Digital Healthcare Service Providers
Digital Healthcare Service Providers
Business Model Description
Invest in B2B / B2C tech-based companies offering digital healthcare services, including development of Operation Management System, telemedicine, as well as a marketplace for pharmaceuticals.
First Womentech Asia (FWA), founded in 2013, specializes in Hospital Operating Management System, with their product, Peth Yoeung, which automates all operations in hospitals and clinics. In 2021, Ssivix Lab Pte. Ltd. and FWA signed a venture partnership to support healthcare service providers with on-demand telehealth consulting services. (12)
Peth Yoeung's Data Management System covers an increasing part of the hospitals at national level and ~20% of private hospitals. (12)
Pilltech, founded in 2021, is a pharmaceutical marketplace that connects suppliers to pharmacy owners. It has B2B and B2B2C models, offering a POS system with subscription in addition to the traditional fee on sales. As of 2022, it has not raised external funding. (13)
MeetDoctor (MD), founded in 2018, is a digital one-stop healthcare service provider, offering online consultations with medical specialists, medicine delivery, home lab test and medical appointments. In addition to providing medical care at affordable costs, they also aim help patients connect with doctors/hospitals from abroad. In 2022, IG Group (IGG) invested in MD in pre-seed round. (14)
Expected Impact
Digital solutions in healthcare to improve efficiency and accessibility of the healthcare system by communities and people that need them the most.
How is this information gathered?
Investment opportunities with potential to contribute to sustainable development are based on country-level SDG Investor Maps.
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Country & Regions
- Cambodia: Countrywide
Sector Classification
Health Care
2021 Global Health Security Index ranked Cambodia 126/195 with an index score of 31.1. The health system scores 12.3, which is very low compared to the global average of 31.5. (1) This is a result of inadequate quality and capacity of public health systems to deal with diseases community health issues and limited investment in health infrastructure.
Ministry of Health's (MOH) Health Strategic Plan 2016-2020
outlines the framework for strengthening operations in the entire health sector (both, public and private) and to address priorities. It also aims to mobilize adequate financial resources, inform fiscal allocation, and guide development assistance in the sector. (2)
Cambodia's out-of-pocket (OOP) spending on health expenditure is ~60%, which poses a substantial risk of impoverishment for the households struggling financially.(3) 79% of total population and 91% of low-income population resides in rural areas (4), where health indicators show a stark divergence with those for urban areas. (5)
Covid-19 has further impacted health care delivery with a ~35% increase in under-five mortality and ~50% increase in maternal mortality in 2020. (7) In 2020, neonatal mortality rate was 13.2 (7a), infant mortality rate was 22 (8) and under-5 mortality rate was 25.7 (8a). Maternal mortality rate was 160 in 2017.(9)
Cambodia ranks medium-low equality in human development indicator achievements between males and females. Although, women are more likely to be on the frontline as caregivers both in the hospital and at home, putting them at greater risk of contracting diseases. (7)
Healthcare expenditure as a percentage of GDP increased from 5.7% in 2017 to 6.9% in 2019. (6) Public sector health expenditure is ~47% of Cambodia’s total health expenditure. (7)
Effectiveness of health service delivery is impacted by diagnostic services capacity limitation, insufficient supply of medicines and health commodities, and insufficient competent healthcare personnel, particularly in rural areas. Cost of private care is not affordable for the poor.
Medical Technology
Low quality of health services (public and private), and persistent inequities in health outcomes, (by urban-rural or by socioeconomic status) (8) result in ~1/4 chance of people dying ‘prematurely’ between the ages of 30 and 70 from an NCD. NCDs kill ~60,000 Cambodians per year. In 2018, NCDs cost Cambodia USD 1.5 bn in health care costs and productivity losses, equivalent to 6.6% of GDP.(9)
Health Equity and Quality Improvement Project (H-EQUIP) aims to strengthen quality countrywide. The MoH recognizes the importance of using digital technology to improve its healthcare sector and is making headway in its digital transformation efforts by adopting smart hospital solution program.
