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Innovation in Healthcare in Asia

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The countries comprising the South Asian Association for Regional Cooperation (SAARC) region (India, Pakistan, Bangladesh, Nepal, Bhutan, Afghanistan, Sri Lanka, and the Maldives) commonly known as South Asia face serious healthcare affordability and accessibility challenges. According to World Bank national estimates, South Asian countries houses more than 390 million poor people and a very significant percentage of total population lies below national poverty line (Figure 1). This large number of population is quite unlikely to afford private healthcare services and heavily dependent on the public healthcare facilities.

Figure 1: % of population below nationally determined poverty line

Figure 1: % of population below nationally determined poverty line

Source: World Bank

Apart from just high poverty levels, the availability of doctors is another critical challenge. As per World Bank data except Maldives, every SAARC country has less than 1:1000 doctor to population ratio which is an area of concern (Figure 2). The availability of qualified doctors in the rural areas is dismal and people often tend to self-medicate or take treatment from self-proclaimed doctors who often have no formal education in practicing medicine. It is also important to note that more than 50% South Asian population amounts to approximately 1.17 billion lives in rural areas that often has to travel to cities to access secondary and tertiary care raising tough accessibility barriers.

The high cost of travel to urban health centers coupled with a lack of awareness make the situation worse. Hence, it can be argued that the basic health care demography for these South Asian countries is reasonably identical, and the problem of health care can also therefore be looked at from a regional level rather than in the context of an individual country.

Figure 2: Number of doctors (physicians) per 1000 people

Figure 2: Number of doctors (physicians) per 1000 people

Source: World Health Organization

These severe affordability and accessibility barriers to universal quality healthcare demands for innovation in the way care in being delivered both to the poor and people living in rural areas. To understand innovation in South Asia, things need to be put into right perspective. Innovation in health care is not only about technological innovation or new systems of health care financing or upcoming health care delivery models targeting a vulnerable population. Health care innovation is a mix of all the abovementioned elements, which covers all aspects from diagnosis to delivery of service to the end customer, which is the patient in this case.

Often, the misconception is that technological innovation is confined to the sophisticated labs of developed nations. The increasing adoption of frugal innovation by many technological firms has changed this notion dramatically in the past few years especially in the area of health care diagnosis. Intel in India launched a device in 2015 called Lifephoneplus, which enable people to take an ECG and monitor glucose levels by themselves. This device uses the existing bluetooth and wireless network to transfer the health information record by phone, from which it can then be sent to the doctor directly.

Since 2007, GE Healthcare, one of the biggest providers of health care systems, has been developing portable and battery-operated ECG systems out of India’s labs, and these are already being used in rural areas in the developing world. The company has recently claimed to launch the first CT scanner made out of its India facility in 2015 for the developing market, keeping in mind the twin big challenges of affordability and accessibility. The challenges of the developing world are very unique and therefore the technological innovation needs to be tinkered in a way that it takes care of local needs and challenges.

South Asian countries have witnessed nearly a wind of various telemedicine initiatives and, of late, mobile apps operating at different levels and scale. Some examples include Apollo Telemedicine and iClinics in India, mPower in Bangladesh, and Aman Telehealth in Pakistan, among many others. The telemedicine-based business models leverage the information and communication technologies to act as a bridge connecting rural patients with qualified doctors in the urban areas and could be effective in improving the outcomes especially in primary care. What is more interesting is the acceptance that telemedicine seems to have generated among the governments of the South Asian countries. India has recently announced that an e-Health authority will be set up in 2015, while the Maldives and Nepal and have national telemedicine helplines in place since 2011. But Telemedicine alone has limited capacity to address the vast healthcare needs in South Asia. There is certainly a need for fostering effective partnerships to increase the geographical reach, impact and service offerings.

So what are the prospects for health care innovation in South Asia? One possibility is that the next wave of innovation in health care will be defined by increasing partnerships, such as those being implemented on a PPP model, where PPP stands for public, private, and people. For instance, the coupling of telemedicine and other innovative health care delivery models with public insurance schemes could be very effective in addressing the huge unmet need of quality rural health care in developing nations. The pairing of the low-cost surgery center, Narayana Health, with state government–supported micro insurance schemes in which poor people pay a premium of only $4–$6 annually in India is one such great success story.

