Doing Good & Social Entrepreneurship.

This year Frederique Constant has sponsored Outlook Business Catalist 2014 in Mumbai, India.

Business Outlook rewards since 6 years Social Entrepreneurs in India for their initiative and entrepreneurship based on their stories, business models and impact.

Screen Shot 2015-02-11 at 21.24.28This year the following six companies were selected: Spatial Ideas, iKure, MicroGraam, Banka Bioloo, iMerit and Janta meals. A Dutch man, Jesse van der Zande, set up the last company, Janta meals. I was quite surprised, as I did not expect to meet someone from Holland starting an adventure in India, more than 6’000km away from his home

country. I was greatly impressed by all 6 companies and their founders, their passion, dedication and hard work to make a difference in the world.

 

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Renowned Indian business leaders, investors, social venture consulting firms, as well as successful social entrepreneurs were present at this event. The keynote speakers were Ajay Piramal chairman of Piramal Group, talking about the nature of social entrepreneurship, and D Shivakumar chairman and CEO of Pepsico India, speaking of how companies need to move beyond CSR.

 

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During the event I presented our involvement in social responsibility; as a for-profit organization we feel we can also participate in making the world a better place by contributing funds to non-profit organizations, and thus we have chosen to help in heart and child related charity. We also

encourage non-profit organization in their pursuit of bettering the world.

 

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Six winners with Aletta Stas-Bax principal associates sponsor

The 6 rewarded companies:

Spatial Ideas

Spatial Ideas provides e-governance tools to enable transparency, accountability, efficiency, and cost savings in the delivery of important citizen services including healthcare, food security, infrastructure, and sanitation.

I Kure

A technology start-up that has been established to leverage ICT’s strengths to extend healthcare services to India’s rural population.

MicroGraam

Micrograam develops innovative solutions to provide the lowest-costing credit to borrowers. They partner with small, local non-profit organizations that work

closely with the communities to provide micro-loans and other supportive services. By leveraging technology, they are able to keep their costs low, and pass on these savings to borrowers and social investors

Banka Bioloo

A women-led business organization engaged in promoting and developing innovative environmental friendly products and services for Human Waste Management System.

iMerit

iMerit connects marginalized youth in eastern India with IT projects across the globe.

Janta Meals

Janta Meals makes nutritious hygienically prepared and affordable food available to the urban working class. With the first restaurant having been opened in July 2013, Janta Meals aims to establish around 30 outlets, feeding nutritious meals to around 10000 people every day by mid-2015 in Gurgaon.

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Pankay Jayaswal VP Outlook Group and Aletta Stas-Bax co-founder of Frederique Constant

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Only Watch

It is heart moving to see and talk with people who have set up non-profit organizations. The passion and determination of these people is impressive. They have an incredible drive to fight against disease and do everything in their capability to make the life’s of the patients better.

OLYMPUS DIGITAL CAMERAYesterday we were invited by Luc Pettavino, president of the Association Monegasque contre les Myopathie (AMM), who started Only Watch in 2005 a fundraising event for AMM. All the funds raised at Only Watch are used for research to find treatments as fast as possible in order to slow down and eventually heal Duchenne Muscular Dystrophie (DMD). HSH Prins Albert II is supporting him in this activity.

We were shown the new research laboratory on muscle dystrophies and handicaps which has been funded by the Only Watch charity auction. This new laboratory is in partnership with the world known “Centre Scientifique de Monaco” (www.centrescientific.mc) and will be officially opened in a few days.

P9050041This laboratory is in the scientific center in Monaco, which has a world reputation in working on research on Marine Biology specialized in coral, Polar Biology and Medical Biology. After visiting the Centre we were invited by HSH Prins Albert II at the reception offered at the Palace for the occasion of the celebration of 10years of Only Watch and the launch of it’s 6th edition. HSH Prins Albert II gave an opening speech followed by Luc Pettavino.

Luc Pettavino’s son is suffering from Duchenne Muscular Dystrophy and Luc Pettavino is working together with a team, which Ursula Ferreyrolles is part of as Vice president of AMM. Her oldest son is suffering from this disease.  Luc Pettavino launched 10 years ago Only Watch and Ursula Ferreyrolles is working on Monaco’s accessibility and wrote together with Eliane Revel “Toujours un chemin” for Monaco, a touristic guide for people who are less mobile and/or in wheelchairs. She is doing everything to make the daily life of handicapped people easier to move around in Monaco. Which has already resulted in special transport and more accessibility with their wheelchairs so that these people can have a better life. She has been working hard to promote to have a law installed in Monaco for access for the disabled. The Government of Monaco promised to work on this. While speaking with her yesterday, in our Dutch native language, I noticed her determination and perseverance to make a difference, for which I do have great respect.

OLYMPUS DIGITAL CAMERAPeter and myself became involved with charity in 2007. At that time we were in the middle to have our watch company grow and conquer a solid place in the Swiss watch market.

Peter and myself were passionately involved in business and watch making by designing and distributing beautiful watches for Frederique Constant. We were very interested to meet other passionate entrepreneurs to share our passions. Therefore we launched the “Passion Awards” and urged people to subscribe themselves or someone they knew for being the most passionate entrepreneur. We advertised in the Financial Times to reach a large international audience and entrepreneurs.  We sat up a jury with Mr. Carlo Lamprecht, who was president of the Canton of Geneva, Dr D. Turpin, director of Business school IMD in Lausanne and editor in Chief of the Financial Times Mr.H. Simonian.

OLYMPUS DIGITAL CAMERAAt that time we were thinking about people in the for-profit sector, similar to us. When the application came in, we also received some people who were working in the non-profit.  Only at that moment we realized something. “These people are actually much more passionate!”. Imagine some of these people had next to their job a for non-profit foundation. One of them was doctor W. Novick. For the Passion Awards 2007 we decided to have 2 prices, one for profit and a one for non-profit.

Now we want to contribute for people in need, next to our passion to let more people enjoy a beautiful Swiss watch.

 

OLYMPUS DIGITAL CAMERAThere are so many charities and we decided to concentrate on heart and or child related charity. With our Double HeartBeat collection we emphasize partly on the charitable sponsoring to make the end consumer aware as well that they participate and help. We are in the process of setting up our foundation and are very excited to help and support people in need.

