By Alex Sharata and Richard Li

1. mHealth In Emerging Markets
Dec 2016
By: Alex Sharata and Richard Li

2. Content
• Global mHealth Industry Overview
• Monitoring Devices (Sensors)
• Service-Based Mobile Apps
• The Emerging Markets: Africa, Latin America
and South Asia
• Key Challenges
• New Solutions

3. Mobile Health Industry
According to various sources, such as
Statista and Allied Market Research, the
global mobile healthcare market is
further projected to reach $50-60 billion
by 2020, at a CAGR around 30% from 2013
to 2020.
The mHealth market is expected to yield
significant revenues with increasing
awareness level and favorable regulatory
impositions specific to the quality and
feasibility of mobile-based medical
devices. Penetration of mobile phones in
healthcare has created a long lasting impact
on the overall health industry
Definition: mHealth (mobile health) is a general term for the use
of mobile phones and other wireless technology in medical care.
• The most common application of mHealth is the use of mobile
phones and communication devices to educate consumers about
preventive health care services. However, mHealth is also used for
disease surveillance, treatment support, epidemic outbreak
tracking and chronic disease management
• More specifically, mHealth can be classified in to to broader
sectors:
• Monitoring Devices: The Healthcare Internet of Things
Industry
• IoT Healthcare
• IoT Fitness / Wearable
• Service-based Mobile Apps: On-demand Healthcare Industry
Patient
Monitoring
Devices
Healthcare
Mobile
Applications
mHealth
Hospital based: ECG/BCG, Vital-sign monitor...
Patiented based (portable/wearable): Blood glucose monitor...
Mobile Tech: Smart watch/phone..
Appointment, Diagnosis, Drug delivery, Emergency Alert, etc.
Source：Statista and Allied market Research

4. Monitoring Devices (Sensors): Healthcare Internet of Things
IoT Healthcare: Internet of Things (IoT) focused on consumer and/or at-home health care solutions
IoT Fitness/Wearable: Internet of Things (IoT) focused on personal fitness and wellness solutions
Value -- Original
Market: The
MarketReseach.com has
predicted an explosive
growth in healthcare IoT
industry over the next
several years. The market
is projected to expand
with a CAGR of 15.1%
Value -- IoT + Big Data:
Combined with Big Data,
IoT is the key for
healthcare organizations
to accurately capture
consumer needs, trends,
and behaviors, actionable
insights that will
ultimately drive their
revenues.
Source：MarketResearch.com; CB Insights
“...clinical data is where the most successful institutions start their analytics problems. But to deliver a
higher level of consumer satisfaction, healthcare providers must know a lot more about their patients
and their needs than the EHR can tell...”

5. Seven Categories of IoT Healthcare Startup Companies
• Clinical efficiency (Digital Medical Device + IoT): using connected objects to improve the delivery of
healthcare in hospitals and clinics, and also track treatments to boost the effectiveness of healthcare providers
• Enable smart wearables like Google Glass to be used for healthcare charting: Augmedix and Obaa
• Harness the Apple Watch for doctors to track patient visits and access EMRs : Simplifeye
• Use IoT sensors for location-tracking on patients and medical equipment in real-time: Awarepoint
• Brain sensors/neurotechnology: hack the brain with high-tech consumer-targeted cranial wearables
• Read brainwaves with its brain-sending headband: Ybrain and InteraXon
• Clinical-grade projects focused on noninvasive neurotech (brain wave reading/recording) in order to analyze
drug efficacy and track neuropathology: Neurovigil
• Neurovigil raised a Q2’15 Series A from Draper Fisher Jurvetson and entrepreneur Elon Musk, among
other investors
• Fitness wearables:
• Fitness tracking consumer wearables: Fitbit
• Smart Apparels: Lumo and OMsignal
Source：CB Insight

6. Seven Categories of IoT Healthcare Startup Companies
Source：CB Insight
• Consumer/home monitoring: develop technology marketed to consumers for the collection of biometric
information
• Addiction cessation tracker: Chrono Therapeutics
• Smart thermometer: Kinsa
• monitoring systems, which allow for ECG (electrocardiogram) testing to be done from home:
Qardio and AliveCor
• Sleep monitoring:
• Focused specifically on sleep tracking: Hello and Beddit
• Infant monitoring:
• Wearable technology that tracks infant movements and vitals: Owlet and Sproutling
• Clinical-grade biometric sensors/wearables: focused on connected biometric sensors for use in a clinical or
hospital setting, and patient care; have FDA approval
• Have FDAApproval: EarlySense and Monica Healthcare
• Pursuing FDAApproval: Quanttus and MC10
The sensor technologies in the above sectors (ECG, Pulse Oximetry, BCG, and etc.) are comparatively mature.
Generally, company evaluation should be based on 1) marketing strategy & ability and business model, 2)
algorithm and potential value in the data (use for research, form partnerships), 3) whether the founding team can
lead a service company with technology orientation. Most of these Companies are more about service than
tech.

