Sustainable primary healthcare delivery for rural Bangladesh

In Bangladesh healthcare service provision has generally focused on maternal and child health services, other groups are left underserved and other health concerns and conditions overlooked (such as prevention, risk factors, communicable and non-communicable disease). More over the country is facing human resource crisis and out-of-pocket informal payments for health services & medicines that are exhausting millions of households.

In iKure, with the evidence we gained from operating across seven Indian states, five Sub-Saharan African countries and one South- East Asian country named Vietnam, we like to scale our solution to bring our unique value proposition to the existing fragmented public care delivery model in Bangladesh.

Our solution runs through a cloud hosted application called WHIMS, indigenous point of care diagnostics and AI based solution for communicable and non communicable disease. Moreover the technology enable solution will be implementing by Community Health Workers with added option for livelihood generation.

Bangladesh heavily depends on govt. or public sector for financing health systems. However, with insufficient allocation of funds ie., 34% of the total health expenditure  spent, 66% is  being out-of-pocket (OOP) expenses. Inequity, therefore, is a serious problem affecting the health care system. With the need to prioritize primary healthcare as the foundation for integrated health reforms in Bangladesh,  iKure proposes a technology enabled solutions to expand the geographic reach of the delivery system for the poor and underserved population. Our  solution is enabled with disruptive technology applications to provide access to treatments, track and monitor illnesses, disease surveillance, measure and monitors body vitals, and identify the underlying health conditions and adequate recovery even at the patient’s door steps.

The solution serves  to improve access to integrated primary care, Community Health Workforce, and vulnerable mother and children. Recognizing that shifts in people’s orientation from proactive to preventive care take time and require continuous engagements, iKure works with the local community members, self help group  and WHIMS enabled health worker’s module to empower them to provide care and strengthen community ties to achieve progress on health information and health seeking behaviour. Healthcare behaviour gets affected by socio-cultural and behavior norms, language differences and traditional healing practices. iKure’s mobile solutions address these factors through text based application for health education and awareness promotions.  Patients receive reminders about treatment and management of their conditions and obtain suggestions from health workers for improving sanitation, hygiene and disease controls. The health workforce further works on treatment plans based on the information available on their fingertips.

iKure’s  cloud hosted technology called Wireless Health Incidence Monitoring solution(WHIMS) is designed with an intuitive graphics user interface. It is accompanied with instruments to measure vital statistics of patients, and for it to be a more reliable diagnostic tool, WHIMS is loaded on a tablet, and trained army of rural health workers, are employed to collect vitals and diagnose patients in remotest areas. The integrated technology solution can provide services acrissdifferet service delivery model, for example

1.Door step services encompass integration of WHIMS with Point of Care devices. WHIMS can capture data at the door-step of the patients without manual error. In fringe area it operates in offline mode and updates the health data in cloud server in online mode.

 2.WHIMS also extends support at Outreach centres. The medical staff from a fixed peripheral (hub) facilitate services at pre-arranged sites (spokes) within the community, providing mix of antenatal and child health services with basic medicines.

3.Utilizing WHIMS, iKure has established effective referral linkages with hospitals through which delivery cases can be seamlessly escalated for tertiary referrals.

Our portfolio of services includes on-site general medicines, diabetic care, cardio vascular care, mother and child, computerized eye care, on-site eye glass cutting & edging, pathology services, AI based solution for diabetic retinopathy, CVD and telemedicine all enabled through Wireless Health Incident Monitoring System (WHIMS), that enables collection and dissemination of accurate wellness information for effective pre-emptive and preventive action.

Accessible &affordable healthcare up to the last mile: The solution has the capability to outpace the reach of conventional infrastructure and offer chance to expand the geographic reach typically for underserved population.   

Reduce risk and complexity of disease: With WHIMS offering high visibility of health data accompanied with periodic monitoring and consultation, it enhances the efficiency of treatment and reduces risks and errors associated with treatment compliance.  

Improved efficiency of healthcare providers: The mobile solution offers the benefit of improving the efficiency of physicians allowing them to diagnose, treat and monitor more patients than face to face settings, utilizing less resources and freeing up time to diagnose more patients and giving more attention to more complex and high value cases.    

Partnering with healthcare providers to enable acceptability and initial apprehensions: iKure’s partnership ecosystem helps mitigate initial apprehension and initial anxiety associated with adoption of  mobile solutions by working with community members at grassroot level up to the govt.  

Offer user-friendly plug and play localized solutions:  WHIMS easy to use interface and plug and play device addresses literacy and language barriers as well as socio-economic disparity.

Capacity building and livelihood generation: iKure’s use of mobile applications improve the effectiveness of CHWs. As these features greatly expand the no. of people who serve as health workers, the capacity of these CHWs is strengthened through intensive clinical and technology training, which equips them with skills to pursue livelihood and adapts technology to their needs.

Theory of Change

iKure is operating across seven states including West Bengal, Jharkhand, Uttar Pradesh, Karnataka, Assam, Orissa and Meghalaya. In these states, we have reached 8.2 million populations,0.9 million patients treated across 3,940+ Villages. 550+ Community Health Workers are trained with this cloud hosted technology. In international market iKure is also working with countries like Vietnam, Finland and parts of sub Saharan Africa like Kenya, Tanzania ,Uganda DRC and Ghana.

 By2023, iKure will deliver access to affordable primary care to 25 million rural populations in 11 Indian states (West Bengal, Madhya Pradesh, Andra Pradesh, Meghalaya, Assam, Telangana, Uttarakhand, Chattisgarh, Nagaland, Tripura, Rajasthan/HP). By 2023, iKure will provide direct and indirect jobs for 5000 low income people (out of which 40% are low income women) in 11 Indian states.