We realize each day what an immense gift it is to be healthy and live in a safe place. We want to give something back by more actively sponsoring certain heart and or child related charity.

Since 2007 we donate 50 USD per Double HeartBeat watch sold to heart and or child related charity.

 

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Developing Strategy

While Frederique Constant focussed in past on Heart Related Charities, focus in future should be more on Children. The UN declared in 1959 the Rights of Children. It is a beautiful document, see below. We took this to distill four categories:

Survival 4, 5, 8
Development 2, 6, 7
Protection 6, 8, 9, 10
Participation 1, 2, 3

The numbers behind the categories for the rights of children refer to:


un-logo

 

DECLARATION OF THE RIGHTS OF THE CHILD
Adopted by UN General Assembly Resolution 1386 (XIV) of 10 December 1959

   WHEREAS the peoples of the United Nations have, in the Charter, reaffirmed their faith in fundamental human rights and in the dignity and worth of the human person, and have determined to promote social progress and better standards of life in larger freedom,
   WHEREAS the United Nations has, in the Universal Declaration of Human Rights, proclaimed that everyone is entitled to all the rights and freedoms set forth therein, without distinction of any kind, such as race, colour, sex, language, religion, political or other opinion, national or social origin, property, birth or other status,
   WHEREAS the child, by reason of his physical and mental immaturity, needs special safeguards and care, including appropriate legal protection, before as well as after birth,
   WHEREAS the need for such special safeguards has been stated in the Geneva Declaration of the Rights of the Child of 1924, and recognized in the Universal Declaration of Human Rights and in the statutes of specialized agencies and international organizations concerned with the welfare of children,
   WHEREAS mankind owes to the child the best it has to give,
   Now, therefore,  Proclaims
THIS DECLARATION OF THE RIGHTS OF THE CHILD to the end that he may have a happy childhood and enjoy for his own good and for the good of society the rights and freedoms herein set forth, and calls upon parents, upon men and women as individuals, and upon voluntary organizations, local authorities and national Governments to recognize these rights and strive for their observance by legislative and other measures progressively taken in accordance with the following principles:
1   The child shall enjoy all the rights set forth in this Declaration. Every child, without any exception whatsoever, shall be entitled to these rights, without distinction or discrimination on account of race, colour, sex, language, religion, political or other opinion, national or social origin, property, birth or other status, whether of himself or of his family.
2   The child shall enjoy special protection, and shall be given opportunities and facilities, by law and by other means, to enable him to develop physically, mentally, morally, spiritually and socially in a healthy and normal manner and in conditions of freedom and dignity. In the enactment of laws for this purpose, the best interests of the child shall be the paramount consideration.
3   The child shall be entitled from his birth to a name and a nationality.
4   The child shall enjoy the benefits of social security. He shall be entitled to grow and develop in health; to this end, special care and protection shall be provided both to him and to his mother, including adequate pre-natal and post-natal care. The child shall have the right to adequate nutrition, housing, recreation and medical services.
5   The child who is physically, mentally or socially handicapped shall be given the special treatment, education and care required by his particular condition.
6   The child, for the full and harmonious development of his personality, needs love and understanding. He shall, wherever possible, grow up in the care and under the responsibility of his parents, and, in any case, in an atmosphere of affection and of moral and material security; a child of tender years shall not, save in exceptional circumstances, be separated from his mother. Society and the public authorities shall have the duty to extend particular care to children without a family and to those without adequate means of support. Payment of State and other assistance towards the maintenance of children of large families is desirable.
7   The child is entitled to receive education, which shall be free and compulsory, at least in the elementary stages. He shall be given an education which will promote his general culture and enable him, on a basis of equal opportunity, to develop his abilities, his individual judgement, and his sense of moral and social responsibility, and to become a useful member of society.
The best interests of the child shall be the guiding principle of those responsible for his education and guidance; that responsibility lies in the first place with his parents.
The child shall have full opportunity for play and recreation, which should be directed to the same purposes as education; society and the public authorities shall endeavour to promote the enjoyment of this right.
8   The child shall in all circumstances be among the first to receive protection and relief.
9   The child shall be protected against all forms of neglect, cruelty and exploitation. He shall not be the subject of traffic, in any form.
The child shall not be admitted to employment before an appropriate minimum age; he shall in no case be caused or permitted to engage in any occupation or employment which would prejudice his health or education, or interfere with his physical, mental or moral development.
10   The child shall be protected from practices which may foster racial, religious and any other form of discrimination. He shall be brought up in a spirit of understanding, tolerance, friendship among peoples, peace and universal brotherhood, and in full consciousness that his energy and talents should be devoted to the service of his fellow men.
XELTIS

Laurent Grandidier

LAURENT_GrandidierCEO Laurent Grandidier of Xeltis tentatively accepted a seat on the Board of the Frederique Constant Foundation.

Laurent Grandidier joined Xeltis from medical device company Endosense, where he was vice president in charge of global commercialisation and portfolio management. Mr. Grandidier previously held leadership positions at a number of brand name global medical device companies, including Teleflex Medical, Boston Scientific and Guidant. He started his career at Procter & Gamble. Mr. Grandidier holds an MSC from INSA-Lyon and an MBA from INSEAD. He is a former international rowing athlete who has participated in two world championships. Mr. Grandidier co-founded one of the first social venture capital funds in France, Investir, where he sits on the supervisory board and investment committee.

Xeltis is a privately held medical device company dedicated to transforming standards of care in heart valve replacement and vascular surgery. The company’s proprietary technology combines novel biodegradable biomaterials with sophisticated material processing methods to deliver an implant prosthesis that allows the body to repair itself by growing natural, healthy tissue. Founded in 2006, Xeltis is headquartered in Zurich, Switzerland, with an R&D facility in Eindhoven, Holland.

XELTIS’ VALUES

1. We are on a mission to improve lives of patients through innovation

2. We are caring and challenging in our communication

3. We are committed to personal development

4. We are flexible, responsible and efficient in executing towards our objectives

5. We are creative in seeking opportunities to have fun and celebrate our successes as a team

Please can you outline Xeltis’ first-in-human feasibility study that has recently been announced?

