The scale of the scenery seemed to match the scale of our task, to figure out how to unlock the eHealth marketplace—that is, unleash entrepreneurship and market forces combined with technology—to provide better health care, or for many rural communities in developing countries, any health care at all.
The barriers are well understood. Very limited access to health care facilities in rural and many peri-urban areas. An absolute dearth of doctors, nurses, and pharmacists in rural areas. Low quality care—few diagnostics, widespread fake drugs. High costs for drugs, doctors, and hospital care that can bankrupt poor families. Can technology help—especially information and communications technology? And how to jump start its use in poor countries when even rich countries have not yet adopted systematic eHealth strategies?
Fortunately, barriers did not slow down the discussions here, and the assembled experts showed examples of business models and eHealth tools that could make a huge difference. Paul Kagame [3], the President of Rwanda, showed up to help open the conference and demonstrate that even a tiny developing country with a forward-looking government could adopt both nation-wide ICT strategies and eHealth policies that put most developing counties to shame—nearly complete broadband coverage by the end of next year, a nationwide chain of public clinics and hospitals all e-linked shortly after that.
The conference confirmed my view that eHealth tools are almost the only way to address the lack of medical talent in rural areas, the only way to commoditize care delivery via para-professionals while keeping quality high, probably the only way to use the coming wave of very sophisticated, very cheap diagnostic tools in remote areas in a manner that Health Ministries will approve—by using eHealth systems for remote supervision by doctors or pharmacists. Yet the conference also made clear that entrepreneurs on the ground don't want to manage the complexity of selecting and deploying eHealth tools themselves—they want to buy eHealth services. So starting an eHealth services company to provide such tools to BoP health enterprises has become central to my health sector work at Ashoka [4].
I can't do justice to the richness of the discussion here, so will just note some of the things that struck me especially and point you to the conference website and its store of short video interviews with many participants from the whole set of conferences. You can see them here [5].
- There are a number of small eHealth projects and pilots, but very few examples of successfully-scaled eHealth deployments in developing countries. A system that covers the entire city of Sao Paulo, with 700 health units with 14 million patients, may be one of the largest; the system manages 1 million patient consultations and 1.7 million prescriptions per month. Getting to scale will be important to demonstrate the value proposition and convince skeptical or reluctant medical/public health establishments.
- eHealth enterprises—and BoP health enterprises that make use of eHealth tools—need access to seed/pilot capital plus mentoring, as well as growth capital; specific recommendations to address both needs are being shaped. For growth capital, financial intermediaries—specialized investment funds--are also needed, and plans for at least two such funds that will blend social and commercial capital surfaced at the conference.
- National eHealth plans or at least agreement on minimum datasets and interoperability standards will be needed to avoid a cacophony of silo systems that can't talk to each other—a state that describes eHealth systems in the U.S. and could easily result from the donor- and disease-specific approach now prevalent in the development community.