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Will e-health Take Off In Emerging Markets and If So, What Are the Implications?

posted by Ajit Jaokar on Wednesday, February 24th, 2010 at 4:05 pm

With all the high profile initiatives in USA and Europe, it is tempting to think that e-health is a ‘western’ concept. While it is true that the idea of e-health is getting a lot of coverage in the West, it may actually arise earlier in emerging markets.

This is not as far-fetched as it first sounds.

The mobile payment system M-Pesa took off in Kenya in a big way capturing 6.5 million subscribers by May 2009 with 2 million daily transactions in Kenya alone. So far, no industrialised nations (outside of Japan and Korea) have managed to create a viable mobile payments system.

The problem is not technical as it is operational. Gartner says that emerging markets are increasingly driving global innovation but they add that the nature of innovation is different:

“In our increasingly customer-centric world we are moving away from the traditional view of innovation, as internally managed and R&D focused,” said Sandy Shen, research director at Gartner. “Innovation doesn’t come from a laboratory. It comes from solving real life problems and responding to everyday needs regardless of how sophisticated the market might be, with the ultimate goal of enriching people’s lives.”

This emphasis for solving real life problems is likely to mean that e-health innovation may take place earlier in emerging markets and in addition to solving real life problems, there is an added incentive that there is little or no existing infrastructure. Ironically, that helped M-Pesa as well to take off in Kenya.

Questions are: If this happens, then How important are standards? Both in relative and absolute terms?

While there is no doubt that standards are important in absolute terms for any e-health implementation. In emerging markets, training may be almost as important to avail of the benefits as an essay Keys and obstacles to e-health in low income countries says:

“Key to implementing e-health tools in developing countries is developing local human capacity; but there is a chicken and egg problem. Low-income countries typically lack programs to train individuals to develop and implement health information technology tools. Without the implementation of these tools there is no place to train people to work with them.”

So, while we are all focused on e-health standards in industrialized countries, emerging markets may be the drivers for innovation and this could have implications for standards.

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Ajit Jaokar says:

Adesina
Interesting links on m-health! thanks. shall have a look.kind rgds Ajit
Ajit Jaokar says:

Mattias
Adesina has answered the question better than I could! Yes,I used it as an example of a domain I know but its an excellent analogy as Adesina elaborates. I was thinking of Brazil + Bio fuels as well and ofcourse there could be more in future. The bottom line(to me) is – a desire to solve real problems especially due to lack of infrastructure and resources. kind rgds Ajit
adesina says:

M-pesa is being showcased here as a great example of impeded innovation in emerging markets. But, just before we get carried away, let shed more light on some critical issues as it will affect eHealth innovations and standardization.
M-PESA was able to start mBanking because it addressed a chronic and long-standing need to for money transfer in Kenya. But as Safaricom is moving close to 300 million US dollars per annual on its network, opposition from Kenyan backs arose. Currently, Kenyan lawmakers are trying to put regulations in place because there is no current one in place for mobile operators to act as bankers.
This becomes a classical case for role of regulation in either constraining or enabling innovations. Without regulation MPESA was quick to diffuse, but its success has encouraged competitions form other mobile operators. So what are emerging now are multiple platforms all over Africa with no standards for ensuring interoperability and cross-platform banking. Commercial competition, customers lock-in and profit maximization is emerging reasons for these silos.
Here, I argue that regulations for standardization to prevent technology lock-in and for forestalling monopoly are required. But any regulation should ensure that standards are not anti-innovation and should promote further entrepreneurship.
I argue here also that this has future implications for mHealth innovations and standards in emerging markets. My observation shows that this silo practice is emerging in mHealth innovations not only emerging markets but also in developed markets. Further information mobile operators and mHealth can obtained from my blog- http://adeiluyemi.wordpress.com/category/mhealth/
Mattias Ganslandt says:

Ajit, Question: What e-health services correspond to M-pesa? /M
Ajit Jaokar says:

Helen, Mattias
Thanks for your comments. Training and standards will be important kind rgds Ajit
Ajit Jaokar says:

Keith
Interesting comments
>>>
It focuses on what is available today using standards, rather than “what can we build for tomorrow”.
<<<
That can be a whole discussion in itself :) My feeling is – it will be hard for any standards body anywhere to predict how things will pan out in future .. Its a chicken and egg situation(and hence a topic in itself) ie will standards come first(and will be designed to predict the future) or will innovation come first(and be subsequently standardised as best practise) kind rgds Ajit
Ajit Jaokar says:

