarthi Pustak Bhandar;2012. 2. Scott Frank, Kristina Knight, Gayle Effron. Reinventing Behavior Change through Public Health Entrepreneurship. United states: Case Western Reserve University;2007. 3. Hanlon. Public Health Administration 60
  61. 61. REFERENCES 4. Hernanden D, Carrion D, Perotte A, Fullilove R. Public Health Entrepreneurship Training in the next Generation of Public Health Innovators. New York: Association of Schools and Program of Public Health; 2014 Dec. Vol (129). 5. Annual report FY 2073/74 (2016/17).Teku Kathmandu :Social Health Insurance Program. Social Health Security Development Committee: 2017 Oct.89p. 61
  62. 62. REFERENCES 6. Yildiz SM. An importance-performance analysis of fitness centre service quality: Empirical results from fitness centres in Turkey. African Journal of Business Management. 2011 Aug 18;5(16):7031. 7. Australia F. Let's get physical: The economic contribution of fitness centres in Australia. Economic Pt Limited[Online] https://secure. ausport. nomicContribu tionFitnessCentresAustralia. pdf [Accessed 28th October 2012]. 2009 Jul. 8. Nepal Demographic and Health Survey 2016 62
  63. 63. Thank You!! 63
  64. 64. Financial stupid are everywhere, Don’t be one of them. -Nabaraj Paudel 64