In Xeltis’ first-in-human feasibility study five children who were born with only one instead of two heart ventricles were enrolled. In order to restore the appropriate circulation of blood, they are implanted an artificial connecting tube which is built from Xeltis technology to enable Endogenous Tissue Growth.

The feasibility study is led by the renowned cardiac surgeon Dr. Leo Bockeria at the Bakoulev Center for Cardiac Surgery of the Russian Academy of Medical Sciences in Moscow, one of the largest and most experienced hospitals in the world for the treatment of complex congenital heart diseases in children.

The patients will be followed up on as part of the clinical trial every three months for one year. Longer-term, these children will typically require only a yearly visit to their hospital.

Why is this study focussing on pediatric patients?

Children are an especially vulnerable population that deserves every chance to live long, healthy and carefree lives. The clinical limitations of currently available products, which are made of non-resorbable plastics or of animal tissues, are particularly serious for children.

The fact that they live their whole lives with these implants in their body unfortunately means that they will have to undergo several surgeries over time to replace the implants, and will often be on medication for their entire lives.

If our technology is proven feasible, safe and effective, it could eliminate the need for repeat procedures, as well as the use of life-long medication, which is a physical, emotional and often financial drain on these children and their families.

What is endogenous tissue growth (ETG)?

ETG or Endogenous Tissue Growth is a new therapeutic category in which surgeons use implants designed to allow the body to repair itself by spontaneously growing natural, healthy tissue from the inside without the use of stem cells or animal-derived products.

Why has ETG previously not been possible?

Xeltis’ proprietary technology holds the promise to enable ETG for the first time. While it is true that there are other implants that can help the body grow tissue, they use animal-based tissue to accomplish this, or stem cells or growth factors at a more research stage, which can bring a host of complications.

Xeltis’ implants require no stem cells, growth factors or animal-based tissue and leave no foreign material behind.

How many children are born with single-ventricle heart physiology each year and how many operations on average do they currently require?

Single-ventricle physiology is fortunately a relatively rare heart malformation. Xeltis’ first product will be a replacement valve for children born with a congenital heart malformation requiring replacement of their pulmonary valve. Nearly 100,000 children are born every year with such a medical condition.

However millions of people of any age around the world suffer from congenital heart defects, degenerative heart damage and vascular diseases and could benefit from ETG.

Xeltis’ technology is said to be based on ‘Nobel prize-winning science’. Please can you tell us more about this?

The Nobel prize-winning science that builds the foundation of Xeltis’ technology is “supramolecular chemistry,” or the chemistry of assembled molecules, which is inspired by biological systems such as the double helix of DNA. Prof. Jean Marie-Lehn shared the Chemistry Nobel Prize in 1987 with two other chemists for their pioneering work in the field.

Using this technology, Xeltis produces synthetic matrices designed to stimulate and guide the body’s natural healing response without the need for stem cells, growth factors or animal tissue. Xeltis’ products are also intended to biodegrade as the natural and functioning tissue grows, leaving no foreign material behind.

What are the matrices made from?

The synthetic matrices that are produced with Xeltis’ technology are made of a novel biodegradable supramolecular polymer. They are designed to stimulate and guide the body’s natural healing response without the need for stem cells, growth factors or animal tissue.

Xeltis’ products are also intended to biodegrade as the natural and functioning tissue grows, leaving no foreign material behind.

How do the matrices work in the body?

Once implanted in the patient, the Xeltis matrix is designed to attract proteins and cells that trigger a cascade of physiological events leading to natural tissue growth.

As it biodegrades over time, components of native tissue, including collagen, endothelial lining and capillary blood vessels, develop and organize themselves into natural functioning tissue.

When the matrix has completely biodegraded, the intended end result is a fully functional heart valve or blood vessel.

By Geography

Our donations by Geography:

NORTH AMERICA SOUTH AMERICA EU MIDDLEEAST AFRICA RUSSIA ASIA
Diagnostic  WHF SH WHF WHF, HKHA
Surgery  ICHF ICHF, HKHA
Care  SH ICHF ICHF, HKHA
Capacity Building AHA WHF WHF ICHF ICHF
Research  AHA, WHF WHF WHF, SH WHF WHF
Awareness  AHA, WHF WHF WHF, SH WHF WHF

ICHF = International Children’s Heart Foundation AHA = American Heart Association PAINT = Paint a Smile Foundation FUDAN = Fudan University Pediatrics Department SH = Swiss Heart Association WHF = World Heart Federation HKHA = Hong Kong Heart Association

Categorizing Projects

While formulating a strategy for the Frederique Constant Charity Foundation, we have been analyzing our prior donations:

CHILDREN WOMEN MEN
Diagnostic WHF, HKHA SH SH
Surgery ICHF, HKHA
Care ICHF, PAINT A SMILE, HKHA SH SH
Capacity Building ICHF, FUDAN WHF WHF
Research WHF, AHA, SH WHF, AHA, SH
Awareness WHF WHF, AHA, SH WHF, AHA, SH

ICHF = International Children’s Heart Foundation AHA = American Heart Association PAINT = Paint a Smile Foundation FUDAN = Fudan University Pediatrics Department SH = Swiss Heart Association WHF = World Heart Federation HKHA = Hong Kong Heart Association

XELTIS

XELTIS

Xeltis Completes Enrollment in World’s First Study of Spontaneous Tissue Growth Technology

Early follow-up shows promise in children with congenital heart defect

Xeltis, a privately held medical device company dedicated to transforming standards of care in heart valve replacement and vascular surgery, has announced that it has finished enrollment in a five-patient feasibility study of implantable products intended to enable for the first time the spontaneous growth of natural, healthy heart valves and vessels. With its proprietary technology, the company has pioneered an entirely new therapeutic category called Endogenous Tissue Growth, or ETG, in which surgeons use unique implants designed to allow the body to repair itself by growing natural, healthy tissue.

