Insights on Health Information

Vital Wave Consulting is pleased to announce two exciting developments that address the growing interest around the use of information technology to improve global access to health care.

The first is the release of a new study entitled Health Information Systems in Developing Countries: A Landscape Analysis, a research report sponsored by the Bill & Melinda Gates Foundation. The paper seeks to analyze and characterize the developing-country landscape of national HIS ecosystems review some prominent individual examples of HIS implementations in the field to:

• identify the critical success factors
  
• determine the building blocks of scalable, sustainable projects that can strengthen health systems and improve health outcomes.

The report is the product of extensive field research around the globe and interviews with dozens of the world’s leading experts on national and regional health information systems.

The report will be housed on a new forum called Insights on Health Information - A Global dialogue on the intersection of health and information technology. The website also has forums that will allow for continued dialogue on the role of IT in health systems, as well as features that allow users to upload their own reports and information on HIS developments in different regions and in areas such as best practices and impact research. The site's library also contains links to papers and websites that will help users get better acquainted with the universe of resources available in the health information space.

We hope that both the report and the forum may serve to stimulate constructive conversations on how technology can play a role in improving access to quality health care for all. We welcome your participation and feedback.

The new website can be found at www.vitalwaveresearch.com/healthit

Gorillas and computers

by Karen Coppock
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Had the pleasure of having breakfast with Lawrence Zikusoka and his wife, Dr. Gladys Kalema-Zikusoka (and their two lovely children) this morning. Lawrence and Glady are the founders of Conservation Through Public Health in Uganda.

The couple was in town to present and exhibit their work at the Wildlife Conservation Network expo and to present at UC Davis.

CTPH leverages the expertise of their two founders - Lawrence is a telecommunications specialists and Gladys a veterinarian (both are conservationists) - to offer programs in wildlife health (primarily gorillas), human health and information, education and communication. Their innovative work in disease transmission control and increasing economic opportunities for people that live in protected areas in Africa has been recognized by a long list of awards including San Diego Zoo Conservation in Action Award, World Summit Award for Digital Inclusion, Conservation Fund Award from Skal International Kampala, Whitley Fund for Nature Gold Award and an Ashoka Fellowship.

Computers and gorillas seem like an odd mix, but CTPH recognizes the value of the wildlife and public health data they are collecting and technology can facilitate its widespread dissemination. Technology can also assist with providing economic opportunities for the people that live in or near remote wildlife parks to stem urban migration and hopefully poaching. Perhaps it is not such an odd combination.

First isiXhosa mNovel written in South Africa

by Karen Coppock
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Steve Vosloo let me know that the Shuttleworth Foundation has just launched the world's first mNovel written in both isiXhosa (an indigenous South African language) and English.

The first chapter of this teen mystery story set in Cape town (about a group of graffiti artists) is available at: http://kontax.mobi - you can read it on your WAP-enabled phone (or your PC).

Check back daily as a new chapter will be posted every day through October 19th.

According to the press release for this mNovel, the pro of mNovels is that it allows teens access books, which are largely unaffordable for them, using the most commonly available technology tool in Africa - the mobile phone. The con is that they many teens use "txtspk"when writing on a mobile phone, which hinders, rather than improves, literacy. The Shuttleworth Foundation is working with University of Cape Town researchers to determine the impact of these novels on teens.

What are your thoughts on mNovels and m4Lit?

Innovating to Increase Rural Reach

The Chinese government's economic stimulus program is giving a shot in the arm to PC sales in the vast but poor rural markets of China. The more than 700 million people that live in these areas have lacked access to the electronic and consumer goods that are now so pervasive in the country's big cities. But in August alone, more than 400,000 PCs were sold under a program that gives rural residents a 13% rebate for select products.

While such financial incentives have been crucial to increasing sales, PC makers like Lenovo and HP are also tapping into longstanding cultural practices and novel distribution methods to increase their market share in small towns and villages. Lenovo has begun a marketing campaign touting its PCs as betrothal gifts. PCs make appealing gifts in part because the large boxes they are packaged in create a buzz for families when they are delivered. HP, meanwhile, has expanded its reach in rural China by sponsoring entertainment events and sending buses with glitzy product displays to small towns, along with vans that sell PCs and other products. This has allowed the company to overcome the relatively large distances of many villages from electronics stores and helped boost its market share in China from 5% to 14% in just four years. PC makers have also increased their sales to consumers in rural China, where per capita income is only about $700, by offering lower-priced models.

All of these tactics demonstrate how important a tailored approach that considers the local cultural, logistical and economic realities is to successfully penetrating new markets. Many consumers in rural markets are hungry for modern conveniences but may still be attached to tradition, live far from traditional distributions channels and have limited purchasing power. Finding innovative ways to make products culturally relevant, affordable and available to rural consumers can be a recipe for success.

