Emerging Insights 2018 - Health
Heart disease, stroke, chronic pulmonary disease, lung cancer and diabetes reign as leading causes of death globally, and malnutrition is responsible for 45% of the deaths of children around the world. 350 million people around the world have been diagnosed with depression, which was estimated to cost at least $800 billion in lost economic output. Half the world lacks access to essential health services, pushing 100 million people into extreme poverty because they must pay for health care out of pocket.
Despite these issues, there are reasons in 2018 to feel optimistic about the state of global health. Technological innovations, driven by the availability of artificial intelligence, have created unlikely scenarios where treatments are discovered and tested: a clinic in Uganda is teaching doctors from the United States a new technique to reduce brain swelling in babies and a new instrument for vaginal delivery of babies was invented by an Argentinian car mechanic. Greater interconnections and cross-border communication pathways are enabling real-time health solutions and enabling more people to take proactive control in their individual health outcomes.
New IdeasPrasanna Shirol was working in sales and marketing in India when his first daughter was born with a rare disease, diagnosed later at seven years of age and the first case to be diagnosed in the country. Dorica Dan was a student of economics in Romania when she gave birth to a daughter with Prader Willi syndrome which went undiagnosed for 18 years. Both Dorica and Prasanna have now dedicated their lives to help other families navigate and shift healthcare landscapes to advocate for holistic approaches to manage rare diseases.
In this year’s cohort of Fellows, we see that Fellows like Prasanna and Dorica can change healthcare systems healthcare by using new technologies that help to connect ideas and people and put powerful solutions into the hands of afflicted individuals. Whether it is in enabling people to power their own healthcare through technologies that focus on preventative screenings or technology to improve financing, it is clear is that the new resources and tools being developed by social entrepreneurs are improving health indicators worldwide.
People powered healthcare
One of the major industries where models of beneficiary-centered interventions are making a difference is in healthcare screenings and prevention. As we have seen, the availability of mobile technology and continuing research and innovation has created an enabling environment for more and more people to access life-saving, preventative, and adaptive healthcare.
Take Andrew Bastowrous. Andrew knows all too well the power of sight. When he received his first pair of glasses at the age of 12 and was suddenly able to succeed in school, he realized just how important it was to be able to catch and treat preventable blindness. A doctor by training, Andrew conducted eye care research in rural Kenya and created over 100 eye clinics. He then developed smartphone technology that would enable lay people to diagnose vision issues. His organization, Peek Vision, develops innovative and accessible technology to screen and diagnose, which he then pairs with local community outreach programs. Andrew also partners globally with Ministries of Education to deliver school screening programs that teachers can lead. His whole-system approach is working to enable local systems to easily and efficiently upgrade how they manage eye health. Peek’s technology is being used in 154 countries worldwide.
Democratizing access with technologyMohammed Dalwai witnessed the loss of a patient who had been incorrectly triaged and diagnosed. He realized there had to be a better way for doctors working in remote locations to be able to get regularly updated and locally appropriate standards and guidelines for treatments. Doctors often rely on outdated paper-based medical information or digital journals that have high fees to access. Mohammed’s Open Medicine Project builds applications that help frontline medical workers gain access to the latest medical resources with locally appropriate data. Example projects include an HIV clinical guide, emergency medicine guide, and a mobile triage app. Based on the principles of open access, Open Medicine has empowered over 150,000 health care workers in over 200 countries. The apps give up-to-date medical information and tools so that healthcare providers in remote and underserved areas can make the best possible decisions for their patients.
From better diagnostic tools for healthcare workers to creating a culture of preventative healthcare through screenings and consultations, Marcos Lacayo is also using technology to democratize access for improved health outcomes. Nicaragua is seeing a major crisis in chronic medical conditions – 10% of the adult population has diabetes with over 373,400 cases reported in 2017. Particularly high levels of poverty and prohibitively long wait times in public health centers has resulted in citizens foregoing preventive care, leading to deteriorating health. Marcos introduced Estación Vital to provide free health screenings in high traffic areas. These are kiosks that use iPads to guide users and help them measure blood pressure, temperature, vision, weight, or BMI. The services are free with an option to add a glucose test for 64 Cordoba ($2). He has also introduced low-cost telemedicine services. Though still early-stage, Estación Vital has already shown that 40% of recurring users, about 7,500 people, have reported concrete improvements in health such as lower blood pressure or reduced weight.
