ClickDiagnostics

The Long Tail Economy in Healthcare: Affordable Care for the Next Billion Through Mobile Technologies

Ting — Mon, 17 Jan 2011 03:52:34 +0000

At this TEDx talk in Taipei, I describe first-hand experiences of healthcare around the world and how we can create mobile health (mhealth) economics, based on the long tail concept, in order to provide affordable healthcare to the billions of under-served people.

Click’s Solution for Maternal, Newborn, and Child Health (MNCH)

Aerin — Fri, 05 Nov 2010 04:07:22 +0000

Maternal, newborn and child health is an important focus of ClickDiagnostics’ projects. In our partnership with BRAC Manoshi, we designed a mHealth system specifically for Maternal, Newborn, and Child Health. We worked to reengineer BRAC’s MNCH program by integrating Click’s mHealth model and equipping female community health workers (CHWs) with mobile phones.

See how:

View more presentations from ClickDiagnostics.

ClickDiagnostics first listened to women in slums and rural areas in our extensive preliminary system studies and learned that women have demands for proper healthcare and are willing to pay for it if they were accessible and affordable, if had they not been already paying to local quack doctors and expensive private hospitals. ClickDiagnostics identified the following three major bottlenecks in the current healthcare system women suffer from — low quality, burden of cost, and lack of timely intervention. The distance from a nearest hospital facility correlates with cost of transportation, therefore with the level of women’s health awareness.

ClickDiagnostics identifies these bottlenecks in existing MNCH system, and then reengineers the system by mobilizing community health workers empowered with simple mobile phones. Through this direct channel to women, we are able to centralize patient data information in real time and prioritize treatments for high-risk pregnancies for example. Early intervention and emergency treatment for complications in delivery is possible through remote consultation from stationed doctors. We are also developing health education materials for women to be delivered through CHWs’ mobile phones. To carefully handle the sensitivity of women’s health concerns, we have trained and deployed female CHWs who are from the local communities.

ClickDiagnostics is an advocate of powerful stories that come out of improvements in women’s health. We believe that women are change leverage and an important indicator of their families’, communities’, and countries’ health.

We will share more stories of maternal and child health from the project grounds in the future!

In this photo: A mother and her child at ClickDiagnostics’ pilot project site in the peri-urban area of Dhaka district, Bangladesh.

3 simple ways to address maternal and newborn mortality.

Aerin — Tue, 17 Aug 2010 03:45:57 +0000

To paint the current situation in maternal and child health in the developing world, check out this video from Melinda Gates. Please pay special attention to the comments about maternal and newborn health, which is between minute 47 and 57 in the video.

Despite improvements in overall global health in last 50 years, as Melinda mentioned, maternal and newborn health is one area where much more progress needs to be made. Every year, 4 million babies, which is equivalent of 1 in every 32 babies in developing world, are dying within the first 30 days after birth. A half million mothers are dying from giving life to newborns every year, leaving straining impacts on their families and communities left behind. In a country like Ethiopia, 94% of women are still having to deliver at homes without any help of birth attendants.

We have been working to address maternal/child mortality issues in Bangladesh for the past two years. Though the numbers seem daunting, what we learned is that the solution to combat this problem is rather simple and none of it requires new resources that have not been identified already.

Three simple solutions that work!

1. Provide basic health education that’s not currently available in rural areas, due to proper health facility being too far for women to access and receive antenatal and postnatal care. e.g. Simple awareness such as not to wash the baby right after birth because it leads to higher chance of hypothermia and to breastfeed the baby right after birth to build a stronger immune system can be practiced by mothers themselves if right channels can reach them.

2. Provide inexpensive drugs (which costs less than $1) that can prevent hemorrhage, bleeding excessively after birth, which is a leading cause of maternal death.

3. Utilize local health workers and the increasing the number of rural clinics, to bridge the current gap in healthcare services for mothers and newborns in developing countries.