The Economist highlights the promise of mobile money

by Brendan Smith

The growing buzz over the use of mobile phones to bring access to financial services to the world's poor got a boost this week when The Economist featured the trend on its cover. The issue's survey on telecoms in emerging markets puts a spotlight on the well-known success of ventures such as Safaricom's mPesa, as well as the efforts by MTN to extend a mobile money service it has launched in Uganda to other markets in Africa. The efforts of organizations such as the Grameen Foundation, FrontlineSMS and Google are also discussed, while the mHealth for Development report authored by Vital Wave Consulting is cited as proof of innovation in the health space.

While mobile money and other mobile services (in areas like health, education and agriculture) show tremendous potential to transform the lives of the world's poor, serious obstacles remain. Regulatory concerns, particularly for trans-border transactions, have to be overcome, while the objections of banks and other traditional providers of financial services may slow the momentum for mobile money in many countries. Each successful demonstration of mobiles' power to transform lives, however, increases the likelihood that mobiles will be the tool to lift millions out of poverty.

mHealth Initiative West Coast Seminar

by Karen Coppock
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The mHealth Initiative hosted a very interesting West Coast Seminar on How New Communication Patterns Will Change Healthcare in San Francisco last Friday.

Interesting tidbits from the various speakers throughout the day:

• EMTs in San Diego spearheaded the introduction of a mobile health application that would allow them to begin to administer treatment and access patient records (i.e., allergies to medications, etc.) on the way to the emergency room.

• The European Unions ultra-strict privacy and medical-oriented regulations make mHealth almost impossible in Europe....shame as Europe is so much more advanced than the US in terms of adopting text messaging.
  

• Walmart and CVS are not competing (successfully) for primary care physicians. One doctor mentioned that if hospitals alienate primary care doctors by requiring that they work after hours to answer patient emails and SMS queries, that they may jump to Walmart and CVS - reasonable working hours, decent pay...new competitive threat.
  

• Doctors categorically DO NOT want patients to send them SMS or email them directly - the doctors fear that they may not receive the message until it is too late and the patient has experienced a "negative event" (e.g., landed in the ER room or died). Doctors prefer for these communications to occur at the practice/group-level where a timely response can be better assured. Not so much a legal liability issue as a ethical one for them. They DO want to communicate amongst themselves, using any and all communication modes possible (e.g., voice, email, IM, video)

• One mega provider's virtual care data (2008): 24 million eVisits, 6 million secure emails, 6 million electronic prescription refills and 17 million electronic transmissions of lab results. In their SMS trials they found that after stating their name (~20 characters) and a mandatory opt out statement (~25 characters), they only had ~120 characters left in their SMS message - not much to work with

Was a great event - slides for the speakers - including the Vital Wave Consulting slides I presented on SMS-based mHealth applications in emerging markets - will be posted on their website soon - look for them here.

Challenges Chinese and Russian firms face with global expansion...

by Karen Coppock
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Moscow’s SKOLKOVO Institute for Emerging Market Studies (SIEMS), a think tank that focuses on emerging markets with offices in Beijing, Moscow and India, recently released a report on Operational Challenges Facing Emerging Multinationals from Russia and China. Is definitely worth reading, but for those pressed for time, below is a short summary.

SKOLKOVO analyzed 92 Chinese and 55 Russian multinational firms and identified six main obstacles - and methods of overcoming them - to international expansion (in order of importance):

Challenge #1: Low brand recognition

• potential solution: build your brand, focus on consumers in less-loyal, more price-sensitive emerging markets
• examples (not from the report): from Bharti's (India) interest in MTN (Africa), Telmex/America Movil's (Mexico) expansion across Latin America and Huawei's (China) success in emerging markets across the globe are all examples of emerging-market firms' exploration of other emerging markets. With different perceptions of risk and cost structures than their developed-world peers, these firms may also be better positioned for success in these markets as well.
  

Challenge #2: Talent shortage

• potential solution: hire locals
• example: "VympelCom has made it a policy to gradually involve local talent in management, replacing Russian expatriates – despite the fact that successful local staffs often see the job in a multinational as a chance to leave the country. Such policies are not very characteristic of young multinationals."

Challenge #3: Unsatisfactory knowledge transfer

• potential solution: make tactic knowledge explicit and foster organizational learning
  
• example: "According to Erik Eberhardson, who had led GAZ through the integration of LDV, two of his main takeaways from the LDV integration were that “one must ‘mix’ people more actively” and that “one should pay more attention to internal communication.”

Challenge #4: Inappropriate organizational structure

• potential solution: Start with scale in mind and empower local subsidiaries while maintaining central control
• example: "managers in remote subsidiaries should have enough decision-making power to adapt to the various environments, and be accountable for results. At the same time, the corporate center should have sufficient authority to harness potential synergies, failing of which would not create additional value."

Challenge #5: Political and regulatory risks

• potential solution: be informed and prepared...the authors offer little guidance in this area aside from saying to rely on local connections, but not too heavily on one group as they may lose favor as government administrations and preferences shift..
  

Challenge #6: Complex labor costs / relations

• potential solution: Tailor HR strategies to local, cultural norms