Health Systems Leapfrogging in Emerging Economies

IPIHD private session, Washington DC

Presentation

7 April 2014

This project is supported by The Boston Consulting Group (BCG)

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IPIHD & World Economic Forum joint private sessionProject: Health Systems Leapfrogging in Emerging Economies

TimingTiming

15.00-15.10

15.10-15.40

15.40-15.50

15.50-16.00

AgendaAgenda

Welcome and introduction

Innovators' perspectives on enablers and barriers of leapfrogs

Q& A session

Closing remarks

SpeakersSpeakers

Dessislava Dimitrova, World Economic Forum

Shelly Batra, Operation AshaTing Shih, ClickMedixGunther Faber, One Family Health

Moderator: Martin Silverstein, The Boston Consulting Group

Open floor

Martin Silverstein, The Boston Consulting Group

Dessislava Dimitrova, World Economic Forum

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In year I, we developed a matrix to systematically categorize and explain leapfrogs

Ecosystem including agriculture, environment, infrastructure, urban planning

0

1

2

3

4

5

Prevention and Health promotion

Workforce

Information

Service delivery

Financing

Leadership/Governance

Medical products/technology

6

Technology

Innovation types

He

alt

h s

ys

tem

ca

teg

ori

es

or

bu

ild

ing

blo

ck

s

Operating model change

Behavior change

A B C

Health system

Note: These categories are based on the WHO's six building blocks of health systems, first introduced in WHO, "Strengthening Health Systems to Improve Health Outcomes: WHO's Framework for Action", 2007. The initial category names were slightly adapted in WHO, "Monitoring the Building Blocks of Health Systems: A Handbook of Indicators and their Measurement Strategies", 2010.

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Three examples today mapped onto our leapfrogging matrix

Enablers

Prevention & Health promotion

Workforce

Information

Service delivery

Financing

Leadership/Governance

Medical products/technology

Technology

0

1

2

3

4

5

6

Operating model change

Behavior changeB CACategories

One Family Health

Gunther Faber, Founder and Chief Executive Officer

3

1

2 ClickMedix

Ting Shih, President

Operation Asha

Shelly Batra, Founder and Chief Executive Officer

Source: IPIHD Innovator profiles, BCG analysis

Primary space of intervention:each innovator participates

Secondary space of intervention:some innovators participate

Unused slides

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Leapfrogging matrix: Definitions

Health system categoriesHealth system categories Innovation typesInnovation types

Service delivery: health interventions delivered and infrastructure established to diagnose, treat and care for patients

Workforce: all people engaged in actions whose primary intent is to enhance health

Information: production, analysis, dissemination and use of information on health determinants, health system performance and health status

Medical products/technology: selected products used to diagnose, treat or care for patients (including medication, vaccines, and technical devices)

Financing: provision of resources to pay for medical products and services consumed

Leadership/Governance: systems and processes regulating and exercising oversight of healthcare activities

Prevention & Health promotion: measures inducing behaviors that counteract occurrence of medical conditions through education, nutrition and demand creation

0

1

2

3

4

5

6

Technology: novelties in the application of scientific knowledge to healthcare activities and products

Operating model change: modifications in the organizational setup and process design of healthcare activities

Behavior change: modification to the conduct of individuals (patients, workforce, etc.) acting within the health system

Sources: WHO, BCG analysis

A

B

C

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Matrix for leapfrogs and new opportunities: Major themes

Prevention & Health promotion

Workforce

Information

Service delivery

Financing

Leadership/Governance

Medical products

0

1

2

3

4

5

6

Health system categories

Innovation types

Micro-insurance products can increase access to care for low income populations while limiting exposure to financial risk. (Example: Hygeia Community Health Care in Nigeria)

Using social marketing employing proven commercial marketing techniques to promote can improve individuals' health choices. (Example: Greenstar social marketing for family planning in Pakistan)

Incentivizing the workforce to prolong equipment longevity through careful handling, regular maintenance, and safe re-use of devices sold as single-use products. (Example: re-using steel clamps at CARE hospitals in India)

Rewarding health insurance buyers for healthy lifestyles by adjusting premiums to measurable exercise activities and consumption habits can improve health and cut costs. (Example: Discovery insurance group in South Africa)

Mobile technology can be harnessed to communicate to broad population segments, especially in rural and low-income areas. (Example: Kenya Integrated Mobile MNCH Information Platform )

Smart cards for health insurance buyers can streamline administration, facilitate data collection and mobility, and improve the quality of service delivery while preserving patient privacy. (Example: RSBY biometric smart card in India)

Refocusing medical product innovation on value to create products balancing quality with cost can increase access to care for low-income populations. (Example: Philips' infant warmer; QIAGEN CareHPV Test)

Clinical decision support (CDS) software can empower health workers to improve the quality of the services they provide. (Example: Diagnostic software used by "MinuteClinic" walk-in clinics in the United States)

Telemedicine can improve the quality of care for remote communities by leveraging centrally-located expertise. (Example: Fortis and GE Healthcare tele-ICU in India)

