futurechat

Further to my earlier post, Health on her fingertips, where I explored the need of Sumita, a poor young woman to find out more information on basic health care, I have built up my thoughts on the need for universal, transparent health information accessible by phone.

• A Central repository of health information + local health information is added in to make it more relevant
• People can access the information through a Call desk and through SMS
• A national health number is created that is manned by people who speak the local language. SMS menu is readily available that gives basic information (in language of choice to subscribers)

Public health services in India are woefully short of reaching the urban poor let alone the vast rural population. While institutional health frameworks for urban poor and rural poor exist, they could greatly be strengthened though this simple mechanism.

A. There are 5 dimensions of access to health services (Obrist et al. 2007: 0002)

1. AVAILABILITY: The existing health services and goods meet client’s needs - What types of services exist? Which organizations offer these services? Is there enough skilled personnel? Do the offered products and services correspond with the needs of the poor? Do the supplies suffice to cover the demand?
2. ACCESSIBILITY: The location of supply is in line with the location of the clients - What is the geographical distance between services and homes of the intended users? By what means of transport can they be reached? How much time does it take?
3. AFFORDABILITY: The prices of services fit the client’s income and ability to pay - What are the direct costs of the services and the products delivered through the services? What are the indirect costs in terms of transportation, lost time and income, bribes, and other “unofficial charges”
4. ADEQUACY: The organization of health care meets the clients’ expectations - How are the services organised? Does the organizational setup meet the patients’ expectations? Do the opening hours match with the schedules of the clients, e.g. daily schedule of workers? Are the facilities clean and well kept?
5. ACCEPTABILITY: The characteristics of providers match with those of the clients - Does the information, explanation and treatment provided take local illness concepts and social values into account? Do the patients feel welcome and cared for? Do the patients trust in the competence and personality of the health care providers?

In India none of the above parameters are remotely met when it comes to the poor. Health services have poor availability, are seldom accessible due to absence of doctors, medication, infrastructure. Most poor people are illiterate and unaware of what to demand from the government health centers, therefore even inadequate and unacceptable services are accepted with gratitude.

B. Mobile phones could serve as a simple, cost effective empowerment tool. Information on the phone could help people empower themselves and solve basic issues that occur due to paucity of information and availability. At a basic level Mobile phones could give relevant information on the following:

1. Methods of identifying, preventing & controling health problems
2. Appropriate treatment of common diseases & injuries
3. Maternity & child health (including family planning)
4. Prevention and control of locally endemic diseases
5. Immunization
6. Availability and sourcing information of essential drugs
7. Health education

C. This in itself is a large body of information. This would need to be converted into a simple information architecture which is accessible on voice call as well as SMS.

To simplify this further, information could also be broken up into information by need.

I. Questions on personal and family Health and wellness

• Personal & Family Hygiene
• Prevention – Malaria, TB
• What will keep my children healthy?
• Protection

II. Questions on Cost of care

• for emergencies
• for doctor visits
• for medicine
• for surgery
• for tests and medical needs and insurance cover for each

III. Questions on Treatment

• Diseases
• Types of treatments
• Caring for chronic illnesses
• Doctor details
• Hospital information
• Types of tests
• Complaint numbers
• Blood banks
• Organ donors

D. The above method of information access would help the government by reducing the burden of health care in some ways by increasing transparency and empowering the bottom of the pyramid people who are frequently short changed because they know no better.

The information dissemination would of course need to be in multiple Indian Languages to ensure penetration and access..

Going back to the 5 dimensions, mobile services would solve some of the issues outlined above:

1. AVAILABILITY: The poor can know what is available, how they can help themselves
2. ACCESSIBILITY: Instant information increases the ability to access health services as patients can now know who to contact and where.
3. AFFORDABILITY: Overcharging and corrupt practices can be curtailed to some extent.
4. and 5. ADEQUACY and ACCEPTABILITY: Better information, means more knowledge of what to expect and therefore a bottom up pressure on service providers to give better care.

E. The issue of funding also needs to be looked at critically. Funds will be required fundamentally for the following:

1. Seed capital to establish the information databases and technology infrastructure as well as hookups to the various telco’s
2. Ongoing costs to update information, services, staff costs and technology

While a simple model would be to make this government funded, I believe that for this service to be sustainable a public private partnership would be a better idea. The revenue generation from incoming calls, SMS interactions alone could be substantial. Other revenue streams could also be explored. For example a rating system for doctors, hospitals, nurses could be set up. Doctor and hospital references could be given on the basis of their track record and customer / patient feedback.

Private hospitals in India use mobile phones to interact with existing customers to communicate information about appointments, health screenings, health camps, vaccinations etc. However, this is largely an urban phenomenon. Access to health information in rural India is virtually non existent, while some companies are trying to penetrate this market, most activities are in a nascent stage. More on this in Health on her finger tips.

No one communicates with local communities on health issues. Both Government and Private Health services use mass media such as newspapers and television to communicate with the general public on health issues – Example – dos and donts of Swine Flu, Swine Flu testing centres, symptoms etc. Mobile phones are not really regarded as a way of mass communication. At times the National Disaster Management society has used mobile phones to communicate with local communities, but this too has been very limited.

The absence of a large information repository that hooks up to multiple telecom operators seems to be limiting the popularization of Mobile Health Services.

The other challenge is that no one has really looked at consumer needs. Instead the discussion on Mobile Health has largely been around Technology Capability. Health Records on the Mobile Phone are great to have, however the larger challenge that most of us face is around the Wellness Lifecycle. Till the time Health Services become as ubiquitous as Music services on the mobile platform, penetration will largely be limited.

The consumer facing challenges are another matter all together. For any service / product to succeed. It should have the following characteristics:

• It should be needed by the target audience / consumers
• It should be part of present consumer behavior

If the above are true, most consumers are willing to pay a price and consume the service.

1. Health Information on Mobiles – Consumers have a nascent need for Health Information. While it may exist, it is not critical to my existence unless I fall sick. Even then, the existing behavior is to ask a friend, family member. Hence, a business model around Health Information on Mobiles needs to be driven by a change in consumer behavior.
Music / Ringtones on mobile phones were not a success till the time mobile companies communicated – ‘the cool factor’ through large television campaigns. While the same marketing logic does not apply to Health Information, a targeted marketing campaign around Emergency Services might not be a bad idea.

2. Personal Health Records – Storing Health Records on the Mobile Phone is an interesting concept. However, it is not exactly a felt need and definitely requires behavior change. It remains to be seen how the business model in this case grows. Do the mobile phone companies have enough belief to back this? or will the market be taken away by someone like Google? I am not sure how this will pan out eventually, but i am sure of the fact that the organization which makes it simpler and easier and integrates with on ground services seamlessly will eventually gain. Another important aspect in health records which transcends usability is trust. Consumers need to answer the deeper question – Who do I trust with my information? – a mobile company or an internet company or a hospital. While the technology may exist, success will be driven by a combination of usability and trustworthiness of the service.

3. Health Insurance Facilitation – this is a need that is being felt by many in Urban India. Buying health insurance, is like buying into a black hole. No one knows what it has, when it will appear and what the impact will be. A service that uses Mobile phones could be very useful to consumers. The service could be a combination of health issues, personal information and policy regulations. If you are in a hospital the mobile phone rather than the PC is your primary communication device. Insurance information would easily lend itself to such a service. The only challenge is the service design. Can Insurance information really be made easy to understand, universally accessible and prompt?