Xeltis’ first-in-human feasibility study, which is led by esteemed cardiac surgeon Prof. Leo Bockeria at the Bakoulev Center for Cardiovascular Surgery of the Russian Academy of Medical Sciences in Moscow, is focused on the implantation of a connecting tube (or “conduit”) designed to treat children born with single-ventricle heart physiology. Early study follow-up indicates that the investigational treatment has the potential to be a one-time, definitive treatment for these pediatric patients, who under current standard of care must undergo multiple dangerous surgeries as they age and often need medication throughout their lifetimes. Xeltis chose the Bakoulev Center for its study because it is one of the largest and most experienced hospitals in the world for the treatment of complex congenital heart diseases in children.

“The Xeltis technology is very exciting because it holds the promise to enable ETG for the first time,” said Prof. Bockeria. “If proven valid, this therapy will finally end the tragic cycle of repeat surgery and lifelong medication that these children and their families must currently endure. This will not only alleviate pain and suffering for families, it will save billions of healthcare dollars each year.”

About Endogenous Tissue Growth and Xeltis Technology
Endogenous Tissue Growth is the process of natural tissue growth from within the body, without the use of external stem cells or animal-derived products. Because the tissue produced through ETG is the patient’s own, the treatment has the potential to overcome the limitations of current standard of care. No foreign material is permanently implanted in the body, so long-term medication may no longer needed. In addition, the risk of repeated surgeries may be reduced.

At the foundation of Xeltis’ technology is Nobel prize-winning science known as “supramolecular chemistry,” or the chemistry of assembled molecules. Xeltis’ products are synthetic matrices designed to work by stimulating and guiding the body’s natural healing response from the inside. The matrices are intended to biodegrade over time as the new valves and vessels grow, leaving no foreign material behind.

First Patient
The children in Xeltis’ feasibility study were born with only one heart ventricle as compared to two healthy, functioning ventricles that pump blood throughout the body. The first enrolled patient was 6-year-old Dominika Zhurkina. Prior to her Oct. 22, 2013, surgery, Dominika was easily winded, had ashen skin and was very limited in her activity. At her one-month follow-up visit, her skin was a healthy pink, and she was able to run and enjoy one of her favorite hobbies, dancing. At her three-month follow-up visit, she continued to enjoy her more active lifestyle.

“Everything started to change from the very first day, from the moment Dominika was discharged from the hospital,” said Dominika’s father, Sergey, at her three-month follow-up visit. “We noticed immediately that she could easily walk one kilometer without stopping, breathing calmly. Before, we would walk for 100 meters, and she would have to stop and rest. On that very first day, we just came out of hospital and walked to the parking without any problem.”

Healthcare Impact
Millions of people around the world suffer from congenital heart defects, degenerative heart damage and vascular diseases. If Xeltis’ technology is proven feasible, safe and effective, Xeltis has the potential to revolutionize the practice of cardiac and vascular surgeries.

Xeltis’ first product will be a replacement valve for children born with a congenital heart malformation requiring replacement of their pulmonary valve. Nearly 100,000 children are born every year with such a medical condition. Under current standard of care, surgeons may implant plastic grafts or parts of animal bodies to repair the damaged or malformed hearts and vessels. However, these techniques have limited efficacy and are plagued with complications, including the potential for rejection, stenosis, calcification and chronic infection. Additionally, the grafts are incapable of growing with the patient, requiring multiple surgeries and medication for life.

“The completion of study enrollment and the very positive early clinical follow-up marks a significant milestone for Xeltis and the new and emerging field of ETG,” said Laurent Grandidier, chief executive officer, Xeltis. “If the results prove our technology feasible, we will be one important step closer to realizing our vision of making it possible for these children to be treated with only one surgery in their lifetimes.”

Ultimately, the company’s technology has potential for broad application across a number of cardiovascular conditions and patient populations, serving as the platform for a multi-billion dollar business.

About Xeltis
Xeltis is a European medical device company dedicated to transforming standards of care in heart valve replacement and vascular surgery. The company develops implantable products intended to enable for the first time the spontaneous growth of natural, healthy heart valves and vessels. Xeltis’ products are synthetic matrices designed to work by stimulating and guiding the body’s natural healing response from the inside. The matrices are intended to biodegrade over time as the new valves and vessels grow, leaving no foreign material behind. Xeltis’ proprietary technology is based on Nobel Prize-winning science.

 

eHealth Centers

e-health

eHealth Centers leverage cloud-based IT and data-sharing systems to deliver 21st century healthcare services and medical diagnostics to people in remote, resource-poor locations.

Problem

  • 75% of India’s healthcare infrastructure and resources are concentrated in urban populations where only 27% of the population lives.
  • 89% of rural Indian patients travel more than 8 km to access basic medical services, and the rest travel even farther.
  • Existing health clinics often lack high-quality medical care.



Vision

  • Provide 21st century healthcare services to patients in rural India by utilizing innovative technologies and solutions to create access for remote locations.

 

Solution

  • In partnership with the Council of Scientific and Industrial Research (CSIR) and other public, private, and nonprofit organizations, eHealth Centers provide quality healthcare services to people in remote, resource-poor locations in India.
  • Used shipping containers transform into cloud-enabled mobile clinics that integrate technology solutions, including workstations, software, and networking.
  • The first five eHealth Centers in India have received more than 35,000 patient visits.



Impact

Human Progress:  Provides access to high-quality medical care to rural India, where people lack access to such provisions—enabling early intervention and treatment of common health problems without traveling great distances.

Economic Progress:  Healthier people lead more productive lives, participate in their local and global economies, and develop innovative ideas to help address community problems.

E-health in low- and middle-income countries

Health systems in low- and middle-income countries continue to face considerable challenges in providing high-quality, affordable and universally accessible care. In response, policy-makers, donors and programme implementers are searching for innovative approaches to eliminate the geographic and financial barriers to health. This has resulted in mounting interest in the potential of e-health (the use of ICT for health) and m-health (the use of mobile technology for health, a subset of e-health) in low- and middle-income countries.

