Enabling female doctors for child, female & elderly patients

In the absence of a functional GP/referral system, patients do not know which doctor to visit and when. For pregnant women, young children, elderly, chronic and bedridden patients, there is no arrangement to get treatment at home. On the other hand, young (specially female) doctors struggle to find suitable jobs. 

Olwel provides a ICT platform that bridges this gap. Female doctors at Olwel call center enables doctors to work in their own neighbourhood under centralised supervision. Senior doctors review each prescription and provide on-job training. Two way followup from the call center ensures proper medication and further treatment. 

Olwel solution creates jobs for female doctors and improves their quality as physicians. It not only reduces self-medication but also reduces pressure on the scarce resources ( e.g., specialists and hospitals) by ensuring early treatment and proper screening.

In the absence of a functional GP/Referral system, getting sick any citizen is plagued with the dilemma - when to visit a doctor and which doctor to visit. This often forces patients to resort to self-medication or visit specialist doctors directly which results in excessive consumption of antibiotics and high load on specialists. Doctors cannot afford enough time for a patient to take proper history and provide counselling. Also, traditional hospitals were designed to cater for patients from a few days to a few weeks. However, low-intensity but fatal NCD patients require patient centric solution, i.e., care at home under continuous monitoring and followup visits. 

  On the other hand, as patients directly visit specialist doctors, young doctors flock to the cities for further education and compete for jobs.  Male doctors often visit the outskirts of the cities which is not a suitable option for female doctors. Also, it becomes very hard for returning doctor mothers to resume their profession. Though female doctors outnumber male doctors (53%-47%, last ten years), many of them are leaving their profession.  

High penetration of mobile phones, popularity of app based services, availability of underutilised doctors make it the right time to start our initiative.

Olwel is providing primary health care to any citizen and regular care for  pregnant women, young children, elderly, chronic and bedridden patients. There are  estimated 7.1 million people with diabetes in Bangladesh and almost an equal number with undetected diabetes. This number is estimated to be doubled by 2025. More than 1/3 of 18+ people are suffering from hypertension. People aged 55+ is ~14M and 65+ ~7M. Children under 10 years is 33M+ and number of pregnancy is 3M+ per year. 

 With the help of ICT, we are providing a family doctor who is giving the pathway to make any medical decision through the consultation with a qualified doctor. Two-way followup by female call center doctors is ensuring continuous dialogue with patients, giving us the opportunity to learn the needs of the patients and adapt our service modality.

In the near future we are going to establish locality based GP center in collaboration with renowned professors of different specialty. Their affiliated expert doctors  will sit at the Olwel GP center weekly basis to treat referred patients. These centres will be particularly important in rural setting.

Olwel bridges the gap between patient’s need and doctors availability with the help of ICT. Patients connect to Olwel using Olwel app or website or just a phone call. A doctor at call doctor triages the patients (i.e., facilitate the emergency patient to visit the relevant hospital). Otherwise, the central system dispatches the nearest doctor (registered and trained) to the patient's location. At the end of the visit, the doctor uploads the prescription electronically. A specialist doctor goes through those and provide review and on-job training. The call center doctor ensures proper medication and further treatment through two-way follow up mechanism. 

We are also providing other services, e.g., sample (Blood, Urine etc.) collection from home, medicine delivery at home and connecting to the nearest ambulance through partner organizations. Specialist consultation is provided over video and other healthcare professionals will be connected to our platform soon. 

We have developed an integrated platform that combines an EHR (Electronic Health Record), a call centre and automated dispatch system based on geo-mapping. A mobile app on the doctors phone connects the doctors to our platform. Patients can also use a mobile app to request a doctor visit and track their medical history. They can also request a visit through a regular phone call or from our website.

 The heart of the system is the backend, written in Node.js. It uses a realtime database, RethinkDB. The call centre doctors operate the system using an application named Mission Control. It is a cross platform desktop application written in React.js and Electron.js. The Mission Control, or MC, connects with the backend using WebSockets. An open source IP PBX named FreePBX is used to connect with the PSTN. We built IP phone functionality into the MC for a seamless user experience by the  operators. The operators receive a visit request in MC, call back the user from the MC and then dispatch a doctor by just clicking a button. The system notifies the doctors nearest to the patient. Then the system selects one doctor for the visit. The status of the visit is monitored in realtime by the call centre. After the visit is finished, the MC automatically prompts the operator to conduct a feedback call. During the course of medication, the MC prompts the call centre operators to conduct follow-up calls. The MC is designed to guide the operators in every step so operations can be scaled easily.