In Bangladesh in 5 years of deployment, we aim to cover 6.6 Million populations through 10 Hubs considering.  We are estimating to serve2%  youth population, 5% working age population and 2 % Elderly population present in rural areas out of total population. 

1St Year we will target to achieve 0.5 million populations.

2ndyear 54% increase in targeted population – 1.1 Million

From 3rd year onwards we increase 1 million target populations with two new hubs opened.

We aim to replicate and scale up iKure’s primary healthcare model across 10 districts in different states of Bangladesh and empower 2000 CHWs within 5 years of deployment of the initiative.  

Per Hub we will train 200 CHWs out of Which 20 will be directly employed by HuB.  Leading to the creation of (10*20= 200) direct jobs for CHWs in the community. The rest of the CHWs(2000-200=1800) will be indirectly involved with iKure by selling various healthcare products and services through iKure’s supply chain model. Moreover, direct jobs will employ all women from low- income community and indirect jobs will employ 40% women and 60% youth from low- income community.

• Operational: Operational risks that could be in terms of generating revenues and earning profits
• Financial: Adequate funding requirement to open new tech enable Hubs
• Technical: Incorporate more cost effective AI based solution into the model
• Cultural: To make people adaptable for tech enable solution for primary healthcare in completely new in the region.
• Market : To gain trust of the community for preventive care 

a. Operational Barrier: Operational barrier that could be in terms of generating revenues and earning profits. To mitigate the risks, the model will facilitate several additional revenues through doctor’s consultation, pathology tests, maternal & child health care, and dispensing nutritional supplements at low cost to the target population.  The project will involve proper identifying, assessing, managing, documenting, communicating, screening, and monitoring the project at regular intervention for effective operation and execution.  

b. Financial Barrier: Serving lower income customer base can consists of financial risk which iKure plans to mitigate through its tertiary linkages with urban hospitals. These linkages provide financial assistance to poor patients to avail discount price for surgery medical care and secondary care through iKure’s network.

c. Regulatory Barrier: iKure’s institutional ethic community comprising of prominent senior members from across platforms like medical practitioners, philosophers, academicians, and lawyers will ensure the project meets the regulatory norms and conditions and carried out ethically on ground.    

d. Technology Barrier:

• Open API and Mobile APK: WHIMS has open API which allows device/software easy integration.
• Using AWS provides several security capabilities and services to increase privacy and control network access.
• WHIMS is deployed onto the cloud server with the capability to work on online and offline mode. 

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We will open 10 fully equipped Hub in 10 Districts of Bangladesh

Assuming CAPEX required to form a fully equipped Hub require $27975(Dollar exchange rate 71.49)

OPEX needed to operate one Hub to run 1 year= $50356

After 1 year we will set up2 Hubs per each year 

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Total Employee=51

Full time=2

Contractual=2

Parttime=1

Founder & CEO, Ashoka Fellow 2016 has over 12 years of experience in the IT sector, started iKure with the vision to provide affordable and accessible quality healthcareupto the last mile.

‘Senior Medical Advisor and Medical Director’ who brings with him a vast body of experience in the domain(s) of clinical practice and Medical Administration and Quality Supervision

Chief Growth Office with 25 years experience in the Health Tech Space globally, served in senior positions including as General Manager & Healthcare Vertical Head in Siemens/ATOS

Research Communication Analyst who is a doctorate in Corporate Communication from IIT Kharagpur, has worked in diverse fields of communications such as Lie Detection, Multimedia Communication

Associate Vice-President, Technology with 15 years of experience with international NGOs, state and national governments in India, consulting firms in project management, communications for development, knowledge management, qualitative and quantitative research studies. Experience of research and project management in healthcare, livelihood, e-Governance.

Dynamic Business Development, Technology, Operation and Research Team for smooth functioning of the project.

We have few ongoing discussions with few private entities in Bangladesh as a ground implementation partners the details will be provided when iKure will zeros down on the list. 

The integrated health care facility will offer various revenue streams to make it self-sustainable in the long run:

Revenue streams will include:

• Doctor’s consultation fees
• AI solutions for pre& post hospital care
• Services obtained through diagnostic facility
• Services obtained through Pathology lab
• Telemedicine Services
• Services obtained by CHWs for door step healthcare delivery
• Medicine
• Power testing, selling of eye glasses, medicines and nutritional supplements
• Services obtained through tertiary linkages

The proposed facility will build successful sustainable development model by establishing effective and strategic partnership with key supporting organizations, across sectors such as businesses, NGOs, philanthropists, and academia. This ecosystem partnership will play a pioneering role in the business development, customer acquisitions and building on a robust network in the respective community. For example, at ground level, iKure’s association with local NGOs support building trust and assess service demands in the local communities. With training partners, it will build capacity of local community to address rural healthcare gap, with leading hospital partners, it will offer discounted prices to avail the services at urban hospitals. With global research partners, iKure will develop global approaches to rural health. The paired partnership will unleash new ways of finding holistic solutions to health, mobilize local resources in hard-to-reach remote settings, and help attain mass level impact on rural health in Bangladesh. 

Key barriers to succeed includes investment, motivated workforce to serve resource constrains settings, technical expertise to scale up and expand our solution. We are looking for technical assistance from solve, mentoring and media exposure to take our solutions in different geographic locations, connect with investors and peer networking.  

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Healthcare diagnostic device partner for identifying low cost devices suitable for rural demographic, Technology partners for developing more features in WHIMS, Industry Partners for exposure in healthcare market. In association with the MIT and Solve community we want to impact globally in affordable quality care domain for the under served communities.