Innovative health financing
For many people in India, purchasing health insurance has not been a high priority, as there always seems to be more immediate basic needs. In light of this, Kumar Shailabh co-founded Uplift Mutuals, a mutual health insurance model built on the principles of solidarity and collective responsibility. His solution enables members to co-own insurance plans and take part in designing the product and processes. They are also empowered with decision making by having access to tools that Kumar’s team developed after testing the methodology in nine locations for over a decade. In doing so, members are empowered to decide premiums and whether certain illnesses should be covered under the insurance. A technological infrastructure enables claims to be processed and reimbursed in as little as eight hours, ensuring that cash gets where it is most needed. Uplift Mutuals partners with organizations like microfinance institutions and taxi and labor unions to enroll individuals who would otherwise not be able to access insurance. In the next three years, Kumar aims to scale to 1,000,000 insured.Nolwenn Febvre has found a solution to reduce costs while improving health care delivery. Her organization Les P’tits Doudous promotes innovations in care and created a free toolkit to establish sustainable revenue streams – like recycling non-contaminated hospital waste like copper scalpel cables. There are 40 chapters with 300 volunteering health professionals who are actively designing and implementing a range of projects. One of the most successful has been the design and use of an app that decreases patient’s anxiety. The app has been adopted by every local team and is lowering the pre-surgery anxiety of 50,000 children a year.
The Opportunity: Collective health outcomes
How can we enable effective co-creation in health innovations around the world?
Physical and mental wellbeing is at the core of creating communities that thrive. And Ashoka will continue to seek out and support social entrepreneurs committed to changing healthcare systems in favor of ensuring everyone has the rights and access to improved health outcomes.
The nine Fellows elected this year in the physical and mental health sectors join 574 Fellows worldwide. Our work to support social innovation in this sector has been supported by a number of strategic partnerships. Since 2010, our partnership with pharmaceutical company Boehringer Ingelheim has supported the work of 81 Ashoka Fellows worldwide who are working in specialized care, sanitation, long-term care, disability, medicine, mental health, primary health care, nutrition and acute care. A partnership with Philips Foundation is supporting efforts to identify new solutions while accelerating co-creation between business and health innovators. There have also been regional collaborations like the 17 Fellows working in health and agriculture in West Africa who have joined forces to create the Innovative Cooperative for Optimal Nutrition (ICON) to challenge nutritional outcomes in their countries by combining their systems changing solutions. More and more, we see opportunities for targeted problem solving through collaborative teams of social entrepreneurs.
 World Health Organization (2018) The Top 10 Causes of Death. Retrieved from https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death
 World Health Organization (2018) Malnutrition Retrieved from https://www.who.int/news-room/fact-sheets/detail/malnutrition .
 Psychiatry & Neurology Resource Center (2017) Depression in Numbers. Retrieved from https://progress.im/en/content/depression-numbers-1
 World Health Organization. (2017). Tracking Universal Health Coverage: 2017 Global Monitoring Report.
 Doucleff, M. (2017) Surgery For Saving Babies From 'Water On The Brain' Developed in Uganda. Retrieved from https://www.npr.org/sections/goatsandsoda/2017/12/20/571780235/surgery-for-saving-babies-from-water-on-the-brain-developed-in-uganda
 Clune, K., & M. Merialdi (2012) Meet the Innovator: Jorge Odon. Retrieved from https://blog.usaid.gov/2012/01/meet-the-innovator-jorge-odon/
 International Diabetes Foundation, South and Central America (SACA) members. (n.d.). Retrieved from https://www.idf.org/our-network/regions-members/south-and-central-america/members/86-nicaragua.html
Institute of Health Metrics and Evaluation. (n.d.) Nicaragua. Retrieved from http://www.healthdata.org/nicaragua
 For more on our long-term partnership with Boehringer Ingelheim, see https://www.makingmorehealth.org/, our partnership with Philips, see https://aha.ashoka.org and with ICON see, https://www.cta.int/en/event/innovative-cooperative-for-optimal-nutrition-in-africa-icon-sid0f17cfbc7-1ae4-471d-9087-cf19918504ba