At first our plan was simple: to use technology to remotely monitor the health of loved ones, store their health data to detect any trends, and build sharable data for better decision-making. With this we created the first version of the CMED app. As the data was hosted in the cloud, and we were providing medical services, naming our product “Cloud-based MEDical service” (pronounced as “C-Med”) seemed appropriate.
With the CMED platform, a user can create an account, store his/her health data, get instant colour-coded feedback and advices based on the vitals. We also started developing an AI-based algorithm that, with adequate data, can predict health risks beforehand.
We felt accomplished — we solved healthcare! Buoyed by the accomplishment, we had the opportunity to showcase our system to BIRDEM, the world’s largest hospital in treating diabetes. They reviewed it to be a great app and acknowledged that Bangladesh needs something like this. But we also realised that, with self-care, only a small segment could be served with just an app. What about the rest? This humbling experience made us think hard and we realised that we needed to go deeper and think more from a local perspective. So, we went back to the drawing board and started researching the problems in healthcare.
Bangladesh is a very fascinating country. Of the world’s population, 2.5 per cent reside here, on just 0.03 per cent of the earth’s land area. It is one of the densest and most homogeneous societies in the world. And contrary to popular belief, people here actually like new technology, as demonstrated by its 63.5 per cent Internet usage growth as reported by the Bangladesh Telecommunication Regulatory Commission in 2018.
Our research bore fruit: we identified four major problems. The first one is the absence of a referral system. People lack the knowledge of where to go in case they have a health problem. Over 70 per cent of the population live in rural areas, and there is a severe lack of awareness about non-communicable diseases (NCDs), which increases the likelihood of having NCDs. Due to this, people tend to find out about their health problems at a very late stage, and end up spending a lot of money just to stay alive.
This brings us to the second problem: healthcare is costly in Bangladesh. There is no national health insurance here, putting the majority of the cost burden on the people, with 67 per cent of the total health expenditure being out-of-pocket cost as reported by the World Health Organization.
The third issue is the lack of health records. There is no patient history stored for doctors on which to make their evaluation. Hence, more time is needed to see and diagnose a patient. In a country where there are places with just one doctor serving 300,000 people, this becomes a major challenge.
The culmination of the three issues above results in the fourth issue: the prevalence of NCDs. In Bangladesh, 67 per cent of all deaths are due to NCDs. Majority of these deaths are of family breadwinners, causing an immense impact on the socio-economic landscape. After discovering the problems, we started working on solutions. We very quickly found one. Up to 90 per cent of the NCDs were preventable through regular health monitoring and changing lifestyle habits.
We also found that over 15,000 paramedics, certified by the government, are currently jobless. What if we can connect them with the people who need health services? That was when the concept of CMED Platform was born — a community-based healthcare service providing a platform powered by the latest technologies. Pairing our CMED app capabilities with a human and humane touch would also help convey results to people who are not adept at technology.
The next step was to transform our plan into action. We wanted to reach out to everyone eventually so we devised three verticals to do so. The first is through corporates and factories. In Bangladesh almost 95 per cent of the offices do not have a dedicated health team. We created a model to serve the workforce of the country by tracking their wellness through the CMED Platform.
The second vertical is the pharmacies. In the country, there are over 100,000 government-registered pharmacies. In 65 per cent of the cases, people go to these pharmacies for primary care. However, the advice they receive in the majority of these cases may not be accurate. We wanted to educate pharmacies about the right way to service patients, provide a system to screen and record patient vitals, and create a referral chain for patients who require further help.
However, all these require massive investment and social awareness, which is impossible to secure for a baby start-up like ours. Fortunately we got the opportunity to present our idea to the Directorate General of Drugs Administration (DGDA), the governing body of pharmacies in Bangladesh.
As they were also trying to accomplish similar outcomes, we agreed to partner up. Since June 2018, CMED has been backed by the government of Bangladesh to provide primary health screening services in all government-certified pharmacies. Although the majority of the population go to pharmacies for basic healthcare, the women do not do so culturally. They tend to stay at home caring for their families and rarely get their health checked, resulting in a multitude of problems later. To address this group, we created our third vertical — Smart Shastho Kormi (SSK), or Smart Health Workers. We designed a model where a paramedic is trained and equipped with a CMED Health Kit. This includes smart sensors and a tablet with the CMED Platform, which paramedics can use to provide door-to-door health services in their community.
We were looking for an opportunity to test our system. That is when we met with Palli Karma Sahayak Foundation (PKSF), the largest rural development agency in Bangladesh working to improve the quality of life of 12 million households in Bangladesh. We visited one of the rural areas they serve, where we observed and noted the difficulties they were facing.
It was a perfect match; they were doing exactly what we wanted to do, and we could provide what they lacked. In June 2018, we partnered with PKSF to pilot our platform in 21 villages. After numerous testing and training, we launched our platform for our partners in July 2018. Fourteen SSKs started visiting households to provide Primary Healthcare services. They also collected key household information and conducted surveys to better understand the health and living standards of the populace. With proper training and app improvements (e.g. offline functions and education content) the system finally started working seamlessly. Our platform is now serving over 32,000 people in these 21 villages.
The outcome of this was more than what we had expected. CMED not only provides villagers with regular monthly health monitoring, but also helps our partners make decisions based on the data. The biggest revelation was the awareness level of the populace about NCDs. For example, only 2.7 per cent of the populace knew they had diabetes, but our health screening found 15.8 per cent actually had the disease. The platform tells them their health status in their language and advises them on how to improve or maintain their current health condition. The SSKs add a new service layer for users as they explain their health status in detail. This human connection helps people to get the best out of the system.
In case of emergencies, health visitors refer users to the closest healthcare centre. The FDA (US Food and Drug Administration)/ CE (Conformité Européenne)-certified, IoTenabled medical sensors add validation as people trust the measurements from these devices more than manual machines.
Increasingly, the population is becoming more aware and educated about their health and are changing their health-seeking behaviours. People started walking to reduce their weight, and voluntarily approached health visitors for follow-up sessions. Health visitors reported they received more respect and people trusted the digital system more than previous manual services. So far, these people have been receiving regular health services every month for the past eight months.
We are now planning to scale this service to 300 to 400 more villages, so that we can serve 500,000 people by July 2019. When we first started CMED, a lot of people thought what we were trying to achieve was great, but impossible. And the beginning was truly difficult. For a culture so heavily dependent on curative care, it is an immense task to try to convert people to preventive care. But we knew that with proper education, human capital development and awareness, this is possible.
It took us almost a year to form a strong and dedicated team that shares the same vision. In December 2016, we were just a concept. In December 2017, we only had around 4,000 users. As of December 2018, CMED garnered more than 55,000 registered users. By June 2019, CMED has crossed a milestone, having attracted 125,000 users. Within one year, the user base has grown more than 11 times. And this is just the beginning.
We have a dream that is shared by many — to see a healthy Bangladesh. The CMED team is working to create a sustainable future together with all our partners, and we believe it will not be long till we reach out to the tens of millions of people, and help the country achieve the Sustainable Development Goals of Good health and Wellbeing, and Decent Work and Economic Growth.
MOINUL HAQUE CHOWDHURY
Moinul Haque Chowdhury is Co-Founder and Head of Growth at CMED Health Limited. CMED’s mission is to accurately assess and advise the vitals of people’s health, over time, in the environments where they live, work and play so they can live more productive lives. For more information, visit www.cmed.com.bd.