Developing countries are experiencing an unprecedented increase in the number of users of cell phone and internet technologies, as well as a decline in the price of devices and services.14 As a result, many health programme implementers and policy-makers are exploring the extent to which e- and m-health (henceforth referred to simply as e-health) can help address the challenges faced by resource-constrained health markets in terms of the availability, quality and financing of health care. This increasing interest is evidenced by the growing number of events, web sites and literature focused on e-health, including the Saving Lives at Birth Grand Challenge,5 the recent Health Affairs thematic issue on e-health in the developing world,6 the m-health summits that took place in Washington, DC, United States of America,7 and Cape Town,8 South Africa, and the survey recently conducted by the World Health Organization on the use of m-health by its Member States.1

Despite the increased interest – perhaps bordering on excess – in some individual programmes, in low- and middle-income countries the e-health field is still relatively nascent. Few programmes have gone to scale and implementation has typically been fragmented and uncoordinated. To date, the literature on e-health in low- and middle-income countries has largely consisted of articles describing single uses of technology in health care delivery,9,10 as well as theoretical discussions and recommendations surrounding the implementation of e-health-based programmes and policies,11,12 with few examinations of the actual global landscape of these programmes. One exception is a white paper commissioned by Advanced Development for Africa that lays out a series of case studies and provides best-practice recommendations from e-health experts.13 Another paper reviews the evidence on the impact of e-health in low- and middle-income countries.14 The aforementioned WHO survey of Member States’ utilization of m-health1 presents a systematic landscaping of health programmes; nevertheless, the survey relied on local government knowledge, which is often limited when it comes to the private sector, where much of the e-health activity is taking place.

By analysing health programmes in low- and middle-income countries that engage the private sector, our paper fills gaps in the e-health literature and provides new insight into several central questions. It examines specifically the geographic distribution of technology-enabled programmes, the key issues technology can address in the health sector, and the key challenges posed by the adoption and implementation of technology for health-related purposes.

Methods

Center for Health Market Innovations

This analysis of the e-health technology landscape (henceforth referred to as ICT or simply technology) relies on information obtained from the Center for Health Market Innovations’ (CHMI) database.15 CHMI, launched in July 2010 and updated daily, systematically collects information on programmes and policies – implemented by a wide variety of public and private actors – that have the potential to improve health systems in low- and middle-income countries, where private providers tend to predominate and household out-of-pocket spending is a major source of health financing. These programmes use innovative delivery and financing mechanisms to improve access to health services, as well as their quality and affordability, for the poor. Examples include private clinical social franchises, vouchers for safe deliveries, high-volume/low-cost maternity hospitals with cross-subsidies for poor patients and government accreditation for private drug shops. Not all CHMI-documented programmes rely on innovative information technologies, but many do.1

Traditionally, clinics, hospitals, and public health programmes run by the government or by non-governmental organizations are outside the scope of CHMI and are excluded from this institution’s database. Since CHMI focuses on programmes that work primarily with private providers, large-scale government e-health infrastructures, such as national electronic medical record systems, were not included in this analysis. Similarly, the database screens out programmes that serve mainly high-income populations and focuses on programmes targeting the poor or people in a range of income brackets.

CHMI data were obtained through systematic searches for innovative health programmes led by partners in 16 countries chosen for their thriving private sectors: Bangladesh, Bolivia, Brazil, Cambodia, Ecuador, India, Indonesia, Kenya, Pakistan, Peru, the Philippines, Rwanda, South Africa, Uganda, the United Republic of Tanzania and Viet Nam. Direct searches were supplemented by literature reviews and self-reported information obtained from the programmes themselves. As a result, the data were limited to the information captured by contributions to CHMI’s database and do not include the full universe of all relevant programmes. Furthermore, CHMI’s focus on private care delivery and its relationships with partner organizations in specific countries may have resulted in data collection biases. More information on the data collection methods can be found on CHMI’s web site.16

At the time of this study, the database included 657 programmes, 176 of which were identified as “technology-enabled”, that is, as deliberately using ICT to improve health. The programmes that passed this screening were those driven by technology as a core function, such as health insurance programmes whose client interactions take place entirely through smart-card technologies, or programmes that use technology as part of a broader health strategy, such as clinics offering comprehensive primary care but using cell phones for patient follow-up. Programmes not considered technology-enabled included those that use no form of ICT or do not report it as a key element that enhances their work. Based on this definition, a programme using an X-ray machine alone would not be classified as technology-enabled; however, if the X-ray machine were part of a remote diagnostic service using telemedicine, the programme would be classified as technology-enabled.

Two taxonomies were developed to categorize technology-enabled CHMI programmes: the type of technology used (Box 1) and the purpose of the technology (Box 2). All 176 programmes were coded in accordance with these taxonomies, which were then combined with comparable data collected on all programmes, such as geographic location, health focus (e.g. human immunodeficiency virus [HIV] infection and acquired immunodeficiency syndrome [AIDS], primary care, family planning) and source of funding, to identify emerging patterns in the technology landscape. Further insights were drawn from 20 qualitative interviews with a subset of programme implementers and from anecdotal self-reports on impact obtained from certain programmes.

Box 1. Technology used, by type of device and use case

Device

  • camera (video/photo)
  • computer
  • GPS
  • PDA or tablet computer
  • phones: smartphone, cell phone, landline phone
  • radio
  • remote/portable diagnostic tool
  • smart card
  • unique ID (e.g. biometric scanner, RFID)
  • other

User case

  • software (e.g. to enable data collection, support clinical decisions, or conduct business intelligence)
  • voice (e.g. VoIP, hotline)
  • Internet: e-mail, web site, instant messaging
  • text messaging (e.g. SMS, MMS)
  • videoconference

GPS, global positioning system; MMS, multimedia messaging service; PDA, personal digital assistant; RFID, radio frequency identification; SMS, short message service; VoIP, voice over internet protocol.

Box 2. Main purposes for which health programmes use information and communication technology

Extending geographic access: the purpose is to overcome distance between physician and patient by replacing a traditional office visit. It includes what would traditionally be called telemedicine (e.g. videoconferencing with patients in rural areas; helplines; instant messaging with a health practitioner for medical advice).

Facilitating patient communications: the purpose is to facilitate communication between health workers/programmes and patients outside regular office visits. Subcategories include:

  • general health education
  • encouraging patient compliance
  • enabling emergency care
  • protecting patient privacy.

Improving diagnosis and treatment: the purpose is to allow a health worker to improve clinical performance during training or in the field through real-time assistance with clinical decision-making and diagnosis.

