Archive for April, 2019

Healthcare in Emerging Economies – a Sad Story

Tuesday, April 2nd, 2019
Image Source: Harvard Business Review

Healthcare is a very complex subject anywhere in the world. Some countries have an established structure in which the government subsidizes healthcare for the population and others trust on the private sector, also known as health insurance companies. There are also examples of hybrid systems: the public and the private sectors working concurrently. Independent on the system, the poor piece of the population always suffers. The subject of this blog post is going to be healthcare in emerging economies since I am doing an online Course at Harvard focused in entrepreneurship in emerging markets. Healthcare and Education are given as examples in this course of areas that technology barely touched in this course. The explanation for that, especially in emerging economies, is mainly due to restrictions of the government and lots of corruption in the system. Credibility, trust and transparency are not the best adjectives in emerging economies. Corruption is everywhere and the poor are the ones who will suffer. I will exemplify one of these issues, focused in healthcare (and also education at some degree since the solution we have built was with students), since I participated as Head of one of the most interesting Projects that the Apple International Program developed in Brazil, my home country. Just as a spoiler alert, this is not a story with happy ending, but worth reading about. Let’s start explaining the basis of the problem we were trying to address in my home country: most of the healthcare system is subsidized by the government in a Program named SUS (“Sistema Unico de Saude” or “Unique Health System” in English). This Program is running for decades and has very successful histories such as giving AIDS medication for free to HIV positive patients (this Health Program got many awards worldwide and was used by other countries). Our main goal was to evaluate the SUS Program as a whole since the government had a database called DataSUS with all the information on public hospitals, facilities and healthcare professionals in the country. To do that, a group from the Apple International Program decided to build a citizen centric App named “Heath Map of Brazil” and aggregate all the DataSUS information with geolocation in the country: for example, if somebody had a health issue, let’s say a heart attack in the streets of Sao Paulo or Rio de Janeiro, a citizen close to the person would do a first response and try finding the closest public hospital using the geolocation feature of the App. Also, citizens from Brazil would be able to give feedback using the App. The main challenge here was to evaluate the efficiency and efficacy of the SUS healthcare system in Brazil. The App was built after we had long talks to the DataSUS people to be able to have a direct connection to their database. The beta of the system was released in the capital of Brazil, Brasilia, where I have lived for a while. The idea was simple: make a geolocation map, such as Google Maps, of all public institutions from DataSUS and the people working in all of them, from nurses to doctors. Very simple task. Since the beta test in the capital worked nicely so we have decided to aggregate data from the whole country and let the citizens interact with it for one year. After this time, we have collected all the inputs from people using it and something shocked us all: lots of citizens in the whole country were trying to find public hospitals that never existed in their town (which I call “ghost places”), trying to find doctors that never worked in a specific place, have already retired or even died amongst several other infrastructure problems. With all this info in hand we started crunching numbers to see how much money was being poored in all of these “ghosts” that the citizens found using the App solution. Our jaws dropped; the numbers were in the billions of the Brazilian currency, even billions of Dollars! All of this money was going somewhere, but not to the right place. So, we decided to present this to the Finance Department of the Country at that time. People listened to us, of course. We had the numbers, the places that never existed but not where the money was going. Interestingly, after this presentation, the government cut our direct connection to the database DataSUS with all the healthcare data and the App started “dying”. There is no need to explain why. Corruption, lack of transparency and lack of trust. This money meant that people were getting rich with these “schemes” all over the nation. This is a very successful idea to help a government that unfortunately is very corrupt (and I am not saying and disclosing any political parties or names from the government involved). In the end, who is suffering with a terrible healthcare infrastructure, unprepared healthcare professionals and long waits to be accepted to do an exam in the public system: the poor people in my home country. Sad but true story. My take on this story is what I’ve learned along the way of building a nice solution that could help lots of poor people. But that doesn’t matter, does it?

Disclaimer: The opinions and views in this article are my own. In this article I have no political or party association with any governmental entity in Brazil.