JBA-BLOG: Rise of Digital Healthcare in Bangladesh

The pandemic has thrust the global healthcare ecosystem to an unprecedented level. Also it has underscored the necessity of a tech-driven, low-cost, accessible-for-all healthcare infrastructure. Things are certainly not exception for Bangladesh; the country's health-preneurs played their roles as front-runners to combat the crisis. Some of them have been able to raise local & international, angel and venture capital funds during pandemic.

Source: medstack.co

History of Telemedicine in Bangladesh

1999: A charitable trust named Swifne Charitable established an email-based link between the Centre for the Rehabilitation of the Paralysed (CRP) in Dhaka and Royal Navy Hospital, Haslar, UK. It was the first telemedicine project in Bangladesh. Under the tele-consultancy project, digital camera was used to capture necessary images and those images were sent to the consultants via emails.

July 1999: A private company named Telemedicine Reference Center Ltd. (TRCL) was launched to set up telemedicine project to deal with preventive diseases. Initially TRCL was able to link 200 specialists to offer their expert opinions to rural doctors. TRCL also conducted feasibility studies to establish national and international telemedicine services.

Mid - 2000: Grameen Communications took rural tele-health initiatives with the help of wireless technology.

2001: TRCL demonstrated a telemedicine system between US and Bangladeshi physicians in the US Trade Show 2001 in Dhaka.

April 2001: The Bangladesh Telemedicine Association (BTA) is formed.

January 2003: Sustainable Development Network Program (SDNP) Bangladesh was inaugurated. Under this program weekly consultancy and diagnostic supports were rendered to the doctors in remote areas in Bangladesh.

In the later half of the year, Bangladesh University of Engineering & Technology (BUET) and Comfort Nursing Home started another email-based Telemedicine project with the help from European Union (EU). In the next year, Comfort Nursing Home started another project with DNS diagonostic center.

August 2005: Grameen Telecom (GTC) in cooperation with the Diabetic Association of Bangladesh (DAB) launched (probably) the first video consultancy services in Bangladesh. Cost per consultation for a new patient was 10$ or 600 tk with discounts for follow-up consultation.

November 2006: TRCL and Grameenphone (GP) started “HealthLine Dial 789” - a GSM infrastructure based call centre for 10 million GP subscribers. Several services such as SMS based LAB reports, ambulance, real time consultation over mobile phone, etc. were rendered initially.

September 2007: A project named ‘ICT in rural Bangladesh’ was inaugurated to develop healthcare facilities in rural areas. The project is funded by Swedish Program for ICT in Developing Regions (SPIDER) and was conducted till the end of 2009.

Transition to High-end Digital Healthcare

The demand side of Bangladesh Healthcare sector has never been feeble. Demand for healthcare services has been increasing on the back of steady population growth rate, double-digit growth rate of Middle and Affluent Class (MAC) population and increasing aged population. Like most Asian countries, Bangladesh is yet to reach its peak population. While total population has increased with a steady 1% 10-year CAGR, number of population aged 50 years or more has increased by around 4% in 2010-2020. Percentage of elderly population stood at c17% in 2020 vs c13% in 2010. As aged people are more prone to diseases, they need more healthcare services. Though lower, compared to the other Asian countries, MAC population is over 10% of total population now, from 6% in 2015, denoting over 12% 5-yr CAGR. Per capita income is $2,227 in 2020 vs $2,064 last year which is another indicator of rising income level. Some portion of this higher income generating people are willing to spend more for safe & fresh food, healthy lifestyle and better quality healthcare services. On the other hand, major portion of population can not or do not follow healthy and disciplined lifestyle. For various reasons, people often jeopardize their health and start to get vulnerable to diseases at an earlier age, resulting in opting for healthcare services for more years. So willingly or unwillingly, either way, the increasing population with rising income level are attributing to higher healthcare expenditure and contributing to the epidemiological shift from communicable diseases e.g. Hepatitis ABC, blood borne diseases, etc. to chronic diseases e.g. such as diabetes, cancer, cardiovascular diseases, etc.

In the supply side, Access, Cost and Quality, have been the top concerns. Number of urban people continues to increase however 61% of total population still lives in rural area. Rural people remain deprived of high-end healthcare facilities as most health facilities and healthcare workers are concentrated in urban areas. Also most private hospitals are in urban areas and average costs are also higher for the private hospitals than those for the public ones.

Bangladesh's healthcare quality has been a burning issue and it is not getting better. In 2018, over 700,000 Bangladeshi went abroad to seek better treatment causing a whooping $4 billion flushing out of the country. In the Healthcare Index 2021, among the 93 countries, we are the penultimate one with the score of 42.7. Only Venezuela (39.67) is after us. All South Asian countries scored higher than Bangladesh.

To solve this seemingly everlasting problem of ensuring the access of high quality healthcare services for a major portion of population with reasonable expenses, Digital Healthcare or Health-tech startups are proving themselves handy. Arguably most of them are focusing more on the access and expense side as several external factors are affecting the healthcare quality, delaying the issue to get resolved any time soon.

Although the growth of usage of digital healthcare services seems newfound during the pandemic, the country’s health-preneurs have been laying up the groundwork on the back of increasing digitization in the last decade. Access to personal computers per household were around 10% in 2006; that increased to over 23% till 2020. Mobile phone penetration grew faster than computers. Currently mobile phone has 69% share in device market in Bangladesh. Though the number of mobile connections are more than the total population of the country we cannot say that all people are using mobile now as the number does not denote unique connections. However considering 4-person per household, it is safe to say, almost all households have access to mobile. 66% of these mobile phone users are using internet. Also price per MBPS data has been following a decreasing trend, thanks to the intervention from the Government. Considering all these, local health-preneurs have been trying to provide mobile-friendly, tech-based and cheaper healthcare solutions to the patients.