Defined global standards for measuring health outcomes can allow meaningful international benchmarking and sharing of best practices (Example: International Consortium for Health Outcomes Measurement ICHOM)

Strengthening supply chains for medical products, for example through supply chain integration, can make products more accessible and affordable to low-income populations. (Example: "Deliver" Project by USAID)

Empowered community health workers can promote health and provide primary care, supported by and acting as a gateway to more qualified health workers. (Example: Pesinet child health programs in Africa)

A holistic approach to prevention and health promotion can bring health considerations into every aspect of people’s' daily lives. (Example: Health Promotion Board in Singapore)

Care can be moved from hospitals to homes by smart phone technology enabling remote support and tracking of therapy adherence. (Example: Helius software tool by Proteus Digital Health in the United Kingdom)

A nationwide, integrated electronic health record system can improve quality and efficiency of care by avoiding data silos. (Example: Electronic Health Record System in Estonia)

Mobile technology can be used to prevent disease and create demand for health care via mobile-phone based health education programs and counseling hotlines. (Example: Project Masiluleke in South Africa)

Imposing excise taxes on unhealthy products (foods, tobacco, alcohol) vsn discourage unhealthy consumption habits (Example: Sugar tax in Norway)

Providing food labeling to help consumers better make more health-conscious choices(Example: Traffic light" nutrition labeling in the United Kingdom)

Increasing workforce awareness of financial considerations can reduce costs by promoting transparency and rewarding suggestions for process improvements. (Example: Physician cost awareness policy by Narayana Health in India)

Insights from behavioral sciences can be used to effect behavior change in both the demand and provision of medical services. (Example: Abdul Latif Jameel Poverty Action Lab study on immunization incentives in India)

Intersectoral governance can bring health considerations into all aspects of public policy making in a holistic manner. (Example: National Committee on Public Health in France)

Proven theme Nascent themeSources: BCG analysis, desk search, expert interviews, project partner organizations

Technology Operating model change Behavior changeB CA

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Matrix for leapfrogs and new opportunities: Concrete examples

Hygeia Community Health Care (HCHC): Provide low-income populations in Nigeria with affordable health insurance covering essential treatments

French National Committee on Public Health: Create an inter-ministerial committee to act as a steering body in coordinating health policies across all ministries concerned

CARE hospitals: Improve equipment longevity and reduce waste by re-using devices sold as single-use products if medically safe

Discovery Group: Reward health insurance takers for healthy lifestyles through lower premiums and other benefits

Kenya Integrated Mobile MNCH Information Platform: Provide pregnant women with mobile phone-based health information to promote safe pregnancy and ensure access to maternal care

Changamka: Offer mobile phone-based insurance services to bring health insurance to low-income communities

Philips infant warmer: Provide reliable, easy-to-use, and cost-effective infant thermo-regulation to reduce neonatal mortality in low-income countries

AMREF e-learning for nurses: Overcome workforce shortages and infrastructure problems by training and

certifying nurses remotely

Abdul Latif Jameel Poverty Action Lab study on immunization in India: Provide non-monetary incentives for parents to immunize their children, thereby overcoming cognitive biases

International consortium for health outcomes measurement: Define global standards for measuring health outcomes and foster better decision-making

USAID "Deliver" Project: Provide technical assistance to streamline medical supply chains in emerging economies, increasing availability and affordability of medical products

Pesinet: Deploy community health workers with limited expertise to detect and monitor childhood diseases with remote assistance from physicians

Singapore Health Promotion Board: Invest in the maintenance of public health through a holistic approach, bringing health considerations into every aspect of people's daily lives.

Proteus Helium system: Administer hypertension therapy remotely via smart phone technology, moving care from service points to homes

Estonian Medical Health Record System: Create a nation-wide, integrated electronic health record system to improve the quality and efficiency o f diagnosis and treatment

Project Masiluleke: Leverage mobile technology for HIV/AIDS and TB prevention through phone-based counseling and text message-supported self-testing.

Project Masiluleke

Norwegian Generalized Sugar Tax: Charge excise tax on unhealthy food (also: tobacco, alcohol) to discourage unhealthy consumption habits

"Traffic light" nutrition labeling in the UK: Simplify food labels to avoid obesity by helping consumers better understand

Narayana Health cost awareness policy: Incentivize physicians to take financially prudent decisions and make suggestions for cost savings and process improvements.

Sources: BCG analysis, desk search, expert interviews, project partner organizations

Greenstar: Conduct social marketing to raise public awareness for reproductive health, leveraging private healthcare providers to act as franchisees

Proven example Nascent example

Technology Operating model change Behavior changeB CAHealth system categories

Innovation types

Fortis & GE Healthcare tele-ICU: Reorganize delivery of critical care by connecting remote ICUs with centrally located intensivists through telemedicine

Prevention & Health promotion

Workforce

Information

Service delivery

Financing

Leadership/Governance

Medical products

0

1

2

3

4

5

6