Despite progress in general access to healthcare, access to quality and specialized care in the provinces and rural areas is particularly low. Adequate planning and focused policies can help reduce the shortage and maldistribution of health professionals by gender and geographical location, particularly in rural areas, to ensure equal access and quality health services for all. (10)
Between 2016 and 2021, MOH introduced several health financing innovations to provide fair and equitable access to health care, specifically for marginalized groups, based on socio-economic status, geographical regions, ethnic groups and gender. (3)
Medical information and technology (MIT) can help increase the capacity and quality of health systems to improve the health status of the country.(16) Reduced travel-time and costs, and shared healthcare staffing help in growth of telemedicine platforms. Covid-19 has led to a need for agility, transformation, and adaptability of telehealth solutions. (11)
There is low investment in medical technology and ICT, with limited capacity at all levels to analyse, interpret and use data; limited use of health data and information in clinical and administrative areas, and multiple reporting systems. High costs and lack of skilled professionals is also a challenge.
Medical Equipment and Supplies
Pipeline Opportunity
Digital Healthcare Service Providers
Invest in B2B / B2C tech-based companies offering digital healthcare services, including development of Operation Management System, telemedicine, as well as a marketplace for pharmaceuticals.
First Womentech Asia (FWA), founded in 2013, specializes in Hospital Operating Management System, with their product, Peth Yoeung, which automates all operations in hospitals and clinics. In 2021, Ssivix Lab Pte. Ltd. and FWA signed a venture partnership to support healthcare service providers with on-demand telehealth consulting services. (12)
Peth Yoeung's Data Management System covers an increasing part of the hospitals at national level and ~20% of private hospitals. (12)
Pilltech, founded in 2021, is a pharmaceutical marketplace that connects suppliers to pharmacy owners. It has B2B and B2B2C models, offering a POS system with subscription in addition to the traditional fee on sales. As of 2022, it has not raised external funding. (13)
MeetDoctor (MD), founded in 2018, is a digital one-stop healthcare service provider, offering online consultations with medical specialists, medicine delivery, home lab test and medical appointments. In addition to providing medical care at affordable costs, they also aim help patients connect with doctors/hospitals from abroad. In 2022, IG Group (IGG) invested in MD in pre-seed round. (14)
Business Case
Market Size and Environment
USD 100 million - USD 1 billion
15% - 20%
2017: Market spending General healthcare - ~USD 1.1 bn Pharmaceutical products - ~USD 296 mn
Telehealth market is expected to witness double-digit growth between 2020 and 2026. This growth can be attributed to the rising adoption of digitalized and virtual platforms, underpinned by the superior growth patterns in the healthcare sector, including prevalence of NCDs with a growing middle-income population. (11)
Rise in remote consultation spurred by higher prevalence of chronic diseases, increase in healthcare costs, technological innovations in healthcare, and efforts to address accessibility issues for healthcare in remote areas,that has been a perennial problem in developing economies, are the primary factors contributing to growth in the telehealth market. (11)
Indicative Return
20% - 25%
Revenue in the digital health market is projected to reach USD 88.2 mn by the end of 2022, with digital fitness & well-being as the largest contributors with total revenue of USD 63.9 mn in 2022. The average revenue per user (ARPU) is expected to amount to USD 19.24. (15)
The geriatric population consumes ~40-50% of the total healthcare facilities' cost, and tend to contribute 4x towards the spending on medical facilities as compared to younger adults. (11)
Pilltech is connected with 1000 pharmacists, 20% of the total market that consists of 5000 pharmacists countrywide. It plans to expand it's operations in the provinces to capture a larger market share, thus showcasing its significant growth potential in the future.
Investment Timeframe
Short Term (0–5 years)
Pilltech, which started its operations in 2021, has had a promising start and expects to breakeven in 3 years by expanding its operations to the provinces.
Expert consultations suggest that digital health businesses in Cambodia have a large market to capture and have the potential to break-even in less than 5 years.
Ticket Size
< USD 500,000
Market Risks & Scale Obstacles
Business - Supply Chain Constraints
Business - Supply Chain Constraints
Impact Case
Sustainable Development Need
Investments in this area can improve the quality of healthcare offered. The healthcare sector still faces a number of challenges in terms of both epidemiology and the health system. Neonatal, infant under-5, and maternal mortality, and prevalence of malnutrition is still high due to inadequacy of health services offered.