Improving data management: the purpose is to improve data collection, organization or analysis. It can quicken and enhance data transmission and enable remote data collection (e.g. using personal digital assistants to electronically collect information about certain diseases or the health of children in certain regions; electronic record systems). Subcategories include:

  • data collection
  • data organization/analysis.

Streamlining financial transactions: the purpose is to expedite financial transactions by making it easier for patients to pay for their care and for the physician to receive the payment (e.g. mobile insurance premium payments, vouchers over the phone).

Mitigating fraud and abuse: the purpose is to prevent fraud and abuse (e.g. texts and pin codes to detect counterfeit drugs, using biometric data to confirm that a health worker has actually visited a patient). Subcategories include:

  • verifying a medical product
  • verifying patient identity
  • verifying financial transactions
  • tracking human resources/operations.

Other: this includes less frequent categories, such as overcoming language barriers or using technology’s appeal to attract more patients and greater attention.

Source: Center for Health Market Innovations.

Our analysis captures the number of programmes using technology, not the scale of technology use, because this information is incomplete. Nevertheless, the limited information on scale does indicate a wide range in programme size. For example, several programmes report reaching hundreds of patients or users,17 whereas others claim to have reached thousands or more. A case in point is India’s government-sponsored rashtriya swasthya bima yojana health insurance, which claims to have distributed over 27 million active smart cards to its subscribers.18

Results

Programme emergence

At the time of this study, 27% of CHMI-profiled programmes used technology as a core dimension of their work. The analysis by launch date of these 176 technology-enabled programmes (Fig. 1) shows considerable growth in the field of e-health: only 8% of CHMI-profiled programmes launched in the early 1990s are currently using technology, compared with 43% of programmes launched in the last five years.

Fig. 1. Percentage of programmes currently using information and communications technology, by year launched
Fig. 1. Percentage of programmes currently using information and communications technology, by year launched

Source: Center for Health Market Innovations.

Technology-enabled programmes are emerging in all lower-income countries, as shown in Fig. 2. Southern Asia – India in particular – leads in terms of the absolute number of technology-enabled programmes, but the percentage of such programmes (out of all CHMI-profiled health programmes) is relatively uniform across regions.

Fig. 2. Technology-enabled programmes, by region
Fig. 2. Technology-enabled programmes, by region

Source: Center for Health Market Innovations.

Technology solutions appear to be emerging across all areas of health, with HIV/AIDS, general primary care, and maternal and child health in the lead in terms of absolute numbers. However, ICT is more likely to be adopted in certain areas of health care, as shown in Fig. 3. For example, the majority (65%) of emergency programmes are technology-enabled, whereas only 31% of HIV/AIDS programmes use ICT.

Fig. 3. Technology-enabled programmes, by health focus
Fig. 3. Technology-enabled programmes, by health focus

Source: Center for Health Market Innovations.AIDS, acquired immunodeficiency syndrome; HIV, human immunodeficiency virus.

Technology-enabled programmes currently receive funding from a variety of sources (Fig. 4), but 47% of the 176 programmes rely primarily on donors. The government is the main source of funding for 22% of the programmes, and out-of-pocket payments (patient fees), for 25%.

Fig. 4. Technology-enabled programmes by primary source of funding
Fig. 4. Technology-enabled programmes by primary source of funding

Note: Due to rounding, percentages do not sum to 100. The total is out of 122, as we have subtracted the 54 “unknown” total sources from the total.Source: Center for Health Market Innovations.

Types of technology solutions

The taxonomy for the type of technology used (Box 1) was developed by coding all programmes on the basis of: (i) the device used (e.g. phone, camera) and (ii) the use case (e.g. videoconference, short messaging service [SMS]). Use case is the way in which the device is applied. Individual devices can link to multiple use cases (e.g. a phone can be used for voice and/or text messaging).

The data revealed that technology programmes rely mainly on phones and computers (71% and 39% of programmes, respectively, as shown in Table 1), and frequently on both. In particular, 63% of the programmes using phones rely exclusively on cell phones for their operations.

Closely tied to the device is the primary use case (Fig. 5). Voice is the most frequent use case for technology devices. Just over 34% of programmes use voice; almost 32% use applications or other software, and approximately 31% use some form of text messaging (SMS).

Fig. 5. Technology-enabled programmes, by use case employed
Fig. 5. Technology-enabled programmes, by use case employed

MMS, multimedia messaging service; SMS, short message service.Note: Individual programmes can fall under multiple purposes; as such, percentages do not sum to 100.Source: Center for Health Market Innovations.

Purpose behind use of the technology

The taxonomy for the purpose behind the use of technology by health programmes (Box 2) was developed through a review of the goals of each technology innovation. Six broad reasons surfaced, the most common one (42% of programmes) being to extend geographic access to health (Fig. 6). Examples range from TeleDoctor in Pakistan, which provides access to physicians through a telephone hotline,19 to E Health Point in India, which facilitates patient-doctor interactions in rural areas through videoconferencing.20The second most common purpose (38% of programmes) behind the use of technology is to improve data management. Within this category, 38% of programmes focus on data collection, 35% on data organization and analysis and 27% on both. For example, Nacer21 uses telephone and internet technology to allow health workers in Peru to collect data on various populations and share it remotely with medical experts for data analysis. Facilitating patient communications outside regular health visits and improving diagnosis and treatment are the purposes behind technology use in 31% and 17% of the programmes, respectively. In addition, a few programmes use technology to mitigate fraud and abuse and to streamline financial transactions.

Fig. 6. Technology-enabled programmes, by purpose of use of technology
Fig. 6. Technology-enabled programmes, by purpose of use of technology

Note: Individual programmes can fall under multiple purposes; as such, percentages do not sum to 100.Source: Center for Health Market Innovations.