7. Service-based Mobile Apps: Healthcare On-Demand
On-demand healthcare
companies allow consumers
to purchase a product or
service through a web-
based or mobile channel
with either offline or virtual
fulfillment.
Offline fulfillment includes
both product and service
delivery, with companies
such as Postmeds and
Pager delivering
medications and sending
healthcare providers,
respectively, directly to
consumers’ homes and
workplaces.
Online fulfillment occurs
when a consumer is
virtually connected with a
healthcare provider to
diagnose a health condition.
On-demand healthcare is comparable with on-demand companies in other industries (Uber and Oderup)
On-demand healthcare company usually start to build their core competence around a niche market:
• SkyMD and DermCheck only do telehealth service on dermatology
Source：Rock Health and CB Insight

8. Industry Trends In The U.S.
Digital Health funding has been growing exponentially, but on-
demand healthcare funding is growing even faster
Most companies founded prior to 2011 were not “digital” by origin. A majority of Teledoc’s “services are done on the phone.
Source：Rock Health
• Physicians are becoming
more interested in flexible
work schedules and in
practicing direct-pay or
concierge medicine
• 71% U.S. adult own
smartphones; “Uber-fication”
• Low-cost technologies (low-
energy Bluetooth, smart
sensors) become available
Funding For On-Demand Healthcare (amount of venture funding by year)
• In 2014, we saw a 300% the year-over-year funding growth rate,
compared to 114% growth during the same period for funding
across all of digital health.
• Traditionally, telehealth companies receive all the funding. Yet,
we see a rise in house calls and delivery companies, including
TinyRx, Zipdrug and PediaQ all raised money in late 2015.

9. The Major Challenges of On-Demand Healthcare
1. Low ratio of customer life value to customer acquisition cost:
• The average transactions per user per year of Uber is 100, and the platform gross revenue for each transaction is $24.90
• The average transactions per user per year of On-Demand Healthcare Companies in general is 4, and the common gross revenue for each
transaction range from $40 to $200
• Word of mouth marketing doesn’t apply to healthcare service; customers are less willing to openly share their healthcare experiences
2. High price sensitivity and high labor cost: according to Rock Health’s national survey, only 7% strongly willing to pay out-of-pocket
Source：Rock Health
A Different Business Adoption Cycle Compared to Other Tech On-Demand companies
Early Adoption Major Adoption Late AdoptionTrial Use
Novelty
Convenienc
e
Reliability
Cost
n Tech On-Demand
Companies
n Healthcare On-Demand
Companies
3. A different business
adoption cycle:
• Most on-demand
technology companies
can rely on the novelty of
their services to pique the
interest of trial users and
continue acquiring
customers primarily by
offering convenience.
Further market uptake
occurs when the service
proves to be reliable and
“affordable”
• The stakes are much
higher in healthcare.
alleviating consumer
concerns around service
quality and reliability
requires greater
consumer awareness
and higher utilization
rates

10. Content
• Global mHealth Industry Overview
• Monitoring Devices (Sensors)
• Service-Based Mobile Apps
• The Emerging Markets: Africa, Latin America
and South Asia
• Key Challenges
• New Solutions