Bangladesh is the most densely populated country in the world. Specially, the urban areas are too congested where traffic jam is often unbearable. Unfortunately, not only the main hospitals are in the cities but also young doctors flock to the cities for further education.  Even though there are only 7 doctors for every 10000 patients, 1 out of 3 doctors are unemployed now whereas rural people are often deprived of consultation with qualified doctors. Note that More than 50% of these doctors are female.

Under this unique context, we need a unique solution. Enabling doctors to work independently in their own neighbourhood  under centralised supervision and on-job training, there will be a dramatic change in healthcare delivery system. Not only traffic jam is beaten, eventually GP system is going to be in place due to the convenience of a doctor at the comfort of one's home. Our innovation not only engage the unemployed doctors but also make proper use of free time of other doctors in the urban areas. 

On the other hand, if the doctors want to build their career as a GP, they need a few years to build reputation to earn a decent income. Earning trust and confidence as an initiative, Olwel is going to cut this time short and allow the growing number of doctors to get distributed throughout the country to serve millions of people. Centralised monitoring and working as a team with specialist doctors dramatically change the quality of healthcare delivery system.

In the absence of functional GP system, the healthcare delivery system is scattered. The treatment journey often inflicts more pain than the disease itself. Proper utilisation of ICT based solutions is giving the opportunity to bring discipline in this chaotic sector.  

We have made the access to a qualified doctor very easy. People can use our app, website or just a phone-call to connect directly to a qualified doctor. Call center doctor is sending an emergency patient directly to the nearest relevant hospital.  Otherwise home visit doctors are providing treatment or referring to the right specialists. If necessary, an specialist doctor is coming over video in the presence of a home visit doctor. 

When our old users make the first repeat call, most of them  get surprised to learn that their past records are already at the fingertips of the doctors. Also, the home visit doctors are provided with the previous history of the patient through doctor's app. This not only improve the quality of healthcare delivery system but also gives the patients confidence on our system. Around 40% of the home visits are repeated, i.e., are taken by the patients from those homes visited earlier. Bringing senior doctors in the loop, making proper referral at the right time to the right specialists, engaging patients through bi-directional followup and providing all these facilities at the comfort of their own homes - GP/referral system is getting into effect as a side-effect. 

17,000+ people have been served by our doctors at the call center. A significant percentage of these people have called our doctors at their home.  As per our current plan we are going to serve 70,000 patients at their home by 2020 and millions in the next five years.

In next five years we bring whole Bangladesh under our service. In Bangladesh 50,000 students are choosing healthcare as their profession each year. On the other hand, the number of ageing population is increasing along with prevalence of chronic diseases.  Facilitating healthcare professionals to the patients' home by real-time spatial mapping under centralised supervision will ensure better utilisation of healthcare resources and quality service for millions of people. 

By the next year, we want to serve the people in all the divisional headquarters. We are also going to bring other healthcare professionals (e.g. nurse and physiotherapists) in our platform by next year. 

With a scalable  technical platform where four layers of doctors (call center, home visit, supervisor and specialist doctors) work independently  and provide the patients a seamless experience, we are ready to serve millions of people in a short time. Within the next five years, we want to expand our service area throughout the whole country. In the rural areas, we will establish some centres and use existing locality based pharmacies as the sub-centres - which will be visited by our doctors both in a pre-scheduled and on demand basis.

Our technical platform is designed and developed in a robust way to support such operation.

• While scaling up,  we need to go through an ice-breaking phase for both the patients and healthcare professionals. During the next one or two years, creating awareness, and earning trust and confidence will be an important barrier.

• Arranging the required funding for the first few years of operation is one of the important barriers. In order to create awareness, build trust and confidence, we need  huge engagement. Also, providing proper training to improve the quality of healthcare professionals is at the heart of the priority list of Olwel. Introducing point of care testing tools, gadgets also requires significant funding. 

• Partnering with the stakeholders at the right time is another important issue. Among the competitors, both traditional centralised healthcare establishment and telemedicine providers are in the scenario. 

• Doctor at home is nothing new. It has not been practiced widely in the last two decades and a half, however, most people can easily relate to it. The need and the simplicity of availing the service is melting the ice quickly.