Through our pilot programs, ClickDiagnostics also realizes how important the channel of door-to-door health workers can become in delivering basic medical supplies and health education for pregnant women. We have focused our efforts to designing a mobile health (mHealth) model to further empower these health workers, known as CHWs (community health workers), to provide timely medical care they need. We believe that reengineering a few missing or malfunctioning wheels in the current system can dramatically improve the access to healthcare by mothers in challenging locations.

In the next post, we look forward to telling you Click’s story on how we are working to create a more effective and efficient healthcare for mothers and newborns through equipping CHWs with mobile-phone based information technology!

Photo Gallery: “Fighting Maternal Mortality” (BBC News)

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Maternal Mortality: Mamma’s Story

Aerin — Wed, 11 Aug 2010 14:23:44 +0000

Each year, hundreds of thousands of women die giving births. Click on the link below for a powerful photo essay by Linsey Addario, who followed a live birth of a young mother in Sierra Leone. (Please note: some visuals may be graphic.)

A young mother’s death in this photo essay is a real story for many women whose health is a matter of survival. Despite the growing awareness, the reality is harsh. The Millenium Development Goal 5 (improve maternal health) that most directly addresses this tragedy lags far behind other goals, and the weight of the problem lies inequitably heavier on developing countries. 99% of maternal deaths occur in poor countries, and 80% of cervical cancer also takes place in developing countries. 60% of those with HIV/AIDS in sub-Saharan Africa are women, which is a leading cause of death for women between ages 15-44 in the world (WHO). Cultural resistance, prejudice, and stigma attached to health concern such as breast cancer often delays proper treatments.

We at ClickDiagnostics have been asking:

If the resources and the right ideas are out there, how can we identify the wheels in the current system that are not working?
How can we implement a sustainable change instead of one-time boost in resources that will deplete, and bring cost-effective solutions, in addition to low-cost services?

We must first find these answers in order to design right mHealth models in different contexts of developing regions. Stay tuned for the next posting on how ClickDiagnostics builds affordable, self-sustaining maternal and child health solutions.

What are your ideas and stories on using mHealth for better maternal, newborn, and child health? Leave us your comments.

Offshore or onsite developers?

Ting — Tue, 10 Aug 2010 12:12:13 +0000

One of the key decisions in building ClickDiagnostics’ services is whether to use offshore or onsite developers. On the one-hand, offshore developers offer competitive pricing, but on the other hand, you are putting your service in the hands of “strangers” and only evaluating their capability, work ethics, trust-worthiness, and efficiency through their website, their online portfolios, and select client testimonials. In comparison, onsite developers sound more appealing as you can obtain primary person-to-person assessment of the above-mentioned qualities. However, this usually comes at a higher cost, and even more challenging, is recruiting for the right talents and keeping them.

At ClickDiagnostics, we use a hybrid approach and carefully select technology partners that meet all of the above criteria and are co-located with our main deployment sites for maximized service support and collaboration.

In our Bangladesh office, we have the pleasure of working with Mitul (CEO of our technology partner) and his team. Because of the partnership nature of our working structure, we can directly work with Mitul to ensure our priorities are met.

From left to right: Dr. Sami, Awlad, Habiba, Ting, Mridul, Mostafizur, Mitul

Experiences working with CHWs and patients in Bangladesh

Rubayat — Thu, 13 May 2010 14:29:55 +0000

Hi everyone! This is my first post after a long time, and I have a lot of exciting learnings to share.

ClickDiagnostics has been operating in Bangladesh for over a year now, and has been working with several large NGOs to empower their systems using mHealth. In this post I will be sharing our key insights from close interaction and involvement with health workers over the past one year, and also include some interesting observations from the patient angle:

