Both start-ups and multinational corporations (MNCs) have led many impactful digital health projects, improving healthcare access in low-and-medium-income countries. However, it remains a complex undertaking for both types of organisation, which has delayed the scale-up of digital health. What is required is a complete reinvention of the established systems, and the pandemic may be just the catalyst to unlock adoption.
Solutions are out there
Despite obstacles, many digital health solutions have made a significant impact for under-served communities, reinventing the playbook of care delivery in the emerging markets.
MobileODT uses machine learning to enable point-of-care diagnostic of cervical cancer via smartphone in Kenya and 14 other countries. Last Mile Health leverages smartphones to capture health data and deliver video training to community healthcare workers in Liberia.
But many start-ups find it hard to gain traction, particularly in large public primary care programs. Public health officers focus on factors like sustainability and scale-up capability. As a result, they often discard start-ups despite superior technology, unless they are backed-up by established organisations (USAID, Bill & Melinda Gates Foundation, WISH Foundation, etc.) or in partnership with MNCs and NGOs.
Even MNCs are challenged
Although well equipped with human and financial resources, and leveraging brand equity, many MNCs struggle to make a difference, faced with myriad obstacles.
As they engage with stakeholders: NGOs, foundations, and governments, MNCs are confronted with questions about their motives. Is this a CSR exercise? In that case, customers and partners expect the solutions to be free. But this approach jeopardizes the sustainability of these initiatives, turning them into short-lived experiments, discarded when market conditions get tough, or when these new businesses do not grow fast enough.
Even when the project is clearly for profit, MNCs’ ambitions are closely scrutinised. Is the firm trying to derive outsized profits from low-income populations? Does it intend to generate revenues indirectly from the data collected? Should it be dealing in countries with questionable political track-records? As a result, MNCs are cautious about engaging in that path.
They also have internal hurdles to overcome because these new solutions require significant resources, time commitment, pilot, and ecosystem management. And, since most of these programs are still in their infancy in terms of monetisation and operational maturity, they often do not meet company’s standards in terms of revenue and margin expectations. As a result, they often get deprioritised internally compared to other initiatives in developed markets.
Then there is the complexity of business development and sales processes in emerging markets. It takes patience and resilience to engage in lengthy and unpredictable tenders, and once sold, the implementation phase can be strenuous. Often, it is led in secluded areas, plagued with infrastructure constraints, such as transportation, electricity, or access to clean water. In some instances, the infrastructure needs to be entirely revamped before beginning the deployment.
Inconsistent or non-existent regulations are another challenge. Some countries have not yet clearly defined the use of these solutions, or have set extremely tight boundaries to protect patients and data privacy.
Furthermore, there is no unique care model across one country, let alone across all the emerging markets. Each context requires a customized approach to address its specificities, and this diversity of cases means that a long iterative exercise is needed to build the right procedures.
A change at hand?
In the context of the severe health crisis today, significant changes are taking place, which could unlock the situation.
An unprecedented wave of innovation has emerged, and countless acceleration programs, PPPs, funds, and competitions have popped up to design chatbots, apps (tracing, diagnosis, telemedicine, information), tests, and vaccines; pushing WHO to set up a registry platform to track all the projects globally (Digital Health Atlas).
There is also a renewed interest in digital devices for contactless diagnosis or remote monitoring to minimize exposure to pathogens for clinicians and overcome resource constraints.
Unimaginable ecosystems have also been set up overnight to accelerate our response to the virus threat, such as the alliance between Microsoft, Amazon, and Palantir (the controversial AI firm), which leverages data models to improve resource allocation for NHS.
There is now an increasing recognition of the importance of data management to handle a crisis of such scale, and several projects have been launched to track and forecast the spread of the pandemic at the national, regional, and global level so that health systems can anticipate outbreaks.
The acceleration of digital health adoption may be a slim silver lining in an otherwise dramatic context, but the crisis could help healthcare leap into another era.