11. Source：Accenture and PwC (Economiest Intelligence)
The Emerging Markets: Africa, Latin America and South Aisa
Patient-centered services may include:
• IoT Healthcare & Smart Sensor: Use of remote devices to monitor a patient’s condition so that the patient does not need to leave
home. This will be particularly impactful amongst aging populations.
• IoT Fitness / Wearable: Personal health applications and devices that promote nutrition and lifestyle improvements are emerging.
These applications make use of mobile phones or are coupled with electronic devices which gamify and socialize physical activity
within the community, promoting exercise.
• Service Based Mobile Apps: Improved two-way communication between service administrators and patients via scheduling tools and
portals can increase the convenience of service delivery and allows maximum use of available health care capacity
In developed market, mHealth will supplement the traditional landline and desktop solutions in the exchange of data, focusing on
convenience, prevention and wellbeing factors
In emerging markets, mHealth can mitigate the challenges
related to limited transportation infrastructure and lack of
access to referral health care facilities
In emerging markets, the “IoT sector” of the mHealth
industry is negligible.
Service-based Mobile health apps can be used to:
• inform patients when and where medicine is available
• how to find the nearest service location with a health care
worker on duty
• facilitate remote diagnoses from doctors and specialists in
cases where physical travel is not an option either on the
basis of high cost or lead time.
¡ mHealth Adoption in 2012
Emerging markets have
great potentials in the
mHealth industry

12. Type of Healthcare On-Demand Services
Source：Deloitte

13. Government
Regulators
Payers
The Ecosystem and Key Stake Holders
Currently, the payers are the key to
fast adoption and probably the most
powerful stakeholder in the mobile
health ecosystem. Making the
payers believe in the effectiveness
and long-term benefits of the
mHealth solution is extremely
important.
National governments and
regulators have a close link to the
payers’ role in this early phase of
mHealth transformation. Payers’
decisions to include mHealth
service depends on objective criteria
and guidelines.
Pharmaceutical companies are
very powerful health care players.
However, they have a conservative
and independent character.
Entrepreneurs are rule breaking,
inherent creative, open-minded,
tenacious, risk-taking and, notably,
they show real passion to make
things work.
Mobile provide the connectivity on
which all mHealth services depend.
The Current mHealth Ecosystem
Healthcare
Institutions
Providers
Patients
Mobile Operators
Device
Vendor
Tech
Entrepreneurs
Startups
Pharmaceutical
Companies
Content /
Service
Mobile
Apps
IT / Software
Companies
Source：Deloitte
The development of mHealth industry in emerging markets depend on:
International Subsidiary, Private or Public Companies, NGOs and Startups Venture Capitals

14. Lack of Resource, Healthcare Workers and Adequate
Infrastructure
Source：PwC and Deloitte
Lack of resources and healthcare workers
• Public health care providers in emerging markets lack funds to buy medicine, hire health care workers, and set up health care systems to
gather data and generate reports for efficient health care.
• Mobile devices offer a decrease in device cost compared to traditional computing. As private ownership of mobile phones increases,
adoption of a bring-your-own- device policy can help lower costs.
• Africa represents 11 percent of the world’s population, yet carries 24 percent of the disease burden and only hosts 1.3 percent of the
world’s health care workers.
Lack of Infrastructure; e.g. electricity
• Infrastructure in emerging markets is not ideal. There is a
lack of electric grids, a plethora of power cuts, few
landlines, fluctuating network connectivity, poor roads and
limited public transportation. There are also rural or
nomadic populations living in completely, or seasonally
inaccessible areas.
• With little regard for limited access to electricity and
troublesome logistics, mobile network connectivity is
spreading even to the most remote parts of the world. It
is a strong game changer in terms of development,
inclusion, and communicating to populations in remote
areas.
• The mobile Internet combined with smart phones is seeing
the emergence of a whole new set of capabilities that can
be leveraged for better mHealth applications. Even where
there is a lack of coverage, native applications can be used
to store data offline. The data can be uploaded when the
network is up again or when the phone is transported to an
area with connectivity.
iDoc, a regional doctor
network whose mission is
to improve the quality of
care in African hospitals.
It provides access to
healthcare providers and
health facilities.
This tablet-based decision
support system empowers
rural health workers
through knowledge and
training, helping them
make local decisions for
community patients, while
also assisting them to refer
patients to appropriate
facilities at the right time.

15. Access to Smart Phones and Internet
Source：Deloitte
Whereas the telecommunication markets in the developed world are becoming saturated, mobile technologies in emerging markets, such
as Africa, are evolving rapidly from simple communication tools into service delivery platforms.
For example, Sub-Sahara Africa has one of the least developed infrastructures in the world but its mobile network coverage is very high.
Improved network coverage, the launch of 3G - and of 4G -, together with the possibilities provided by WiFi, have increased mobile
connectivity in Sub-Sahara Africa.
The growth rate of the mobile market in Sub-Sahara Africa is one of the highest worldwide. Consequently, mobile-cellular penetration
rates and the growth of 3G connections are high compared to the developed world as well as other parts of the developing world
3G Connection % in 2013