BCG Provided insights and framework for leapfrogging improvements for healthcare systems.

1. Health Systems Leapfrogging in
Emerging Economies
IPIHD private session, Washington DC
Presentation
7 April 2014
This project is supported by The Boston Consulting Group (BCG)

2. IPIHD & World Economic Forum joint private session
Project: Health Systems Leapfrogging in Emerging Economies
Timing
15.00-15.10
15.10-15.40
15.40-15.50
15.50-16.00
Agenda
Welcome and introduction
Innovators' perspectives on enablers and
barriers of leapfrogs
Q& A session
Closing remarks
Speakers
Dessislava Dimitrova,
World Economic Forum
Shelly Batra, Operation Asha
Ting Shih, ClickMedix
Gunther Faber, One Family Health
Moderator: Martin Silverstein,
The Boston Consulting Group
Open floor
Martin Silverstein,
The Boston Consulting Group
Dessislava Dimitrova,
World Economic Forum
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3. In year I, we developed a matrix to systematically categorize
and explain leapfrogs
Health system
0
1
2
3
4
5
Prevention and Health promotion
Service delivery
Medical products/technology
Workforce
Information
Financing
Leadership/Governance
6
A B C
Technology
Innovation types
Operating model
change
Behavior change
Ecosystem including agriculture, environment, infrastructure, urban planning
Health system categories or
building blocks
Note: These categories are based on the WHO's six building blocks of health systems, first introduced in WHO, "Strengthening Health Systems to Improve Health Outcomes: WHO's
Framework for Action", 2007. The initial category names were slightly adapted in WHO, "Monitoring the Building Blocks of Health Systems: A Handbook of Indicators and their Measurement
Strategies", 2010.
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4. Three examples today mapped onto our leapfrogging matrix
Enablers
Categories
Prevention
& Health
promotion
Service
delivery
Medical
products/
technology
Workforce
Information
Financing
Leadership/
Governance
A Technology
B C Behavior change
0
1
2
3
4
5
6
Operating model
change
Operation Asha
Shelly Batra, Founder and
Chief Executive Officer
2 ClickMedix
Ting Shih, President
One Family Health
Gunther Faber, Founder and
Chief Executive Officer
1
3
Source: IPIHD Innovator profiles, BCG analysis
Primary space of intervention:
each innovator participates
Secondary space of intervention:
some innovators participate
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5. Unused slides