Discussion

The use of technology by a large percentage of programmes to extend geographic access to health care is particularly promising given the critical shortage of health workers and poor distribution of service providers in many low- and middle-income countries.22,23 These programmes often take the form of telemedicine, which connects physicians and patients via technologies such as video chat, or health hotlines, which provide patients with around the clock access to qualified doctors. Interestingly, 70% of the programmes focused on improving diagnosis and treatment also use technology to extend access. These two purposes go hand-in-hand, especially when a programme aims to enable workers with less training to provide high-quality care by using clinical decision-support software to improve the quality and consistency of practice. For example, M-DOK was a pilot mobile health system that allowed rural community health workers in the Philippines to send patient information over text message to specialists in urban areas, who then advised on accurate diagnosis and appropriate treatment.24

Although mitigating fraud and abuse and streamlining financial transactions are the least common of the identified purposes for technology-use, this may be a major area of opportunity for e-health in the future. Low- and middle-income countries are seeking new solutions to improve oversight and accountability in health transactions. They can reduce the loss of scarce health care resources by monitoring drug purchases and verifying receipt of services before insurance payments are transferred. Mobile payment technologies, such as M-Pesa in East Africa, have become increasingly popular25 and in all likelihood will continue to be used for streamlining financial transactions in health.

Devices and use case

Anecdotally, many policy-makers and funders seem to be particularly excited about the potential of newer, emergent technologies, such as tablets. Nevertheless, the expansion of mobile infrastructure and the concurrent increase in the use of telecommunication devices among the poor has allowed programmes to utilize existing devices and invest less in new technologies. This study shows that common technologies such as basic cell phones and computers are frequently used.

Interestingly, text messages fall third in the distribution of technology use cases, with voice and software/applications ranking higher, despite the global excitement over SMS.26,27 Programme implementers have cited greater accessibility for illiterate populations as one of the advantages of voice messages over text messages.

Certain purposes are logically more closely associated with specific devices. This study found that 94% of programmes that facilitate patient communications outside traditional health visits use phones, while only 28% use computers. This is not surprising, since patients in low-income settings are more likely to own phones.

Health focus

Primary care staff require strong diagnostic skills, while secondary care providers need specialized knowledge about particular diseases and conditions. According to this study, programmes focused on primary and secondary care use technology primarily to extend geographic access to care (57% of general primary care and 75% of general secondary care programmes) and to improve treatment and diagnosis (26% and 67%, respectively). In this way, these programmes are able either to connect underserved patients with specialized and trained physicians or to improve the skills of lesser-trained health workers who are more accessible to the patients.

On the other hand, 43% of HIV/AIDS, 35% of tuberculosis and 33% of family planning and reproductive health programmes that are technology-enabled use technology to facilitate patient communications, which is thus one of their most important aims. This is probably because they require frequent low-level provider-patient interactions to ensure compliance with treatment protocols and impart general education.

Impact

Broadly assessing the impact of ICT programmes on indicators such as service access, quality, cost and efficiency was beyond the scope of this study for lack of the necessary data. However, 16 of the 176 technology-enabled programmes responded to a request for self-reported clear and quantifiable impacts, from improvements in the quality of care to decreased costs. Six programmes described an increase in user satisfaction, the most common impact reported. For example, 92% of the patients using GlicOnLine, which helps diabetics in Brazil calculate insulin dosages and plan their diet, reported that the system had improved their lifestyle.28 User satisfaction is a key impact, since acceptance by end users, whether patients or health workers, is a big concern for many e-health implementers. Five programmes reported improvements in the quality of care, often relating to increased patient adherence to the physician’s recommendations or to drug regimens. Operation ASHA reports that its system, which uses fingerprint scanners to verify adherence to tuberculosis medication in slums in India, has decreased the fraction of patients who fail to complete treatment from 60% to less than 3%.29 Four programmes report an impact on efficiency, often in the form of time saved. The e-health community may see an increase in reports of efficiency impacts because it is natural for technology to have such an effect, particularly on account of ICT’s ability to transfer data almost instantaneously. For example, the RapidSMS system in Malawi, which collects data on paediatric patients using mobile phones, has reduced transfer times for some data from 1 to 3 months to only 2 minutes.30 Similarly, decreased costs resulting from technology are reported by few programmes at present,31 but such reports could rise,31 especially as savings from increased efficiencies overcome initial capital costs. This small number of self-reported, quantifiable positive results suggests that e-health can have an impact, although more rigorous evaluation is needed.10

Barriers to implementation

As programmes look for opportunities to scale up e-health services, they may be hampered by persistent reliance on donor funding (Fig. 4), which highlights the need for an eventual transition to alternative and diversified revenue sources (e.g. government contracts, insurance or direct payments from consumers) to bring effective programmes to scale. In addition, it appears to be more difficult to adapt an existing organization to a given technology than to build an organization with technology from scratch. Fig. 3 suggests that programmes launched before the advent of ICT are not rapidly adopting the new technologies. When this study was conducted, 73% of programmes in CHMI’s database were not technology-enabled, and interviews with a selection of implementers suggest that organizations face important barriers to implementation. Implementers have pointed out problems with end-user acceptance of the technology attributable to factors such as the user’s lack of familiarity with the technology, a lack of cultural appropriateness or a lack of incentive to adopt new tools. Another key concern is the lack of the necessary infrastructure to provide reliable electricity and internet access. One implementer cited this as a key reason for moving from computers to mobile phones, for which the necessary infrastructure is more readily available. Costs, both initial and ongoing, also surfaced as a key impediment to technology implementation. Such considerations may determine if, when, and how a technology is incorporated into a programme.

Conclusion

ICT is being deployed around the world in many areas of health. Six major reasons for the use of ICT in health have emerged in this paper. Some, such as extending access to care or improving data management, are rather common, but there are budding uses as well, specifically in fields such as mitigating fraud and abuse and streamlining financial transactions. These fields deserve special attention to ensure their proper development. As e-health continues to evolve, many of the current challenges faced by health systems in low- and middle-income countries, such as the shortage of health workers in rural areas, the variable quality of care, lack of patient compliance, and fraud, will potentially be mitigated through the wide deployment of ICT. It will be crucial to continue to track which of these purposes are being successfully fulfilled by technology and what devices and use cases are most effective in attaining them. This will require more systematic evaluations and better codification of lessons learnt from existing programmes, which in turn will allow programmes that are currently struggling to employ technology to make educated decisions about when and how to implement ICT.


Funding:

This study was funded by the Rockefeller Foundation and the Bill & Melinda Gates Foundation.

Competing interests:

None declared.