The immediate need is not only for stand-alone frugal innovations or new delivery mechanisms, but devising a way to better integrate the various actors across the health care delivery value chain. The governments in South Asian countries need to upgrade their role from being merely a support provider to that of being a key enabler to bring all stakeholders on a single platform. If low-cost medical devices and technology-based frugal innovation are not being implemented in public health care systems then the potential impact of these advancements will be very limited.

The health care delivery services could also be contracted to the innovative and effective private health care providers by the different governments so that the much-needed quality primary care services are provided in the rural areas. The public insurance schemes supported by the government can be used as payment for these services. The health care innovation driven by the private sector brings in expertise and ideas but the scalability can only be achieved from active government participation in it, and not merely support. Therefore, this may be the right time for both the government and the private sector to reconsider the current innovation ecosystem in the health care sector in South Asia from the lens of active collaboration and setting the clear standards for service delivery.

Given that both of the challenges and solutions to healthcare look similar for South Asian countries, it may also be a good idea to form a regional cooperation model to foster innovation in healthcare. Different countries can both share and learn from each other experiences in adopting innovative healthcare delivery practices. The lessons learned from the establishment of SAARC as a regional multilateral institution could also be leveraged in this regard.

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About the Author

This article was written by Anshul Pachouri of Asia Pathways. Asia Pathways is the blog of the Asian Development Bank Institute which was established in 1997 in Tokyo, Japan, to help build capacity, skills, and knowledge related to poverty reduction and other areas that support long-term growth and competitiveness in developing economies in the Asia-Pacific region. Anshul is currently working on strategy practice at a global consulting firm based in India.

Entrepreneurship

Is There A Coworking Space Bubble?

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An annual growth rate of nearly 100%, almost five years in a row? More than 60 coworking spaces in a city like Berlin? Are these the characteristics of a bubble? Nope, these are characteristics of a lasting change in our world of work, which has been further catalyzed by the recent economic crises in many countries. But what makes this change different to a bubble? We’ve summarized some arguments of why the coworking movement is based on a sustainable change. However, that doesn’t mean it’s an easy job to open a good working coworking space.

Five reasons why the growth of coworking spaces is based on organic and sustainable growth: 

1. Coworking spaces invest their own money and create real wealth

Already, there is a convincing argument supporting why coworking spaces are not developing in a bubble: the fact that they create real wealth.

Whether referring to the dotcom bubble a decade ago or the real estate crisis in Spain or the United States, the crisis originated in a glut of cheap money, in an environment in which the sender and the recipient were unacquainted. From funds and banks, money flowed in steady streams to investments which offered little resistance and the most promising returns – which only a little while later turned into delusions and ruined investments.

Redistributed risks create illusions. Those people who distributed the money rarely wore the risk of investment decisions. The risk was mainly taken by small shareholders or people who bought parts of those investments. This was because either both parties’ (better) judgement was drowned out by the noise of the market, or because shareholders were unaware of the risk, and were at the mercy of banks and funds for reliable information.

Another fundamental condition for the creation of bubbles are the sheer amounts of money that flow from various locations globally and are concentrated, by comparison, in much fewer places.

Most coworking spaces, however, receive their funding from local or nearby sources and do not operate within this financial system. In fact, the founders mainly inject the bulk of the required investment, and turn to friends or relatives for additional support. They wear the full brunt of the risks that are involved in small-time investment.

They have access to much more information, because it is their own project, rather than a foreign one thousands of miles away. This also includes failures and mistakes that are encountered along the way, but the risk is less redistributed, thereby decreasing the probability of failures.

2. Labor market changes demand on certain office types lastingly

Most users of coworking spaces are self-employed. The proportion of employees is also on the rise, in many cases simply because they work for small companies that increasingly opt to conduct their business in coworking spaces rather than in traditional offices. The industry of almost all coworkers fall within the Internet-based creative industries.

