Developing countries offer lessons for the West

By Neil Versel
04:00 am

Neil VerselIf you read MobiHealthNews, you undoubtedly know about GE Healthcare's Vscan pocket ultrasound, available for about $8,000, or less than one-tenth the cost of a traditional ultrasound machine. But did you realize that the impetus for shrinking ultrasound technology to handheld size came from GE's efforts at cracking the Chinese market?

In a shining example of what GE CEO Jeffrey Immelt and Dartmouth business professors Vijay Govindarajan and Chris Trimble called reverse innovation, the American conglomerate developed technology for an emerging market, then brought the idea back to the West. Specifically, GE created a $15,000 device for use in rural clinics in China that plugged into a laptop, then the company refined its idea until the Vscan was born.

This bit of insight comes to us from a "sponsored supplement" in the fall issue of the Stanford Social Innovation Review, written by Jaspal S. Sandhu, a partner at Bellevue, Wash.-based consulting firm the Gobee Group. (In this case, "sponsored" means that the research was funded by the California HealthCare Foundation.

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Mobile health applications from developing countries have the same potential to penetrate developed markets. In developing countries, these applications span a wide range of activities, including data collection, disease surveillance, health promotion, diagnostic support, disaster response and remote patient monitoring," Sandhu writes.

But it is an unrealized potential, according to Sandhu. "Although myriad mHealth programs are operating in developing-country markets, only a few prominent mHealth innovations in the United States have been imported from abroad. Among the most notable are Vitality GlowCaps and GreatCall Medication Reminder Service, both of which are working to improve medication adherence," he writes. According to Sandhu, both are outgrowths of technology that originated in South Africa.

The Text4baby messaging service for pregnant women and new mothers was modeled after VidaNet in Mexico and Mobile 4 Good Health Tips in Kenya, though, like GlowCaps and GreatCall Medication Reminder Service, it is not an exact replica of the original. This is intentional.

The goal should not be to copy programs exactly, but rather to adapt global innovations for the developed-world market," Sandhu says. "Models need to adapt to the wide differences between the United States and the developing world, not to mention between the United States and other developed nations. Aside from the variations in disease burdens and health systems, many countries have different cultures of mobile phone use. In the developing world, prepaid, or pay-as-you-go, models dominate; users commonly maintain active accounts with multiple providers; people often share phones; and users do not pay to receive phone calls or text messages."

One reason why more mobile health innovations haven't been imported stateside is that the market is so fraught with uncertainties. There is a dearth of scientific evidence demonstrating better health outcomes, questions about how the U.S. government will regulate the technology, lack of insurance reimbursement and simply failures in the marketplace, Sandhu explains.

So, for Sandhu, who teaches design and innovation in the University of California's School of Public Health, it might be time for innovators to change how they approach the market, and perhaps push for some disruption.

"For example, many of the innovations coming online in developing countries will be linked to mobile money services. Changamka [a mobile service that helps open up access to care] uses smart cards and the Safaricom M-PESA mobile money service to help Kenyan women save for safe pregnancy and delivery services. The United States does not have a strong culture of patients directly purchasing health services, as is common in the developing world, but the Changamka model has the potential to fuel any number of breakthroughs," he writes.

The direct-to-consumer approach has failed often in the U.S., but Sandhu has a suggestion: partner with mobile carriers, and not necessarily the big ones like AT&T, Verizon and Sprint, since those three often miss low-income, immigrant and other underserved populations. Instead, approach the prepaid service providers such as Cricket, Sprint's Boost Mobile, MetroPCS, and TracFone.

And instead of working on apps for high-end smartphones, don't forget about voice and text. "Although smartphone applications might represent the bleeding edge, simple text and voice represent powerful tools with almost ubiquitous reach," Sandhu says.


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