IDLC MBR TEAM

Overview of The Eco-System

With the vision of Digital Bangladesh, the nation has been blessed with eHealth which has helped its people to save time from traveling long distances
and waiting in lines for countless hours and also from paying high visit costs. Mobile health services were introduced around mid-1999 in Bangladesh by “Swinfen Charitable” a charitable trust. At present, the availability of mobile phones in every household has made healthcare affordable and available more than ever. According to the Bangladesh Bureau of Statistics, it was estimated that previously in order to avoid the trouble of visiting a practiced doctor, around 58% of patients would consult unqualified individuals like pharmacy sellers, homeopaths, hakims, etc.

 

E-health covers all of Telemedicine, electronic health records, digital platforms, mobile health services (m-Health), and clinical decision support. According
to Dr. Bhupinder Aulakh, WHO Deputy Country Representative to Bangladesh, e-health has enabled easy access to health care to the patients when the
government declared a nationwide lockdown last year due to the pandemic. Thus, the development of e-health is imperative for the country where the
healthcare system is fractured, additionally, the road towards digitization especially in the healthcare sector provides a route for the socio-economic
development of the country.

The past few years have seen an escalating rise in access to the internet, which rose by 19.4% annually since 2012, surveyed BTRC. Easier access to mobile phones has led to a boom in the telecommunications industry, which has allowed many new business ideas to emerge. The booming market in the
telecommunications industry provides a whole new platform for the emerging health-tech platforms.

The Emergence of The Health-Tech Industry in Bangladesh

In 2005, Grameen Telecom (GTC) in association with the Diabetic Association of Bangladesh (DAB) took the initiative of providing telemedicine services to patients from Faridpur General Hospital by connecting them to specialized doctors from BIRDEM Hospital, Dhaka. Unfortunately, due to technical and logistical issues, the project was unsuccessful. Fortunately, with the initiative of digital Bangladesh and the booming telecommunications industry, the health-tech sector is ameliorating.
Addressing this rising demand, numerous health-tech service providers have emerged to fill the gap in the health sector exploiting the blessing of artificial
intelligence. Research by LighCastle Partners concluded that at present investors consider e-health to be a good prospect for investment, with preference
from 67% of investors, it stands at 3rd on the list of preferred investments.

Some of the key market players in the Health-tech industry of Bangladesh are:

Praava: A “brick-and-click” healthcare venture consisting of a network of family doctors, who provide consultations online and dedicate a minimum of 10 minutes per patient. Additionally, Praava has blessed Bangladesh with the first-ever fully integrated HIS (Hospital Information System) with Electronic Health Records (EHR). Along with that it was the first to provide patient portals online through the internet or using an app, which stores all the medical records of the patients helping them to thoroughly study the patients they are serving. World Economic Forum awarded Praava as 2021 Technology Pioneer for its role in healthcare innovation in Bangladesh. Additionally, this year Praava health raised a seed amount of $ 10.6 million, with which they intend to develop a “super app” for their patients.

Doctorola: A platform which attends to 3 types of patients need, starting with helping patients reach the doctors they are seeking and if that is not possible then assist them to reach doctors in the similar field. Then comes the patients who are not sure of the medical care they need to address. Doctorola helps them recognize the case and get the treatment. Lastly, they come forward to patients who do not know which doctor to reach out to, junior-level doctors help them via call centers or Facebook page to reach the doctor they require.

AmarLab: A health platform which started by providing diagnostic test services at home, and at present along with that provides online doctor consultations and a platform for doctors to conduct practices virtually. The main target patient groups are: elderly patients suffering from chronic diseases, pregnant women, newborn babies, and 9-5 professionals for whom it is quite difficult to visit hospitals amidst their busy schedule and due to the heavy Dhaka traffic. AmarLab has been a part of the recent cohort of accelerating Asia and is walking down the road towards raising their pre-seed and seed investments with which they intend to reach new horizons.

DoctorKoi: With the help of its flagship product Digital RX, Doctorkoi enabled doctors to write prescriptions with just a few clicks and digitally handle their medical practice. Along with that, the platform provides a path for consultation between expert doctors of different specializations and patients. Pharmaceutical giants like ESKAYEF, ACI, Healthcare, Incepta are working alongside Doctorkoi to help them reach their goals. 

Tonic: The initiative of Telenor Group seeking to develop a “digital front door to health for all”. Tonic is a monthly subscription-based service intending to provide a mobile-based health and wellness service, building a road towards the Universal Health Coverage [UHC]. The benefits include free health tips for
a healthy lifestyle, availability of advice 24 hours a day from trained doctors on primary care and general medicine, availability of numerous discounts, and lastly cash coverage for members who spent three or more nights hospitalized with terms and conditions.

Maya: In a country where there are countless barriers for women to ask their desired questions, Maya has taken the initiative to eliminate the barrier and provide on-demand advice related to public health, psycho-social and legal issues using intelligent technology. It provides a twenty-four-hour service and
allows the user to remain anonymous which allows them to ask questions without hesitating at any time they need. Maya further allows users to ask questions in English, Bangla, Banglish (Bangla in English scripts), or over voice. Recently Maya partnered with Pathao, hoping to provide its patients not only digital consultations but also smooth, efficient, and quick medicine delivery to their doorsteps. This year, Maya raised $2.2 million in seed funding lead by an early-stage venture investment fund. They plan on launching new products and expand internationally. Also, Maya has launched its services in Sri Lanka and testing its services in India and Pakistan. 