Niklas
Re
>>>
So to bounce your question back to you; what are the implications on standards in a global perspective? Will the implemented standards be locally developed or coming from Western organizations? And is there any element of first-come first-served, meaning that the first standards to be adopted – be it in emerging countries or the West – will spread to global use?
<<<
Good questions. I dont have all the answers :) but I think (If I were to see m-pesa)) – best practise will be globally deployed and may be standardised i.e. the initial innovation in emerging markets may be subsequently standarised. There are other areas where it could happen – ex Brazil in biofuels

So, the optimist in me says that local knowlegde and innovation will be subsequently standarised
kind rgds
Ajit
Ajit Jaokar says:

Adesina
Thanks for your comments. You certainly have practical experience in this space. I am also a big advocate of emerging markets being involved in standards process and in fact, I take it a step furthur to say that – in some cases(like m-pesa) they may actually be leaders and drivers of the change because they will (possibly) implement it first. I agree that the conditions will be different but today many in telecoms(my domain) actually look to learn from m-pesa and carry that implementation knowledge to the west.
many thanks for the comments
kind rgds
Ajit
adesina says:

I am glad that emerging markets or developing countries are considered on eHealth standards. As this is not often the case.
We have to understand that standards define innovation, enterprises and industry. If many developing countries are lacking in capacity to tap into these opportunities afforded by universal standards, sustainability of eHealth programmes will be in jeopardy, I am afraid. Currently lack of global and inclusive eHealth standards makes many projects in Africa unsustainable. Empirical data from eHealth projects in Africa that I am currently analysing supports this argument. As eHealth is technology driven, my findings are that software and hardware used for eHealth projects in Africa are usually imported. Implications are that local expertise to maintain and innovate is lacking thereby increasing chance of failure. Dependence on foreign technology and technical expertise is a long-term implication of this, I argue.
But current practice evidence indicates that open source eHealth software that promotes local ownerships and encourages local expertise development is essential. Projects like Open MRS, an open EHR project and DHIS, also an open health management information system (HMIS) in Africa are examples.
Therefore, inclusion of developing countries’ actors and institution in standard development is essential for global sustainability. This should not be limited to eHealth software alone, but eHealth hardware and telecommunication standards should also be considered.
Niklas Lindblom says:

Ajit, a very interesting piece. M-Pesa (and other mobile services) are great examples of how the developing world “skip” many of the developmental stages of the West and implement innovative solutions. Why is this? Are there lower barriers to implementation of new technologies in emerging countries than in the West, as we already have established systems which are slow to change? Also, I believe you are right in saying that eHealth deployment is likely to be rapid in emerging markets. So to bounce your question back to you; what are the implications on standards in a global perspective? Will the implemented standards be locally developed or coming from Western organizations? And is there any element of first-come first-served, meaning that the first standards to be adopted – be it in emerging countries or the West – will spread to global use?
Keith W Boone says:

In my own experience, emerging markets are more able to embrace standards because they are looking to solve problems for which they don’t already have a legacy solution.

The legacy in developed countries makes it more difficult to deploy solutions based on standards. No such legacy exists in many emerging markets.

In addition to legacy in developed markets, there is also a willingness to spend more on design or in some cases, redesign. Developing markets seem to be more willing to use an architected solution without major redesign, especially when that solution already uses standards.

In the US, a rural eHealth Exchange with limited resources set up a few years ago took the approach that they wanted a “Me-Too” Exchange. They selected standards and profiles which would give them necessary capabilities without engaging in an extensive and expensive design stage. This cost-focused approach is also common to emerging markets. It focuses on what is available today using standards, rather than “what can we build for tomorrow”.
Helen Disney says:

Yes, e-health has the potential to effect huge social change in developing countries – just as people have discovered mobile phones instead of installing landlines, so e-health can speed up the process of dealing with health problems but infrastructure will be needed – computers, access to the internet etc and also the skills to use new systems as Mattias points out above. Standards can help spread confidence in use of these new systems and provide a way of ‘rolling out’ learning more broadly (not reinventing the wheel).
Mattias Ganslandt says:

Ajit, Refreshing perspectives. It is easy to have a Eurocentric perspective on these issues. ICT can give low-cost access; creating a potential for better health care everywhere. Coming back to a point that made elsewhere, it could be critical to introduce systems for standardized information to give better data and research on diseases and treatments also in developing countries where knowledge and information have often been limited or lacking. David Ingram has made the point that implementation is both the greatest challenge and best way forward for eHealth (learning-by-doing).
Training is probably vital in this context (i.e. capacity to use and adapt).
Let me point out that standards may play a key role in knowledge transfer. /Mattias

Will e-health Take Off In Emerging Markets and If So, What Are the Implications?

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Ajit Jaokar

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