A team of emergency medical responders at Emergency Management and Research Institute (EMRI). EMRI's state-of-the-art call response centers are able to dispatch over 2600 free ambulances across multiple states in India to respond to medical, police and fire emergencies. via
Skyrocketing health care costs are a global problem, but creative entrepreneurs in South and Southeast Asia are figuring out how to do better with less. Changemakers worked with its network partner, The Center for Health Market Innovations (CHMI), to spotlight four promising strategies that innovators in this region are using to tackle high out-of-pocket costs and simultaneously ramp up the delivery of quality health care.
These cutting-edge, cost-saving health solutions are homegrown, within ecosystems of limited resources. Leveraging both technology and creative business models, they are proving once again the old adage that necessity is the mother of invention.
1. Health hotlines
In rural areas with few trained doctors, health advice call centers are proving to be crucial lifelines. For example, Health Management and Research Institute (HMRI) runs a free, 24-hour helpline through two call centers in Andhra Pradesh and Sarathi, India that answer more than 43,000 calls per day.
Other advice hotlines, like MeraDoctor and Hello Doctor, are becoming popular businesses, offering low-cost advice and ending long queues and wait times at hospitals. MeraDoctor is a startup in India that allows anyone to receive medical advice for a fraction of what it would cost to see a doctor in person. According to MeraDoctor, 7 out of 10 cases are resolved without the caller having to go to a clinic or lab.
Other innovators like IndianBloodDonors.com are using SMS technology to connect patients in need of blood to a network of voluntary donors. In India, patients often rely on relatives to serve as blood donors, or else pay high premiums to blood banks and hospitals.
If a patient knows no donor in a particular city, the results can be dire. IndianBloodDonors.com’s SMS version of a helpline allows patients to send a text message and quickly connect to a donor in their city — even in an emergency.
2. Low-cost, high-quality retail pharmacies
“Countless mom-and-pop pharmacy operations line the streets of many Asian cities, towns, and villages,” notes Rose Reis, program officer at Results for Development Institute, the host institution for CHMI. “Unfortunately, their quality is equally all over the map.”
Counterfeit drugs can be ineffectual at best, and toxic at worst. But franchise networks and professionalized pharmacy chains like Generics Pharmacy and MedPlus are using business models that may improve drug quality and operational efficiency while keeping prices low.
Generics Pharmacy in the Philippines uses a franchising model to make generic drugs accessible and ensure their authenticity through vetted supply channels. The franchise network also allows the franchisee to benefit from technical education, marketing assistance, and management training, as well as a reliable supply of inventory from the franchisor.
To find out whether pharmaceutical chains really do benefit drug quality, Boston University’s Institute for Economic Development is currently working with CHMI on a study to evaluate whether MedPlus in Andhra Pradesh, India has affected drug quality throughout the marketplace.
3. Telemedicine
“Telemedicine is a low-cost, fast way to bridge the rural-urban health divide,” said Reis. “In many countries doctors cluster in urban areas, leaving rural areas underserved—or there simply aren’t enough doctors, not to mention specialists, to go around.”
Telemedicine can be as simple as using SMS to help a doctor based in a remote area connect with a specialist who is miles away to solve a perplexing medical problem, as with BuddyWorks in the Philippines. It can also involve more complex technology, such as store-and-forward technology to facilitate the exchange of data, as well as specialized kits that allow for the remote monitoring of a patient’s vital signs.
HMRI’s Asara project uses telemedicine to accomplish its mission to end infant and maternal mortality in tribal villages in India. It has developed two portable technologies that allow health workers to perform low-cost lab tests on-the-go, and capture data efficiently.
“Dox-in-Box® is lightweight, portable, and integrated with HMRI’s patient service software,” according to HMRI. “It is equipped with digital medical technology that captures vital signs and skin/ENT images, and performs ECGs and blood glucose tests. HMRI software automatically captures data, providing tremendous scope to eliminate data entry errors.”
Telemedicine businesses, however, often struggle to get a sufficiently high volume of patients to pay their overhead. The solution? A creative business model.
“They tend to run pharmacies, clean water shops, or even grocery stores to get foot traffic and generate revenue,” Reis said.
For example, Sehat First, located in Karachi, Pakistan, is a small for-profit chain that offers a telehealth consulting service, but generates most of its revenue from its pharmacy and grocery store. And E HealthPoint in India has built clean water sales into its health services delivery model.
4. Public-private partnerships for emergency transportation
“Who do you call when you’ve been in a car accident?” Reis asked. “In many countries, you flag down a cab or a kind soul with space in his car.
“Yet, in a growing number of Asian countries, governments are picking up the slack and paying private companies to train EMS professionals, man dispatch centers, and operate ambulances. CHMI profiles 18 such models in its database.
“Many companies also run health advice lines, so they can direct ambulances to pick up people in an emergency. Many ambulance drivers report that their most common occupant is a woman about to give birth—these programs save lives!”
Through EMRI, you can dial 108 in India and reach a call center that can dispatch more than 2,600 free ambulances in multiple states in India. Other models, like 1298 in Maharashtra, charge patients on a sliding scale based on their income.
118 in Indonesia is another free ambulance service, funded by the Indonesian government and made possible through partnerships with a multitude of players—the Indonesian Red Cross, public and private hospitals, and a telecommunications company.
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Are you interested in finding out more about health innovations? Visit the Making More Health competition site for health solutions from all over the world. IndianBloodDonors.com, HMRI, and E HealthPoint are all entries in the competition.
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