CMED Digital Primary HealthCare Service Model

In Bangladesh, Healthcare is in dire straits. First, there is no referral system, rural patients don't have a structured primary healthcare system which can route them to next level of health services. No individual health record exists. On top of that, nearly one million people in Bangladesh die due to Noncommunicable Diseases(NCDs)/year. However, upto 90% of these deaths are preventable through health awareness, regular monitoring & changing lifestyle. CMED has taken the initiative of establishing digital primary healthcare services in rural areas utilizing IoT enabled A.I. driven cloud based CMED smart preventive healthcare platform. Using this platform, we have already created digital health account for over 32,000 people living in rural area, providing door to door health service & education through community based health volunteers, and creating referral chain for next level of service.

We are connecting people with health services using cutting-edge technology, creating a structured ecosystem for healthcare service delivery.

There are major issues regarding rural Healthcare in Bangladesh. There is no referral system - patients don't have a structured primary healthcare system where they can receive first level of care and can route them to next level of health services. People don't get appropriate service at the right time, causing their condition to get worse. On top of that, patients don't store their history, causing doctors to treat with less information. Due to this, About 886,000 deaths a year in Bangladesh happen due to Noncommunicable Diseases(NCDs). About 19% adult are currently suffering from diabetes, but shockingly half of the suffering populace never did a diabetes screening. 17.9 percent of adults aged 25 years and above amongst the Bangladeshi populace are seen to have hypertension. About 17% of the adult populace are suffering from overweight or obesity. This is effecting each individuals living in Bangladesh, and rural populace are bearing the brunt of it. However, with regular health monitoring the health risk & cost can be reduced up to 5 times. Upto 90% of these deaths are preventable through health awareness, regular monitoring & changing lifestyle. According to WHO, 80% of patients are treatable in lower facilities. 

CMED Health was founded by University professors after publishing a research journal to improve the healthcare delivery in rural sector. Over 120 million people are living in rural area. Even so, in Bangladesh, the most neglected populace in terms of healthcare are people living in rural area. From our research, we have identified the problems regarding healthcare in rural areas. They have very low access to quality healthcare. They are unaware of the health risks, and steps to mitigate them. Each of them needs essential healthcare services that we are providing.  To implement our solution, we have selected Somvag Union under Dhamrai Upazila in Dhaka, Bangladesh. With our partners, we have created a digital health account for each over 32,000 individuals where their health data are stored. They are receiving health education & primary care at their doorsteps from people they know and get referral to next level of service when required. Regular monitoring & health education is helping them stay healthy & aware of health risks.   

CMED has developed a cloud based Artificial Intelligence driven Smart Primary Care Platform that utilizes IoT enabled FDA/CE certified medical devices connected through a mobile application. The platform creates a health account for an individual. Through the account, one can store his/her health information securely in the cloud, removing the risk of losing it. The medical devices are used to screen key health vitals data and store them securely on the cloud. The platform immediately shows color coded health status(green, yellow & red) and advice based on the vitals. In case of emergency(red), the patient is referred to the next level of service. To serve the population, we have made localized changes to the platform. The complete system is in Bangla, making it easily understandable. However, majority of the rural people are not highly educated. There needs to be another layer to explain the outcome and ensure quality healthcare service delivery process. To close this gap, we are using thoroughly trained Health Volunteers. 

These HV are equipped with CMED Health Kit, which includes IoT enabled Smart Blood Pressure Monitor, Smart Glucometer, Smart Weight Scale, height scale, Smart Pulse Oximeter & Thermometer. Using the kit they're visiting each family at least once a month, screening their health vitals, providing feedback based on the data and referring them to Medical Assistants. After the MA check the patient, they will provide primary care. If the patient need further treatment, he/she will be referred to a doctor. 

This way, we are creating a referral chain. All level of health service providers will have access to patient health data, allowing them to provide appropriate care. Majority of the health services will be done at doorstep, reducing pressure on higher level of healthcare and therefore ensure better quality. 

Our platform is made using - 

•Android : Android Studio, Gradle

•Web: IntelliJ Idea, Maven, Node.

Server: Amazon Web Server(AWS) 

Previously, most of the rural area in Bangladesh had no structured healthcare system where patients can receive primary care and be routed to the next level of health services. Even if some places had a system, it was completely manual. People would have to store the data in paper, which is difficult to maintain & gets lost after some time. There was also human error in writing the data down. Our innovative solution implements a strong primary care system with referral chain utilizing cutting-edge technology to create a new paradigm for healthcare service delivery. Through creating digital health account, we are creating a database of health data which can be tapped into by authorized personnel to serve the populace. 