Jeeon: A platform facilitating remote service delivery from pharmaceutical companies, who can cost-effectively increase their market presence, to pharmacies, seeking for seamless product search and delivery experience. Key features include: smart search functionality with a single list of products across various companies, product summary presented company-wise, easy editing and single-clicking order, and comprehensive transaction history. With a countrywide distribution channel, Jeeon currently has 2,084 pharmacies in its network.

 

Bangladesh Startup Ecosystem: Funding Landscape in HealthCare Sector by LightCastle Partners:

 

Health-Tech in Combating The Pandemic

 

After the lockdown was announced last year, patients feared visiting doctors in person due to the spread of the virus. Neither did doctors entertain the concept of face-to-face consultations, which led them to reach out to their patients virtually through video conferences, and audio calls to provide consultations. Along with private hospitals, most government hospitals including Bangladesh Medical College Hospital embraced this mode of treatment. Traditional renowned hospitals have also embraced the new method of treatment in order to
reach out to their patients. Several telehealth approaches were adopted by the Ministry of Health, however, for it to be successful adequate data infrastructures, well trained staff, and clear management and communication protocols in dealing with patients need to be ensured.

Technology has also been used to fight the existing situation, where some of the national initiatives include:

National Corona Portal-Corona Info: A portal providing all the necessary information one needs to know starting from the updated Covid information,
symptoms of covid, directions by WHO, emergency numbers, safety protocols, and many more.

Chatbots: Many chatbots have been developed, which provide services through messenger. They extract relevant information from IEDCR, WHO, and CDC,
and operate in both English and Bangla.

Mobile awareness: Mobile networks have stepped up as well, for example spreading awareness whenever someone makes a call, Grameenphone took the
initiative of embedding messages like “stay home” beside the signal bar of their users, and free call service to provide information related to Covid.

Social media platforms: With the majority of the population having access to social media, the platform has been used to spread awareness and safety protocols in the form of documentaries, Facebook lives, and awareness posts.

Shohojoddha: Acts as a platform for corona recovered plasma donors and recipients jointly launched by the ICT Division, Directorate General of Health Services (DGHS), a2i Innovation Lab, and eGeneration. This platform aims to ease the process for Covid infected
patients in search of plasma.

The turn of events in the majority of the people’s life due to Covid has led many individuals to suffer from mental health issues, something which is equally
important to stress about. Talking about mental health being a social stigma in our society used to prevent many patients from opening up. However, many
initiatives have been taken by numerous platforms to bridge the gap for this issue like LifeSpring, Moner Bondhu, Maya, etc.

Neighboring Countries Fighting Covid with Health-Tech

Nepal: In this challenging time, the neighboring countries of Bangladesh have also embraced technology to fight against Covid.
Just like Bangladesh, the government of Nepal took the initiative of establishing online portals and they also developed a two-way interaction platform. The sole purpose of the interaction platform is to allow its citizens to communicate their situation and needs to the
governing body. The interaction is done through government websites, municipal messaging systems, and computer centers which has allowed the government to communicate directly with its people and cater to their needs. This means of communication has also helped migrant workers to communicate and return and to ensure safe quarantine for them and their families. The online portals on the other hand have
been active in providing all covid related updates to the Nepalese, starting from the status of the virus, the quarantine spots available, hospitals and pharmacies in operation, and raise awareness and help people figure out the symptoms of Covid.

India: In India, while the frontline workers got engaged with the influx of infected patients, the government body took the opportunity of utilizing technology to curb the spread of the virus. Just like Bangladesh, numerous health-tech platforms, came forward to help fight the virus. They
helped to track the individuals quarantined, an app named GoK Direct-Kerala contributes by providing the latest health updates. Several apps also took the initiative to help the government contain the virus by detecting affected patients and areas with the highest number of cases. As soon as the deadly second wave hit the country many platforms, like Search My Bed, COVID SoS, Sprinklr, etc, emerged to help patients find hospital beds, medical supplies, ventilators, oxygen supplies, etc on the palm of their hands. 

Pakistan: Similar to Bangladesh, doctors in Pakistan have also started online consultations by partnering with some organizations. The federal and provincial government of Pakistan has independently and through local health services took the initiative of telemedicine services in the country. Organizations like Marham link patients to the nearest specialized doctors and also provide them with regular health updates. Through their social media
platforms, they attend to their patients’ queries. Another platform called “Sehat Kahani” partnered with UNDP Pakistan and helps doctors and patients connect with each other. Furthermore, they joined hands with the Ministry of National Health Services, Regulation and Coordination (MOH) to upgrade 60 ICUs to tele-ICU in both the private and public hospitals. This allowed the hospital staff to connect to specialized doctors and doctors to monitor thousands of ICU patients from different hospitals online. Other platforms like these have also emerged who not only provide covid related information but other health issues are also taken into account.

