Micro Health Entrepreneurship Workshop Held in Bangladesh with the Support of Kyushu University Japan
Two days long Micro Health Entrepreneurship (MHE) workshop held on 4-5 July 2022 in Dhaka, Bangladesh. The objective of this workshop was to find out prospective MHEs in Bangladesh to provide affordable healthcare services to the unreached community. The workshop was organized by SocialTech Lab, Faculty of Information science and Electrical Engineering (ISEE), Kyushu University, Japan, and Global Communication Centre, Grameen Communications, Bangladesh. Entrepreneurship training was provided by the Uddog o Uddokta, Bangladesh. This program was financed by A total of 23 participants got the opportunity as 1st Intake participants. Participants came from different regions of Bangladesh, and they all have a medical education background.
Health is one of the basic needs of human beings. Good health and well-being can make people more productive. Unfortunately, almost half of the world's population is unable to receive the healthcare service they need. To ensure necessary health services to all we need to implement Universal Health Coverage (UHC). Universal health coverage means that all people have access to the health services they need without any financial difficulties. UHC includes a full range of essential health services, from health promotion to prevention, treatment, rehabilitation, and palliative care. SDG Target 3.8 mentioned achieving universal health coverage, including financial risk protection, access to quality essential healthcare services, and access to safe, effective, quality, and affordable essential medicines and vaccines for all. The world is moving toward achieving the UHC goal by 2030 as part of the sustainable development goal.
Achieving UHC in all countries requires strengthening the health systems with strong financial structures. The Covid 19 pandemic exemplifies the limitations of healthcare preparation and the importance of expanding healthcare financing. To meet the health workforce requirements of the SDGs and UHC targets, over 18 million additional health workers are needed by 2030. Investment in primary healthcare, recruitment of a sufficient health workforce, quality education and training for healthcare, complementary health insurance, and complementary medicine service are necessary for achieving UHC around the world. Government policy and regular monitoring also need to make continuous progress. Monitoring progress towards UHC should focus on 2 things:
• The proportion of a population that can access essential quality health services (SDG 3.8.1)
• The proportion of the population that spends a large amount of household income on health (SDG 3.8.2)
There are many challenges to achieving these goals in developing countries. Government and Non-Government organizations are taking many good initiatives to improve the health system and it is going better day by day. But, still, it is challenging to achieve the UHC goal by 2030. The rapid transformation of digital technology is helping to make significant improvements to the healthcare system. We are introducing the MHE model to work with Portable Health Clinic (PHC), which is a known digital health system and has experimental results working in developing countries. Portable Health Clinic can ensure affordable primary healthcare services to all communities. The MHE model can make sure the sustainability of this initiative by spreading it in a business model at the community level. Portable Health Clinic already experimented in 8 developing countries including Bangladesh, now we are planning to experiment MHE model with PHC in those countries. This workshop is part of this initiative.
Micro Health Entrepreneurship (MHE) is business model to make health entrepreneurs in community level to work for quality healthcare services. The person who has entrepreneurial mindset, passion, feelings, and courage to take challenges to create a significant social impact can be a Micro Health Entrepreneur. An entrepreneur has strong mind to take challenge and to serve for the community with innovative efforts. These health entrepreneurs can take this challenge to provide health services to all unreached community and to make this service continue for good health and wellbeing for the specific community. If a person has health education and license to provide healthcare services (like medical assistants, nurse, community health worker) he/she can provide PHC health services by own. He/she can work as health entrepreneur as well as a health worker. If that person do not have health education or license but has the mindset and preparation to conduct this service, he/she can employ a health worker to conduct the service and entrepreneur can play the role only for business management. All health entrepreneur will get basic training to provide on primary healthcare and entrepreneurship. In developing countries, it is very challenging for the government to recruit health workforce and to fulfill the necessary demand. Also, performance monitoring and evaluation is very challenging for the government. Private sector health service providers mainly focused on secondary health service and urban base health service.
Also, they are mostly focus on profit maximization. In MHE model it encourages people to focus on social impact not on profit maximization. Standard business profit will make for the business sustainability, but it should not be profit greedy. Entrepreneurs will also try to understand the demand and situation of the community and based on that he/she will take strategy to deliver the service, they can lead, they can modify their business, they can be innovator to provide primary health care services in root level.
To implement MHE model for the first time in Bangladesh we arranged this workshop to select highly motivated people who are ready to start this business and take the challenges. The workshop was conducted in two broad categories in seven sessions:
MHE Sessions: Concept of Micro Health Entrepreneurship, Startup funding for MHEs, How to start an entrepreneurship, Business Plan preparation
PHC and Digital Health Sessions: Digital health service’s prospect and challenges in Bangladesh, PHC digital health system, PHC service demonstration (primary health checkup to all trainee)
At the end of the workshop, we also conducted a feedback survey to understand the challenges from the target group to run PHC and MHE. In this workshop the target participants were final year students (diploma/bachelor) in health education, community health workers, service/business holder in health care service. We have selected 25 participants in several steps. An online call for application circulated on social media and personal networks was used to collect the prospective MHEs for the workshop. There were some eligibility criteria related to education, profession, age, and others. They were asked to register in a google form and in the primary application 580 applications were submitted within one week.
After the primary eligibility check, they were invited to join in an online meeting for a primary discussion about PHC, MHE, and program plan and to know their expectations. In that online meeting, 113 participants joined. To understand the entrepreneurial mindset, they were asked to fill second screening application. Based on the second screening application 35 participants were sorted out. In the application form and screening questions related to entrepreneurial mindset, interest in PHC and MHE, interest to serve the community, and plan for future works were asked. A total of 25 participants in the male and female categories were selected from this 35, also they were categorized into professional categories (students, job/business, and unemployed). Then phone interview was conducted to check their availability for two days of training in Dhaka, Bangladesh because participants applied from many districts of Bangladesh. All 25 confirmed that they will join the workshop but on the final day of the program 2 participants canceled due to sudden sickness and 23 attended the whole program.
SDG 3 is aiming "To ensure healthy lives and promote well-being for all at all ages. Among 9 targets of SDG 3, target 3.8 is mentioned about "Achieve universal health coverage". UHC is necessary for sustainable and inclusive growth and the main point of UHC is to ensure quality health service for all as they need without experiencing financial hardship. Bangladesh and other developing countries are struggling to achieve UHC, although it is progressing in a positive trend the achievement score is not satisfactory. Out-of-pocket expenditures are so high here, the number of the health workforce is not enough, there are lacking in policy and implementation, interoperable health information systems are still not practiced widely, and there are infrastructures to provide basic health services, but all are not functioning, resources in the health sector are not used properly, people are not aware to maintain primary healthcare, rural people cannot have enough access to quality healthcare service. There is a need for alternatives to accelerate access to quality health services. Micro Health Entrepreneurship (MHE) could be a good solution to make available quality health services for all in a sustainable way. MHE with a digital health system like PHC might be helpful to overcome the existing challenges of UHC. Youth is the largest group of the population of Bangladesh, they are ready to take on challenges. They are ready to become MHEs and want to contribute to achieving UHS they just need proper support and guidance.
Written by: Forhad Hossain
Researcher, SocialTech Lab, Kyushu University, Japan
E-mail: hossain.forhad.380@s.kyushu-u.ac.jp
*This work was supported by JST SPRING, Grant Number JPMJSP2136