With flexibilisation of work markets, new mobile technologies that are changing work patterns, and the increase of external services purchasing from large and medium-sized enterprises (outsourcing), the labor market has changed radically in many parts of the world.

The long-term financial and emotional security of becoming an employee no longer exists, especially for younger generations of workers. Bigger companies are quicker to fire than hire, and precarious short-term contracts are on the rise. Promising options on the labor market are more often recuded to freelancer careers and starting your own company.

And that’s possible with less money to invest. All you need is a laptop, a brain and a good network. For years, the number of independent workers and small businesses has been growing worldwide – particularly in internet-based creative industries. Anyone who has sufficient specialized skills and the willingness to take risks may adapt more quickly to market conditions if they own a small business or are self employed; more so than if they were to work in a dependent position in an equally volatile market.

Coworking spaces provide an environment in which to do this. Once they have joined a (suitable) coworking space, these factors become apparent to coworkers, who will remain in their space for years to come.

Furthermore, independent workers rarely fire themselves in crises, and even small companies are less likely to give their employees the boot – compared to their large counterparts. This combination enables more sustainable business models – and less business models à la Groupon.

3. Coworking spaces don’t live on crises

Global economic growth is waning while the number of coworking spaces is continually growing. Do coworking spaces thus benefit from this crisis?

The current crises accelerate the formation and growth of coworking spaces, because they offer solutions and space for the resulting problems. Coworking spaces are therefore not a result of a crisis, but the product of change that pre-dates their existence. A crisis is simply the most visible expression of change.

The first coworking spaces emerged in the late 1990s; the movement’s strong growth started six years ago – before the onset of economic downturns in many countries.

4. Coworking spaces depend on the needs of their members

Most coworking spaces are rarely full. Does this mean they are unsuccessful? On average, only half of all desks are occupied. But the average occupancy rate of 50% refers only to a specific date.

In fact, coworking spaces generally serve more members than they can seat at any given time, since members do not use the spaces simultaneously. Coworking spaces are places for independents who want to work on flexible terms. Smaller spaces rely more on permanent members. Larger spaces can respond more flexibilty to the working hours of its members, and, can rent desks several times over.

If a coworking space is always overcrowded or totally empty, the purpose of said space would be defeated. Firstly, it is rather impossible to work in an overcrowded room. Second, it’s impossible to cowork in an empty room. Given the nature of flexible memberships, a coworking space only can survive if they fit the needs of their members. Members would otherwise be quick to leave, and membership would be much more transient.

5. The coworking market is far from saturation

Less than 2% of all self-employed – and even fewer employees – currently work in coworking spaces. Reporting on coworking may increase, but inflated reporting on the coworking movement in the mainstream media is still far away.

Coverage of coworking space are most likely to be found in the career or local sections in larger publications – front cover coverage remains the dream of many space operators. This is because the whole coworking movement can’t be photographed in one picture. What appears to be a disadvantage, however, is actually a beneficial truth: niche coverage allows the industry to grow organically, and avoid over inflation.

Conclusion

Coworking spaces don’t operate in parallel universes – like the financial market. Demand and supply are almost exclusively organic and operate in the real world economy.

For the same reason, there is no guarantee that opening a coworking spaces will be automaticly successful. Anyone who fails to learn how to deal with potential customers in their market, or is unfamiliar with how coworking communities function, will have a difficult time of making one work. In the same way that business people in other industries will fail if they do not understand their market.

Those who simply tack on the word ‘coworking’ to their space’s facade will need to work harder. The structure of most coworking spaces is based on real work, calculated risk, and real-world supply and demand.

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About the Author

This article was produced by Deskmag. Deskmag is the magazine about the new type of work and their places, how they look, how they function, how they could be improved and how we work in them. They especially focus on coworking spaces which are home to the new breed of independent workers and small companies. see more.

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Callum Connects

Dextre Teh, Founder of Rebirth Academy

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Dextre Teh is a consultant and marketing guru, helping F&B businesses to tighten their operations and grow their businesses.