Our Artificial Intelligence driven system assesses health risk, and provides feedback on health condition. Our system is running an algorithm to further assess health risks based on previous data so we can predict health risks in future. Our IoT enabled medical devices collect health screening data directly to the mobile application, nullifying the risk of error. Moreover, the Health Volunteers are all local people, creating trust and confidence in the patients. This is having a huge impact the lives of our rural populace. 

There is a massive need for quality healthcare service in the rural area in Bangladesh. With proper implementation of a referral system and primary care services, we are significantly reducing health risks & costs of rural populace, treat majority of patients at lower facilities therefore reduce the pressure on higher level of healthcare facilities and overall helping people to be aware of their health risks, control/prevent NCDs leading to reduced mortality rate due to NCDs. We are also serving pregnant women, ensuring Antenatal care, Postnatal care for them and reduce mortality rate of mother and child. As mentioned above, Bangladesh is in high risk for both type of deaths, which can be significantly reduced with CMED Digital Primary Care platform. When spread to all across Bangladesh, this will create an aware & educated population who will have access to essential healthcare services, reduce health risk of patients. We are already seeing the benefits, as research shows that people are very enthusiastic and are more aware of their health risks, even changing lifestyle after using CMED platform. Currently, over $10 Billion is spent in healthcare costs in Bangladesh. Proper implementation of our solution will significantly reduce this burden. This will allow Govt. of Bangladesh or other governing bodies to get detailed knowledge derived from primary data to devise policies, make decisions and prevent massive disease outbreaks.

1. Currently, we are serving all the populace in one Union. There are over 7000 families living in 21 villages. The total number of people who're receiving our services is 32,607 as of July 2019.

2. We have recently agreed to expand this service to 50 more unions. With an average 30,000 populace per union, our estimation is 1,500,000 people will receive our service by July 2020.

3. Our goal is to expand this service to 200 unions across Bangladesh within next 5 years. This will increase the number of beneficiaries to 60,000,000.

Our goal within the next year to spread our CMED Digital Primary Healthcare model in 50 unions all across Bangladesh & create Digital Health Account for each individual living in ~1000 villages in Bangladesh, where they will receive monthly health checkup, health education, store their health data & referral to next level of healthcare. This will impact over 1.5 million people's lives in next year. We have already signed an agreement with our partner for this expansion. We want to reach out to 6 Million people by next 5 years.    

As of now, there are no companies that are providing exact services as ours. However, there will always be copycats that might pop up in the near future. There are a few external risks, which are discussed below. However, our Seedstars Global Innovation Prize, which we won amongst 67 startups from 67 countries, has garnered adulation from Government who are very supportive of our initiative and helping us moving forward.

Dependency on the supplier for the devices: We have tried to make the devices by ourselves first. But we faced multiple challenges which made it not cost effective. Then we decided to import the device from already established companies who are expert and connect them with our platform. This ensures we get certified medical devices. However, since they're not made here, there is a lead time to get the devices. 

Execution risks: Lack of Health Education & Technology Acceptance of Bangladeshi People.

Quality Human Resources: This is already a big problem for majority of the organizations in Bangladesh. We are also suffering from this.

Political Landscape: Development is a political process. Our goal of developing digital primary healthcare structure for rural area can also get affected greatly depending on the change in political landscape.

Dependency on the supplier for the devices: CMED being the platform makes it easier to reduce dependency on a single manufacturer and allow different options without having to depend on one. We are working with different manufacturers for FDA/CE approved medical devices to ensure quality. CMED being the platform makes it easier to reduce dependency on a single manufacturer and allow different options without having to depend on one.

Execution risks (Lack of Health Education & Technology Acceptance): Bangladeshi people are highly acceptable to technologies, we are working with Key Opinion Leaders like doctors, equipping them free prescription software to create awareness, our devices are all either FDA/CE certified, ensuring quality & acceptance, we’re working with government to spread awareness. We are creating tutorials and training manuals which are easy to use with Bangla instructions in both video and written format. Also 24/7 customer care is available for any queries regarding device usage. 

Quality Human Resources: By using our network, experience, reputation, on campus recruitment and university connection we can remove this barrier.

Political Landscape: We are bringing high quality healthcare service at a very affordable price for people who are in need of it. What we are doing is actually for good of the people. Bangladesh government is very appreciative of it, and also expressed interest to support us to expand our service region. 

Not Applicable

Our solution team has a total of 30 full time employees. On top of that, we also have 3 advisors & Consultants working with us.