Trends in local Health-tech

We have followed some 10+ local health-tech startups. They are operating in several segments like - appointment booking, medical advice, medicine delivery, ambulance service, testing facilities, insurance service etc. These startups have done a tremendous job by having decent traction through great strategy and by capitalizing on digitization. Some of them have raised funds in recent years and are ready to expand to different verticals and gather traction in different regions. There are still some aspects where local health-techs can put more focus and can attract global investments.

Healthcare Analytics helps medical professionals and health-tech knowledge workers to identify, acquire and utilize valuable information data to provide better healthcare services. Software plays pivotal roles in determining procedures that not only reduce paperwork, but also acquire data to improve quality of services and increase efficiency.

The Paradigm shift from Physician-centric to Patient-centric, engagement-based, digitized healthcare is phenomenal. However people are not wholly convinced about interacting through digital-only touch-points. So some portion of the services, at least the critical ones, will always be rendered through human support. Artificial Intelligence & Machine Learning (AI/ML)-based Med-tech breakthroughs, and Augmented Reality/Virtual Reality (AR/VR)-based solutions are expected to help to replace the human interaction.

People are still preferring to be treated by PEOPLE and opt for traditional methods over digital ones. Also health-techs still have long way to go in having traction in rural healthcare space. Even not all urban consumers are tech-savvy and health-techs do face challenges regarding the digital literacy of the demand side, hence operating in the semi-digital infrastructure. CMED is working diligently on increasing digital engagement and literacy of the healthcare consumers.

Rural reach is yet to reach at satisfactory level, even with tech-inclusion, in the healthcare space. Strategic and reciprocal partnerships with bigger companies and startups with more reach might come handy in this regard. Partnerships with big Telco players like GP, Robi, Local brands like Walton, Runner, MFS providers like bKash, Nagad, Food-tech giant Foodpanda, Ride-sharing & Food-tech startup Pathao may help the healthtech startups to gather reach faster. Also strategic partnerships with NGOs are expected to ensure effective rural deployment.

Telemedicine Companies

Praava Health started its operation on full-scale from 2018. Praava provides in-person consultation, video consultation, diagnostic services including lab and imaging, pharmacy with delivery, and customized health check service from home. In the pandemic, Praava rendered COVID-19 tests in its family health center at Banani and in the sample collection booths across Dhaka. It also offered home sample collection, processed 75,000 COVID-19 tests in-house in 2020. According to Techcrunch, Praava serves over 150,000 since its inauguration in 2018. Following the "brick and click" model, meaning integrating both offline (brick) and online (click) presences, Praava has built flagship medical center in Banani and 40 other smaller clinics in Dhaka. With the recently raised $10.6M Series A funds, Praava plans to build 10 more clinics in Dhaka and to expand in Chittagong. The health-tech startup also plans to build a Super-App to offer all its services consolidated into one mobile app.

DocTime is a tele-medicine service provider where a patient can search doctors and can opt for video consultation. After the consultation, doctors can upload e-prescription in the app. The company claims that the consultation is secured, safe and confidential. DocTime also offers integrated payment services and medicine delivery services in the app with more convenience. It provides other services such as - medicine reminder, discount on various diagnostic, follow-up consultation reminder, etc. Backed by investors from both Bangladesh & England, DocTime is currently offering some promotional offers like - Consultation with a medicine specialist with only 10 tk cost, a Child specialist with 29 tk, gynocologist with 39 tk, and COVID consultation with 99 tk.

Maya is a tele-consultation provider specially for women, for sensitive issues such as mental and sexual health. The company uses Machine Learning (ML) and Natural Language Processing (NLP) technology to offer Q & A based services where users can ask health-related queries, get answered and also get routed to experts if needed. Users can also schedule appointments with the doctors registered on Maya app.

Maya partnered with another local medicine delivery provider BanglaMeds to offer medicine delivery services to the users. In April 2021, ride-sharing startup Pathao rolled out in-app health service features dubbed as "Pathao Health" in partnership with Maya. The company raised $2.2 million in 2021, which is the largest seed fund raised by any local health-tech company so far. The seed round was led by Anchorless Bangladesh, an early-stage venture investment fund, and The Osiris Group, a private equity firm focused on impact investing in Asian markets. As Maya claims, it will use the fund to introduce new products to its tele-health platform and to expand to international markets.

DoctorKoi has smart prescription writing software by which doctors can write prescriptions quite conveniently. From a report from futurestartup, DoctorKoi has worked with over 1300 doctors, established B2B partnership with top pharmaceutical companies, and has processed over 2.6 million digital prescriptions. The company raised funds from Accelerating Asia, a Singapore-based startup accelerator and Bangladesh Angels Network, the country's first angel investment platform.

Arogga is an online pharmacy where medicines from different brands are easily organized and order and delivery of the medicines can be tracked. Consumers can check out necessary medicines and buy the suitable ones. There are promotional offers like discount, cashback, free delivery that enable the customers to purchase medicine at cheaper rate. Launched in 2020, Arogga app recorded 50000+ installs as yet. The company has raised undisclosed amount of fund from Dubai-based angel investment company, Falcon Network.

CMED is a cloud-based, IoT-enabled, Artificial Intelligence-driven, preventive healthcare platform providing regular health monitoring services. The startup offers analytics based health monitoring report to the patients. The startup graduated from GP accelerator in 2016 and won the Innovation Award at the Seedstars Summit 2018.

CMED workers are diligently working on availing smart healthcare services by providing health literacy and teaching the patients usage of medical devices. CMED's local health workers come to the doorstep and provide with digital healthcare services, and if required, refer to the doctor.

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