CHW Ownership

CHWs can be the strongest champions of mHealth, because it simplifies their work and reduces redundancy (e.g. monitoring, reporting, etc.). However, they need to be kept deeply involved in the planning or designing of the system, without which they tend to offer the greatest resistance because of a ‘fear of the unknown’. In our case, initially there was a lot of resistance to change because they feared this would increase their workload, but once we involved them in deciding the features and functionalities of the system, they grew ownership and eventually started lobbying for replacement of their previous systems with ours.
In order for CHWs to understand the value of the system, we showed them the data coming in real time on a computer screen, and how a doctor can see the patient data and respond with an advice. This got them very excited about the possibilities of the system and helped them understand the true scope of the technology.
We made short video documentaries of their work, and also interviewed them for their feelings about the system. These videos were later shown to them, and they were informed that people all over the world will be benefited by their work and see their work as pioneering examples. We also showed top management executives of our partner NGOs these videos to show them how much ownership the ground level personnel had over this system. They were surprised to see it, and it went a long way in convincing them that this was a generally acceptable solution which would not lead to ground level discontent.
It is important to repeatedly remind the CHWs that their mobile phone is only a tool, and that their goal is to achieve health outcomes (e.g. a reduction in maternal and child mortality) through real-time interventions. This, we found, motivates them and keeps the focus strongly towards health impact.
In order to give CHWs ownership over the system, we remained flexible to incorporate any feedback they brought from the ground. M-health interventions should therefore be a looked upon as long term iterative processes of designing solutions and testing them on the ground, and bringing back for fine tuning.

Process and HR optimization

Job roles and time distributions of various HR levels (including CHWs), along with other processes and structures, need to change with the introduction of technology. In BRAC’s case, the pilot was imposed on top of their existing structures which made it suboptimal at times.
Personnel in existing systems also need to be taken through a process of change management to avoid friction and suboptimal results. This typically has been a significant portion of our work beyond technical management.

CHW Training and usability

We trained health workers through a practice session, where they interviewed each other, with one posing as patient.
During implementation phases, we tried to deploy modules in phases, starting with demo modules with a limited number of questions for CHWs to try out and practice in the field for a few weeks. During this period, they were asked to give extensive feedback about how the system could be improved to make their work easier.
Extensive localization is a crucial deciding factor for CHW and patient comfort – simple translations often miss out important differences in dialect and connotations which can even vary between neighboring communities.

Value-addition, and building trust

With respect to gaining trust with patients, even the simple act of taking a picture of the patient made them feel important and want to be registered in the new system. The picture also helped remotely monitor the work of CHWs, and ensure that they were indeed with the patient while collecting their data.
M-Health not only provided better services, but ensured patient compliance. Generalized advice from health workers are often not heeded by patients and their families because health workers are not deemed to be knowledgeable enough, and because the same advice given to everyone receives less importance. However, when a personalized advice for a patient comes from a “city doctor”, the advice carries a lot of weight and is often closely adhered to.
Patients in Bangladesh seemed not to be particularly bothered about data privacy – rather, the fact that their information was being reviewed by a doctor and customized advice was being given to them gave them a lot of confidence. Nevertheless, in the roll out stage, we will voice record patient’s agreement to disclose their data to doctors and BRAC personnel.

Sorry for the really long post, if you have gotten through this far! A lot more to come from Click Bangladesh in the coming months. Stay tuned!

December 2009 – It’s almost time!!!

Deirdre — Wed, 10 Feb 2010 15:13:05 +0000

Though the team is scattered all over right now (Florida, California, and Massachusetts) we are getting really close to our trip to South Africa! Wahooo! All that harf work in the classroom and those long nights spent researching mobile health and the health industry in general will now be paying off. My team is really excited because it is only 9 days until we leave for South Africa. We have been told how beautiful the country is and how many things there are to see so I think at this point we just want to get there and get started. We will be staying mainly in Midrand a city halfway between Rand and Pretoria in Johannesburg. The name, Midrand, literally means Halfway House, but not the kind we are thinking of. In South Africa, Halfway House does not have the same connotations!

Right now, we are just taking care of all the little last-minute details that every traveler must take care of. Things like: how much money do we take with? will our cards work there? what kind of medicines or remedies might we need? what kind of travel adapters do we need? how will my cell phone work? things of that nature. Then of course, there comes the question of what to pack… I mean, for a week in Florida I felt like I packed half of my closet… what’s going to happen to me when I am gone for almost a month??? (note to self: check airline baggage fees)

The class that has brought us to this point, G-Lab is now officially over but the work has just begun. We will be working very closely with important South African parties in order to roll out ClickDiagnostic’s mobile health technology and implementing their primary care services in the country. We really want ClickDiagnostics to walk away with a great experience, a lifelong relationship, and a successful outcome. To that end, I know I can count on my team to pull whatever all-nighters are necessary to get the job done… just supply us with lots of coffee! Hmm, I wonder what kind of coffee they have in South Africa?