References

  • WHO Global Observatory for eHealth. mHealth: new horizons for health through mobile technologies. Geneva: World Health Organization; 2011 (Global Observatory for eHealth series).
  • Vital Wave Consulting. mHealth for development: the opportunity of mobile technology for healthcare in the developing world. Washington & Berkshire: UN Foundation-Vodafone Foundation Partnership; 2009.
  • International Telecommunication Union [Internet]. Worldwide mobile cellular subscribers to reach 4 billion mark late 2008: ITU estimates over 60 per cent penetration driven mainly by BRIC economies (press release). 2008 Sept 25. Available from: http://www.itu.int/newsroom/press_releases/2008/29.html [accessed 22 February 2012].
  • Lambert O, Littlefield E. Dial growth: how handheld devices are enabling nascent economies to skip a generation of development. Finance Dev 2009; 46: 48-50.
  • Saving Lives at Birth: a grand challenge for development [Internet]. Washington: Grand Challenge for Development; 2011. Available from: http://www.savinglivesatbirth.net/ [accessed 22 February 2012].
  • Dentzer S. E-health promise for the developing world. Health Aff 2010; 29: 229- doi: 10.1377/hlthaff.2010.0006.
  • mHealth Summit [Internet]. Rockville: Foundation for the National Institutes of Health; c2008-2009. Available from: http://www.mhealthsummit.org/2010/ [accessed 22 February 2012].
  • Mobile Health Summit [Internet]. GSM Association & mHealth Alliance; c2010. Available from: http://www.mobilehealthsummit.com/ [accessed 22 February 2012].
  • Schenker JL. MPedigree’s Rx for counterfeit drugs. Bloomberg Businessweek [Internet]. New York: Bloomberg L.P. 2008 Dec 3. Available from: http://www.businessweek.com/globalbiz/content/dec2008/gb2008123_027994.htm [accessed 22 February 2012].
  • Otto K. MAMA Knows Best. The Huffington Post [Internet]. 2012 Jan 17. Available from: http://www.huffingtonpost.com/kate-otto/mama-knows-best_b_858645.html [accessed 22 February 2012]
  • Gerber T, Olazabal V, Brown K, Pablos-Mendez A. An agenda for action on global E-health. Health Aff (Milwood) 2010; 29: 233-6 doi:10.1377/hlthaff.2009.0934 pmid: 20348066.
  • Crean KW. Accelerating innovation in information and communication technology for health. Health Aff 2010; 29: 278-83 doi:10.1377/hlthaff.2009.0795 pmid: 20348074.
  • Lemaire J. Scaling up mobile health. Geneva: Advanced Development for Africa; 2011.
  • Blaya JA, Fraser HSF, Holt B. E-health technologies show promise in developing countries. Health Aff (Milwood) 2010; 29: 244-51 doi:10.1377/hlthaff.2009.0894 pmid: 20348068.
  • Center for Health Market Innovations [Internet]. Washington: CHMI; 2010. Available from: http://healthmarketinnovations.org/programs [accessed 22 February 2012]
  • Center for Health Market Innovations [Internet]. CHMI methodology. Washington: CHMI; 2011. Available from:http://healthmarketinnovations.org/about/chmi-approach/chmi-methodology[accessed 27 February 2012]
  • Center for Health Market Innovations [Internet]. Pesinet. Washington: CHMI; 2010. Available from: http://healthmarketinnovations.org/program/pesinet[accessed 22 February 2012].
  • Center for Health Market Innovations [Internet]. Washington: CHMI; 2010. Rashtriya swasthya bima yojana (RSBY). Available from: http://healthmarketinnovations.org/program/rashtriya-swasthya-bima-yojana-rsby [accessed 22 February 2012].
  • Center for Health Market Innovations [Internet]. TeleDoctor. Washington: CHMI; 2010. Available from: http://healthmarketinnovations.org/program/teledoctor-0 [accessed 22 February 2012].
  • Center for Health Market Innovations [Internet]. E Health point. Washington: CHMI; 2011. Available from: http://healthmarketinnovations.org/program/e-health-point-0 [accessed 22 February 2012].
  • Center for Health Market Innovations [Internet]. Nacer. Washington: CHMI; 2010. Available from: http://healthmarketinnovations.org/program/nacer[accessed 22 February 2012].
  • The world health report 2006: working together for health. Geneva: World Health Organization; 2006.
  • World Health Organization & Global Health Workforce Alliance. The Kampala Declaration and Agenda for Global Action. Geneva: WHO; 2008.
  • Center for Health Market Innovations [Internet]. M-DOK: mobile telehealth and information resource system for community health workers in the Philippines. Washington: CHMI; 2010. Available from: http://healthmarketinnovations.org/program/m-dok-mobile-telehealth-and-information-resource-system-community-health-workers-philippines [accessed 22 February 2012].
  • Out of thin air: the behind-the-scenes logistics of Kenya’s mobile-money miracle. The Economist. 2010 June 10. Available from: http://www.economist.com/node/16319635 [accessed 22 February 2012].
  • Bansal S. Can text messages be used to improve health outcomes? Forbes. 7 Oct 2011. Available from: http://www.forbes.com/sites/sarikabansal/2011/10/07/mhealth-text-message-txt2stop/ [accessed 22 February 2012].
  • Sweeney C. How text messages could change global healthcare [Internet].Popular Mechanics [Internet]. 2011 Oct 24. Available from:http://www.popularmechanics.com/science/health/med-tech/how-text-messages-could-change-global-healthcare
  • Center for Health Market Innovations [Internet]. GlicOnLine. Washington: CHMI; 2010. Available from: http://healthmarketinnovations.org/program/gliconline [accessed 22 February 2012].
  • Center for Health Market Innovations [Internet]. Operation ASHA. Washington: CHMI; 2010. Available from: http://healthmarketinnovations.org/program/operation-asha [accessed 22 February 2012].
  • Center for Health Market Innovations [Internet]. RapidSMS, Malawi. Washington: CHMI; 2010. Available from: http://healthmarketinnovations.org/program/rapidsms-malawi [accessed 22 February 2012].
  • Schweitzer J, Synowiec C. The economics of eHealth. Washington: United Nations Foundation; 2010.
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