• We are already engaged with investors from both home and abroad, relevant government bodies and development partners. We are confident to secure necessary funding in a reasonable time-period.

• We are already making good progress in partnering with the right stakeholders.

• We are bridging the gap between the traditional centralized healthcare delivery system and the emerging telemedicine industry. Our holistic approach is making us a one-point solution.

Olwel BD Ltd. is a joint venture company with Finland based Olwel Oy Ltd. 

Olwel doctor service is designed in a very flexible way so that the doctors who are pursuing their further education can be accommodated. 

There are 7 full time employees and 54 part-time employees. 

All of the team members except Saleh and Vilho studied together in either school, college or universities. First 3 of them finished their BSc in EEE from BUET in 2001. Feroz studied with Hossain and Hasanat in NotreDame college, and in school with Faiz.

Aftab Hossain obtained his MSc (2009) and DSc (2016) degrees from Aalto University, Finland and worked as a postdoctoral researcher in KTH RIOT. He also worked for Robi from 2002 to 2007.

Mojahedul Hasanat is one of the finest software architect and developer of Bangladesh with 20+ years of experience. Being the CTO of Therap Services, LLC for 12 years, he built a  software platform in the developmental disabilities sector, serving half a million people 24x7 in the USA. He is also a co-founder and CTO of Dynamic Solutions Innovators (DSi) since 2001.

Abdullah Faiz has 15 years of commercial experience. He is working as the Director, B2B product and marketing at Banglalink. He ranked #2 in his MBA from IBA, Dhaka University.

Vilho Jonsson was with KTH Royal Institute of Technology and Tele2 before co-founding Curlabs AB. He is working as the head of international cooperation. 

Dr. Salahuddin Feroz obtained his MBBS from Dhaka medical college and MD from BSMMU. He is the consulting director, medical services in Olwel BD.

Dr. Saleh Mahmood got his MSc from UoN, Uk and M Phil. from KCL, UK after obtaining MBBS from Rajshahi Medical College, Bangladesh. He is in charge of quality assurance, medical service for Olwel BD.

Thyrocare BD Ltd.- They collect samples (e.g., blood and urine) from the patient's home, do tests in their own laboratory and deliver the reports at the patient's place. They also send soft-copy of the reports to our supervisor doctors.

LifeSpring: They provide mental health support at patient's home.

Diacare: They delivers insulin and any diabetic related products at the patient's home.

Ural: They connects to the nearest ambulance.

E-pharma: They delivers medicine to the patient's home. 
Maya Aapa: They provide answers to any questions asked by anonymous users on health issues. 

UHC: UHC is an emerging think-tank on sustainable development including public health and health economics.

Dhaka South City Corporation(DSCC): We provided doctor at home service partnering with DSCC when most of the hospitals got overrun with patients suffering from dengue at the end of July, 2019.

Our business model is pretty simple. Any citizen needing a instance-based doctor consultation is served in a pay-as-you-go mode.

For patients who need long term care (e.g., pregnancy care, neo-natal care, elderly  and chronic patient care), we provide subscription based service.

We provide GP doctor consultation, Specialist doctor consultation in presence of a home visit doctor at the patient’s place. 

We also facilitate sample (e.g., blood, urine) collection from home and report delivery, connecting to the nearest ambulance, diabetic product home delivery and mental healthcare at home through partners. We also facilitate the patients to visit diagnostic centres. Some of these partnership give us parallel revenue streams.

In order to be sustainable, we need the combination of both selling services and raising investment capital. During 2020 we plan to raise US$1.4M and in 2021 US$1.2M to  become cash positive.

Winning Tiger Challenge will give us recognition and open the doors of much needed partnerships with relevant organisations from home and abroad. As we have a robust technical platform in the heart of our system, Tiger IT will be a good partner to consult with while scaling up. 
 We believe that disrupting healthcare delivery system is a huge task and partnering with existing and emerging organisations is essential to do that. We are counting on the strategic and operational support from a successful organisation like Tiger IT. 

The organisation that provide impact funds will be very helpful to ensure our fast growth.

Partnering with the providers of healthcare training will be vital to improve the quality of services, specially for support staffs  (e.g., nurses and physiotherapists). 

Partnering with the organisations that are working with disrupting technologies in healthcare sectors will be important too.