We have a multidimensional team with experience from different fields working cohesively. Our founder, Khondaker Abdullah Al Mamun, PhD. is a Machine Learning and Biomedical Engineering Scientist with 18+ years of experience working in healthcare and ICT sector in UK, Canada, USA and Bangladesh. Farhana Sarker, Ph.D, Managing Director of CMED is a distinguished data scientist with working experience in industry and academia in Bangladesh and abroad. Mr. Ashraf Dawood, co-founder & COO has over 30 years of experience working in sales and operations in Pharmaceutical sector with the largest pharmaceutical in Bangladesh, and 10 years of experience in the Telecommunications Sector with the largest telecom in Bangladesh. Moinul Chowdhury, co-founder & Head of Growth, is a Biomedical Informatician with a business and engineering degree & experience in startups and business incubators in USA and Bangladesh. Dr. Mithila Faruque, Advisor, Medical Services, is the medical and public health expert and Head of the Dept. of NCD, BUHS(Bangladesh) and actively working in reducing NCDs in Bangladesh. Our Tech lead Saroj Roy is one of the top software architects in Bangladesh. Dr. Mohammad Badruddoza, our Strategy & Planning Advisor has over 30 years of experience in NGO sector. Besides, we have many competent team members who are experts in operations, marketing, sales and partnerships.

We understand the problem we are trying to solve, have faced the challenges that our people are currently facing and have a burning passion to make an impact that will change the healthcare paradigm in Bangladesh.

We clearly understand the massive undertaking we have in our hands, and our own capability. Our expertise lies in technology & innovation. Which is why we have chosen partners who are expert in their respective field. Our partner in this endeavor is PKSF.

Palli Karma-Sahayak Foundation (PKSF), an apex development organization, was established by the Government of Bangladesh (GoB) in May 1990, for sustainable poverty reduction through employment generation. PKSF has flexibility and authority to undertake programs in a dynamic environment, implementing them throughout the country and manage its affairs as an independent organization. The foundation is the largest agency for development in rural Bangladesh. 

For this solution, CMED is working on the technology side, whereas PKSF is working on the operation side.  PKSF employs Health Volunteers from the local community, who are well known by the people they serve. They employ the medial assistant and doctors as well. PKSF oversees the operation, government liaison, maintains the infrastructure and also implements interventions based on the data from CMED. CMED provides them with data analytics, service monitoring tools and a central dashboard with detailed information about each Union.

Beneficiaries: Each Individual in Bangladesh, Government of Bangladesh, Non-Government Organizations in Bangladesh

Customers: Families in Bangladesh, Government of Bangladesh, Non-Government Organizations in Bangladesh

Intervention: CMED Health Kit(), CMED Primary Care Platform, Digital Primary Healthcare Service, CMED Mobile Application, Central Dashboard

Beneficiaries Value Proposition: Doorstep Digital Primary & preventive Health Service, Referral Chain, Health Data Storage, Health risk assessment and intervention

Customer Value Proposition: Doorstep Digital Primary & preventive Health Service, Health risk assessment and intervention, Referral Chain, Health Data Storage, Data Analytics, Central Dashboard

Impact Indicator: # of Digital Health Account, # of Health Measurements, # of Referrals created, Reduction of out of pocket healthcare cost, Economic burden, Productivity

Channel: Door to Door, Partner, internet

Key Resource: Management team, Software team, Operations team, Patented CMED IP & Platform, Revenue from Services

Key Activities: Digital Health Screening Service, Health Risk Assessment, Health Education, Referral chain

Partner+Key Stakeholders: Palli Karma-Sahayak Foundation(PKSF)

Cost Structure: 

Human Resources

Training & Operations

Software Development

Revenue: 

Subscription from Partner Organization - 5.5%

Subscription from Families - 49.5%

Device Sales - 16%

Consumable Sales - 29%

We are following a hybrid version of Organizational Support Model. Our financial sustainability is coming from 3 different channels. The first one is through yearly subscription fee from families who are receiving our service. Second one is through monthly subscription fee from the Partner Organizations who are using our platform and dashboard. 3rd one is through selling  medical devices for digital health services. 4th one is through selling consumables for the services rendered. 

We are also planning to raise investment capital for the expansion of the service.

Tiger IT is one of the largest software organizations in Bangladesh. TIF can help us by connecting us with capable software developers or other Human resources. We are in need of Experienced Back end Developers, Project Manager & Tester. 

We have an agreement with our partners to expand our solution to 50 more unions. To expand, we need financial support so we can serve more people and create access to primary healthcare for over 1.5 million people.

One of the key aspects we are struggling is Impact Assessment. It would be great if we can get professional help to assess the impact CMED Health is creating.

Micro-Credit Authority

International Non-Government Organizations