Once on the ground in Johannesburg, I am going to be blogging frequently… I will also begin to add pictures. One thing that anyone who is around me for more than 5 minutes knows, is that I take a lot of pictures. At the time, I’m sure I am more than slightly annoying, but later on I have a lot of happy people who are glad I captured the memories… the good news is that we will also be traveling with several ClickDiagnostic’s team members including Ryan (see his blog too) who is talented in the photography and graphic arts fields. I think this trip will be a tremendous cultural education for us and cannot wait to get it started! January 1, 2010 hurry up please!

November 2009 – Digging In

Deirdre — Tue, 09 Feb 2010 13:48:24 +0000

We are now a couple of months into G-LAB Africa GHD and things just keep getting more interesting. We have received confirmation that we and ClickDiagnostics will be working with the Mvezo Tribe for our pilot remote diagnostics clinic in the Umtata Region of the Eastern Cape. The Eastern Cape is South Africa’s poorest province and the healthcare situation within the region is dire. While there is approximately one doctor for every 650 patients in the Western Cape (just a few hundred miles west), there is one doctor for every 30,000 patients in the Eastern Cape. As a result, the healthcare infrastructure is poor and many patients have to travel long distances and wait in long lines to get treatment if they do at all.

The Mvezo region is perhaps best known as Nelson Mandela’s birthplace and, while not everything has yet been finalized, we will be working with a couple of his grandchildren in order to develop a sustainable and affordable healthcare solution for the region. By addressing cervical cancer and TB, two very common opportunistic infections, we hope to rollout the Click mobile diagnostics technology and create a sort of case study that seeks to prove that this healthcare delivery model is not just good for now but is sustainable in the long term.

In class we have heard from several other great guest speakers and have studied several cases of interest. We are currently working on our Interim Research Report on South Africa and the existing healthcare system. Researching another country’s healthcare system has been an extremely educational task and actually helps us understand our own much better. We have also found some very interesting facts as well. Despite the fact that private health sector in South Africa covers 16% of the population, it spends 1100% more than the government does on the public health sector. What this translates to, is the fact that for every dollar spent on a patient in the public sector, 72 dollars is spent on a patient in the private sector. When it comes to medical care in South Africa, there is no gray area; there are those that can afford to receive decent medical care and those who cannot. Unfortunately for many, the latter group is far greater than the former. Among all nations, South Africa has one of the widest disparities between its rich and poor.

In exciting news: we have all booked our tickets to Johannesburg now. We will be arriving January 2 and staying for approximately 3 weeks. During that time, we will split out time between Johannesburg and Mvezo in the Eastern Cape which is just a plane and car ride away. In the coming weeks, we will be finishing up our research report and our draft business plan for the clinics. We will write once more before we leave but we hope to update this blog on a daily basis while in South Africa! Until then, we will be trying to understand as much as we can about the country and its people and health system. Check back for our December update!

October 2009 – Getting Started on Global Health

Deirdre — Thu, 04 Feb 2010 14:44:34 +0000

My team has been looking forward to this class for a very long time. Global Entrepreneurship Lab (or G-LAB) is a class at MIT Sloan that seeks to match up groups of 3-4 students with companies in the developing world in order to not only provide the students with hands-on business experience, but to provide the company with business acumen for their developing venture. We are in G-LAB Africa, which focuses specifically on Global Health Delivery (GHD). My team consists of myself (Deirdre Hatfield), Andrew Black, and Danniel Garmendia and we come from backgrounds that are about as different as you will find in business school. Andrew is originally from California and has started several very successful software companies, Danniel is from Venezuela and has a very strong financial background from his graduate degrees and his work at P&G, and I am from Boston and am interested in sports and retail strategy.