What’s your story?
I help frustrated F&B business owners stuck in day to day operation transform from a glorified operator into a real business owner. I’m a 27 year old Singaporean second generation restaurant owner and a F&B business consultant. Entering the industry at 13 years old, I have always been obsessed with operations and systemisation. At the age of 25, I joined the insurance industry and earned a six figure yearly income. However, I left the high pay behind because it was not my passion and returned to the F&B industry. Now I help other F&B companies to tighten operations and grow their businesses with my consulting and marketing services.

What excites you most about your industry?
The food. I’m a big lover of food and even have a YouTube show on food in development. But that aside, it is really about impacting people through food. Creating moments and memories for people, be it a dating couple or families or friends. Providing that refuge from the daily grind of life. So in educating my consulting clients and training their staff to provide a better experience for their customers, I aim to shift the industry in the direction of creating memories instead of just selling food.

What’s your connection to Asia?
I was born and bred in Singapore. I love the culture, the food and travelling in Asia.

Favourite city in Asia for business and why?
Singapore hands down. The environment here is built for businesses to thrive. The government is pro business and the infrastructure is built around supporting business growth. Not to mention the numerous amount of grants available in helping people start and even grow business. If I’m not mistaken, the Singaporean government is the only government in the world that offers grants to home grown businesses for overseas expansion.

What’s the best piece of advice you ever received?
Learning to do things you do not intend to master is a BIG mistake in business. Focus on what you are good at and pay others to do the rest.

Many business owners including myself are so overwhelmed by the 10,000 things that they feel they need to do everyday. We try to do everything ourselves because we think it saves us money. The only thing that, that does for us is overload our schedules and give us mediocre results. Instead we should focus on what we do best and bring in support for the rest.

Who inspires you?
Christopher M Duncan.

At 29, Chris has built multiple 7 figure businesses. He opened me to the possibility of building a business on the thing that I loved and gave me a blueprint of how to do it. He also showed me that being young doesn’t mean you cannot do great things.

Imran Mohammad and Fazil Musa
They are my mentors and inspire me every single day to pursue my dreams, to focus on celebrating life and enjoying the process of getting to where I want to be.

What have you just learnt recently that blew you away?
Time is always more expensive than money. Money, you can earn over and over again but time, once you spend it, will never come back.

If you had your time again, what would you do differently?
I am a firm believer that your experiences shape who you are. I am grateful for every single moment of my life be it the highs or the lows, the successes and the failures because all these experiences have led me to become the person I am and brought me to the place that I’m at so I will probably do things the same way as everything was perfect in its time.

How do you unwind?
Chilling out in a live music bar with a drink in hand, listening to my favourite live band, 53A. Other than that I’m big on retail therapy, buying cool and geeky stuff.

Favourite Asian destination for relaxation? Why?
Bangkok. It feels like a home away from home where the cost of living is relatively low, the food is good and the people are friendly.

Everyone in business should read this book:
Everything you know about business is wrong by Alastair Dryburgh. It is a book that challenges commonly accepted business “truths” and inspires you to go against the grain, think different, take risks and stand your ground in the face of the challenges that will come your way as a business owner.

Shameless plug for your business:
I’m the creator of the world’s first Chilli Crab Challenge. It gained viral celebrity earlier this year with 3 major newspaper features and more than a dozen blog and online publications featuring it in the span of two weeks. In the span of the two weeks, the campaign reached well over a million people in exposure without a single cent spent in ads.

Now I help F&B companies to tighten operations, increase profits and grow their businesses with my consulting and marketing services. Chilli Crab Challenge (https://www.chillicrab.com/nationalday)

How can people connect with you?
You can connect with me on Facebook (www.facebook.com/djtehkh) or visit www.rebirthacademy.sg for more information or book a 10 minute call with me @ www.tinyurl.com/dexclar

This interview is part of the ‘Callum Connect’ series of more than 500 interviews

Callum Laing is an entrepreneur and investor based in Singapore. He has previously started, built and sold half a dozen businesses and is now a Partner at Unity-Group Private Equity and Co-Founder of The Marketing Group PLC. He is the author two best selling books ‘Progressive Partnerships’ and ‘Agglomerate’.

Connect with Callum here:
twitter.com/laingcallum
linkedin.com/in/callumlaing
Download free copies of his books here: www.callumlaing.com

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