Digital Health in Rural Areas

The paradigm of health-tech is complex in developing countries like Bangladesh, especially in rural areas due to the lack of available resources. However establishing the usage of modern equipment (telephone, internet, video conference, mobile, and computer) in the rural areas will allow better quality treatment and decision, exposure to available alternative ways, increased awareness on health risk, and monitor health services in remote areas along with the availability of improved health services. At present various pharmacies from different districts of Bangladesh owns computerbased low-cost diagnostic equipment and software telemedicine services to provide services to the rural poor as they are the first stop for women or senior citizens for whom traveling and using a mobile phone is critical. Additionally, these centers provide free consultations to the underprivileged and for cases in need of attention, the patients get to consult doctors from urban areas through video conferencing. Apart from patients, doctors in those regions can also enable these facilities to consult experienced doctors from the urban areas, when they encounter a critical case or in times of emergency. Hence, the disparity arising due to the uneven distribution of doctors between urban and rural areas can be dealt with.

To stand beside the pregnant women in the rural areas, the initiative of “Aponjon” was launched back in 2011. This allowed women to take health advice from home and contributed to reducing child death and maternal matrimony. Expecting mothers can register to “Aponjon” and receive health advice regarding pregnancy for 86 weeks free of cost.

A study conducted by Sadia and Rokhsana (2015), came up with the issues for which implementing technology in the Habiganj Sadar Hospital has been difficult are shown in the pie-chart. Upon surveying several factors were noted which makes the development of health-tech difficult in those regions. 

In addition to those, the shortage of technical personnel makes maintenance and repair work difficult to handle. Furthermore, the unavailability of public facilities like proper access to roads, electricity, and water is a major factor. The instability of information infrastructure at hospitals makes the embedment of digitization difficult.

Challenges in Establishing Health-Tech Services in Bangladesh

The digital divide hinders the underprivileged, older population, and ethnic minorities due to limited access to technology, socio-cultural barriers, and geographic location.
1. Inadequate ICT facilities: Even though the mobile signal is available in most areas of the country, varying speeds in different regions make it difficult for people in remote areas to have access to health facilities. Despite the majority of the rural population having mobile phones under their possession, they do not own a smartphone which is required to obtain tech-health services. Owning a smartphone however, does not guarantee health support as high internet fees, unstable electricity supply, and poor ICT infrastructure stands between the rural poor and proper treatment.
2. Rural areas lagging behind internet knowledge: A significant part of the population are not familiar with the internet and its applications. Not only the internet but they also are not used to operating a mobile phone. Women and aged people who are in dire need of such services are deprived of them, due to the lack of internet awareness amongst them.
3. Resistance to user acceptance and low health literacy: Not being literate enough and elderly people being more comfortable with the traditional
form of treatment might not welcome this new form of health service. Health literacy, which is the ability of individuals to understand the basic health information upon which health decisions are made, is very low. The usage of e-health services requires health literacy which will allow them to understand which services to opt for and apply that knowledge for their treatment.
4. Lack of motivation, trust, and patient satisfaction: Lack of incentives and heavy workload forces the hospital administration to avoid such changes. As such changes can be time-consuming and require effort, they choose not to walk on the path of digital transformation. Furthermore, the physical presence of a doctor helps the patient to express themselves, and doctors in return can provide empathy and compassion to them gaining their trust. The absence of physical interaction makes it difficult to establish trust and satisfaction in e-health services causing a majority of the rural poor, especially the
aged population to not be satisfied with it.
5. Lack of security in this emerging sector: The digital security act was enacted in 2018, however, nothing specific has been referred to telemedicine.
Medical data are usually very sensitive and confidential for which safeguarding them is of utmost importance, however, Bangladesh has not been able to level up in that stage yet. 

Way Forward

Multiple new health-tech platforms have emerged and are still emerging to fill in the gap in the health care sector of Bangladesh. At the end of last year,
an investment readiness program named Accelerate Bangladesh was hosted by Bangladesh Angel networks and BetterStories Limited who collaborated with Bridge for Billions and Biniyog Briddhi. The 12-week long program was designed to invest in the fresh start-ups Bangladesh is growing with an investment worth USD 50,000- USD 100,000 in the time span of 12-18 months. The purpose behind the program is to support 5 potential companies in health tech which will help fight the pandemic. It further intends to guide the youth by experienced professionals and mentors of the specific field. Such initiatives should be encouraged to combat the existing crisis.

For reshaping the healthcare ecosystem, a constructive approach needs to be developed by the governing body as we are unaware of the turn of events Covid might take. Funding should be provided to the start-ups and for training the existing staff. Better IT facilities should be established especially in rural areas, as social distancing is of utmost importance during the pandemic this can allow them to have a seamless experience of getting health advice just by staying indoors. Health records need to be developed for strengthening the system. Special care needs to be taken for the aged group who are not as tech-savvy as the rest of the population. As initiatives have already been taken by both the public and private sectors to reshape the existing system if the two sectors collaborated then a successful health-tech system could be seamlessly achieved using the existing resources.