So far, the class has consisted of relevant cases on GHD in Africa and other applicable parts of the world. We have an incredible and accomplished set of faculty that are teaching this class as well. Our professor, Anjali Sastry, has degrees in Physics and Russian and a PhD. in System Dynamics from MIT. She has previously worked as a consultant at Bain, and, her research focuses on health systems in settings where the resources are constrained. Every week, we have at least one class with an expert guest speaker as well. In the past month alone, we have had Dr. Robert Riviello, Michael Seid, and Paul English speak to our class. Nowhere else that I know of, can one have access to such a set of world health experts who also teach us about important business concepts from their experience.

The next part of our class was to find a company. MIT works very hard at securing potential projects with companies in Africa so that we will have a great list to choose from. We then applied for projects and were lucky to get our first choice, ClickDiagnostics. ClickDiagnostics is a company that was born out of the MIT Media Lab a couple of years ago. ClickDiagnostics also won the Development Track of the MIT 100K Business Plan Competition on 2008. ClickDiagnostics aims to provide healthcare solutions via mobile technology that are both affordable and sustainable. Our project focuses specifically on the rollout of the technology at a couple of pilot clinics in South Africa. From there, using what we learn while on the ground in January, we will write a business plan for the further expansion of the clinics. We will also focus on the government and other potential sponsors to see whether there is a possibility of long-term sponsorship for ClickDiagnostics’ model.

For three individuals whose careers will likely not focus on healthcare, this class offers a great way for all of us to gain GHD experience in an international setting. We will spend three weeks on the ground in South Africa in January implementing and revising the work we will do while at MIT during the fall. We have no doubt that the experience we will gain through this class and project will be valuable not only in our careers ahead but during our time at Sloan too. Look for our blog in the coming months… we will be excitedly updating you as we progress. Stay tuned!

Boston to Botswana – A Quick Pre-Departure Rundown

ryanlittmanquinn — Wed, 16 Dec 2009 18:02:02 +0000

In the wee hours of the morning on January 3^rd I will be leaving the dark, cold Boston winter for the sunny, hot (like, really hot) sub-saharan African summer. For 3-4 months, I will work on ClickDiagnostics projects in and around both Gaborone, Botswana and Johannesburg, South Africa. I definitely have my work cut out for me in terms of preparation, but am excited for this upcoming chapter in my life.

In Botswana (my primary residence when abroad), I am volunteering under Dr. Carrie Kovarik who is an Assistant Professor of Dermatology, Dermatopathology, and Infectious Diseases at the University of Pennsylvania. Dr. Kovarik has been an integral part of the ClickDiagnostics’ presence and success so far in Gaborone, Botswana, which is experiencing one of the most severe HIV/AIDS epidemics in the world.

One of my biggest projects in Botswana will be setting up a server to facilitate knowledge sharing from the amazing PubMed service put together by the US National Library of Medicine (NLM) and the National Institutes of Health (NIH). The goal will be to develop mobile access while embracing a universal design philosophy of sorts so doctors from Botswana can utilize the resource using different types of cell phones- from basic phones (using only SMS texting) to smart phones supporting our java application which makes the searches easier to use. Information communication technology (ICT) is, in my opinion, key to the future of the healthcare systems worldwide, so I am excited to have the opportunity to contribute to this project on the ground and learn as much as I can from the experience.

In South Africa, I will be joining a team of three MIT Sloan MBA students (will also be blogging come January) who are implementing our primary care services in rural areas and measuring effectiveness and workflow. I’m very much looking forward to working with these talented individuals and photographing and blogging about our progress. Once they return to America at the end of January, I will continue to work on the projects when necessary. I will travel back and forth whenever I have some free time in Botswana.

That’s just a quick look at two of my objectives. There are many more projects (including a few unexpected ones that surely will arise while I am there) that will certainly keep me busy during my time abroad.

Updates will come more regularly/frequently (and with photos and videos) once I depart. Feel free to reach out to me with questions, suggestions or advice (especially pertaining to living in South Africa and Botswana!) at ryanlq@clickdiagnostics.com.

Cheers,

-Ryan