6. Leapfrogging matrix: Definitions
Health system categories Innovation types
Prevention & Health promotion: measures inducing
behaviors that counteract occurrence of medical
conditions through education, nutrition and demand
creation
Service delivery: health interventions delivered and
infrastructure established to diagnose, treat and care
for patients
Medical products/technology: selected products
used to diagnose, treat or care for patients (including
medication, vaccines, and technical devices)
Workforce: all people engaged in actions whose
primary intent is to enhance health
Information: production, analysis, dissemination and
use of information on health determinants, health
system performance and health status
Financing: provision of resources to pay for medical
products and services consumed
Leadership/Governance: systems and processes
regulating and exercising oversight of healthcare
activities
0
1
2
3
4
5
6
Technology: novelties in the application of scientific
knowledge to healthcare activities and products
Operating model change: modifications in the
organizational setup and process design of
healthcare activities
Behavior change: modification to the conduct of
individuals (patients, workforce, etc.) acting within the
health system
Sources: WHO, BCG analysis
A
B
C
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7. Matrix for leapfrogs and new opportunities: Major themes
Health system
categories
Innovation
types
Prevention &
Health
promotion
Service
delivery
Medical
products
Workforce
Information
Financing
Leadership/
Governance
0
1
2
3
4
5
6
A Technology B Operating model change C Behavior change
A holistic approach to prevention and health
promotion can bring health considerations into
every aspect of people’s' daily lives. (Example:
Health Promotion Board in Singapore)
Telemedicine can improve the quality of care for
remote communities by leveraging centrally-located
expertise. (Example: Fortis and GE
Healthcare tele-ICU in India)
Strengthening supply chains for medical
products, for example through supply chain
integration, can make products more accessible
and affordable to low-income populations.
(Example: "Deliver" Project by USAID)
Empowered community health workers can
promote health and provide primary care,
supported by and acting as a gateway to more
qualified health workers. (Example: Pesinet child
health programs in Africa)
Defined global standards for measuring health
outcomes can allow meaningful international
benchmarking and sharing of best practices
(Example: International Consortium for Health
Outcomes Measurement ICHOM)
Micro-insurance products can increase access
to care for low income populations while limiting
exposure to financial risk. (Example: Hygeia
Community Health Care in Nigeria)
Using social marketing employing proven
commercial marketing techniques to promote can
improve individuals' health choices. (Example:
Greenstar social marketing for family planning in
Pakistan)
Insights from behavioral sciences can be used
to effect behavior change in both the demand and
provision of medical services. (Example: Abdul
Latif Jameel Poverty Action Lab study on
immunization incentives in India)
Incentivizing the workforce to prolong equipment
longevity through careful handling, regular
maintenance, and safe re-use of devices sold as
single-use products. (Example: re-using steel
clamps at CARE hospitals in India)
Increasing workforce awareness of financial
considerations can reduce costs by promoting
transparency and rewarding suggestions for
process improvements. (Example: Physician cost
awareness policy by Narayana Health in India)
Providing food labeling to help consumers better
make more health-conscious choices
(Example: Traffic light" nutrition labeling in the
United Kingdom)
Rewarding health insurance buyers for healthy
lifestyles by adjusting premiums to measurable
exercise activities and consumption habits can
improve health and cut costs. (Example: Discovery
insurance group in South Africa)
Mobile technology can be used to prevent
disease and create demand for health care via
mobile-phone based health education programs
and counseling hotlines. (Example: Project
Masiluleke in South Africa)
Care can be moved from hospitals to homes by
smart phone technology enabling remote
support and tracking of therapy adherence.
(Example: Helius software tool by Proteus Digital
Health in the United Kingdom)
Refocusing medical product innovation on value
to create products balancing quality with cost can
increase access to care for low-income
populations. (Example: Philips' infant warmer;
QIAGEN CareHPV Test)
Clinical decision support (CDS) software can
empower health workers to improve the quality of
the services they provide. (Example: Diagnostic
software used by "MinuteClinic" walk-in clinics in
the United States)
Mobile technology can be harnessed to
communicate to broad population segments,
especially in rural and low-income areas.
(Example: Kenya Integrated Mobile MNCH
Information Platform )
Smart cards for health insurance buyers can
streamline administration, facilitate data collection
and mobility, and improve the quality of service
delivery while preserving patient privacy.
(Example: RSBY biometric smart card in India)
A nationwide, integrated electronic health
record system can improve quality and efficiency
of care by avoiding data silos. (Example:
Electronic Health Record System in Estonia)
Imposing excise taxes on unhealthy products
(foods, tobacco, alcohol) vsn discourage unhealthy
consumption habits (Example: Sugar tax
in Norway)
Intersectoral governance can bring health
considerations into all aspects of public policy
making in a holistic manner. (Example: National
Committee on Public Health in France)
Proven Sources: BCG analysis, desk search, expert interviews, project partner organizations theme Nascent theme
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8. Matrix for leapfrogs and new opportunities: Concrete examples
Innovation
types
Technology Health system A B Operating model change C Behavior change
categories
Singapore Health Promotion Board:
Invest in the maintenance of public
health through a holistic approach,
bringing health considerations into
every aspect of people's daily lives.
Fortis & GE Healthcare tele-ICU:
Reorganize delivery of critical care by
connecting remote ICUs with centrally
located intensivists through
telemedicine
USAID "Deliver" Project: Provide
technical assistance to streamline
medical supply chains in emerging
economies, increasing availability and
affordability of medical products
Pesinet: Deploy community health
workers with limited expertise to detect
and monitor childhood diseases with
remote assistance from physicians
International consortium for health
outcomes measurement: Define global
standards for measuring health
outcomes and foster better decision-making
Hygeia Community Health Care
(HCHC): Provide low-income
populations in Nigeria with affordable
health insurance covering essential
treatments
French National Committee on Public
Health: Create an inter-ministerial
committee to act as a steering body in
coordinating health policies across all
ministries concerned
Greenstar: Conduct social marketing
to raise public awareness for
reproductive health, leveraging private
healthcare providers to act as
franchisees
Abdul Latif Jameel Poverty Action
Lab study on immunization in India:
Provide non-monetary incentives for
parents to immunize their children,
thereby overcoming cognitive biases
CARE hospitals: Improve equipment
longevity and reduce waste by re-using
devices sold as single-use products if
medically safe
Narayana Health cost awareness
policy: Incentivize physicians to take
financially prudent decisions and make
suggestions for cost savings and
process improvements.
"Traffic light" nutrition labeling in
the UK: Simplify food labels to avoid
obesity by helping consumers better
understand
Discovery Group: Reward health
insurance takers for healthy lifestyles
through lower premiums and other
benefits
Project Masiluleke: Leverage mobile
technology for HIV/AIDS and TB
prevention through phone-based
counseling and text message-supported
self-testing.
Proteus Helium system: Administer
hypertension therapy remotely via
smart phone technology, moving care
from service points to homes
Philips infant warmer: Provide
reliable, easy-to-use, and cost-effective
infant thermo-regulation to reduce
neonatal mortality in low-income
countries
AMREF e-learning for nurses:
Overcome workforce shortages and
infrastructure problems by training and
certifying nurses remotely
Kenya Integrated Mobile MNCH
Information Platform: Provide pregnant
women with mobile phone-based health
information to promote safe pregnancy
and ensure access to maternal care
Changamka: Offer mobile phone-based
insurance services to bring
health insurance to low-income
communities
Estonian Medical Health Record
System: Create a nation-wide,
integrated electronic health record
system to improve the quality and
efficiency o f diagnosis and treatment
Project
Masiluleke
Norwegian Generalized Sugar Tax:
Charge excise tax on unhealthy food
(also: tobacco, alcohol) to discourage
unhealthy consumption habits
Prevention &
Health
promotion
Service
delivery
Medical
products
Workforce
Information
Financing
Leadership/
Governance
0
1
2
3
4
5
6
Sources: BCG analysis, desk search, expert interviews, project partner organizations
Proven example Nascent example
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