Promotion of efficient utilization of limited healthcare staff. Healthcare system struggles to meet the ever-changing demands of its ageing population. Cambodia has 1.93 doctors per 10,000 population (lowest in SEA region), lower than the WHO recommendation of 10 doctors per 10,000 population. (16)
Lower the burden on public healthcare system. Charging private payers more in response to shortfall in public payments has increased the burden on hospitals to bear the cost of premium medical facilities, resulting in a hike in healthcare costs. (11)
Gender & Marginalisation
There is a need to reduce gender and regional disparities in health indicators resulting from an inadequate and unequal distribution of resources. Infant mortality is relatively high among rural and less educated households. Women tend to be unhealthier than men in all age-groups.
Reduce travel time for patients to ensure timely diagnosis and treatment. Almost all private hospitals providing medical specialties and quality services are located in Phnom Penh and in main cities like Siem Reap or Kampot, forcing patient in rural areas to travel long distances to get treatment.
Affordable primary care solutions should be provided to low and middle-income families to ensure protection against impoverishment due to health service costs to patients. (3) 67% of total health spending in Cambodia is for primary care.
Expected Development Outcome
Ensure sufficient supply of healthcare infrastructure (shortage of beds, staff, supplies, and diagnostic equipment) to avoid overcrowding of hospitals that causes delays in care, resulting in delayed diagnosis and treatment, and thereby higher morbidity and mortality. (16)
Reduce the prevalence of deadly diseases by ensuring proper preventive care, and focusing on non-communicable diseases. (3)
Provide easy access to primary healthcare at affordable costs by reducing waiting time and transportation costs.
Gender & Marginalisation
Ensure availability of trained healthcare staff across the country. Health workers are primarily concentrated in urban areas because of greater prospects and pay in these places, leaving rural areas understaffed. (16)
Reducing inequities in health outcomes, especially for marginalized groups—the poor, remote rural population, ethnic minorities and women by providing improved access to quality health services and by protecting them against impoverishment due to health service costs. (3)
Offer easy access to affordable reproductive health services for women, including those from vulnerable groups, especially in remote areas. (3)
Primary SDGs addressed
3.1.1 Maternal mortality ratio
3.2.2 Neonatal mortality rate
3.2.1 Under‑5 mortality rate
160 in 2017.(17) 13.2 in 2020 (18) 25.7 in 2020 (19)
70 in 2030 (20) 12 in 2030 (20) 25 in 2030 (20)
Secondary SDGs addressed
Directly impacted stakeholders
People
Gender inequality and/or marginalization
Planet
Corporates
Public sector
Indirectly impacted stakeholders
People
Gender inequality and/or marginalization
Planet
Corporates
Public sector
Outcome Risks
Poor internet connectivity, low reception, technological illiteracy and lack of access to gadgets are barriers to telehealth.
Law is still unclear about sale of medicines online. Although, Pilltech is authorized to sell medicines, RGC may impose restrictions unless progressive guidelines and reforms, including licensing norms are introduced by the government.
Older adults (major healthcare recipients) are averse to utilizing technology. To facilitate the adoption of new technology, providing sufficient support is essential. (16)
Emergency support or retrieval care may not be easily available in remote areas due to inadequate roadways, connectivity and ambulance services.
Gender inequality and/or marginalization risk: Vulnerable sections of the community may require additional financial assistance (concessional prices or lending support) to make use of such services.
Impact Risks
Only people with smartphones and online payment systems can afford to pay fees online on digital platforms. This limits the inclusion of and impact on the underserved and the most vulnerable communities.
While the model is proven in urban areas, external factors (limited connectivity and digital literacy of target populations) might limit the efficacy of service in more rural / remote areas.
Lack of adequate consumer protection measures may negatively impact consumers from low resource settings (women, people with disability and low-income population) with limited information on registering grievances or on complaint mechanisms.
Inadequate healthcare value chain may impact the efficiency of health management services, if online consultation is not followed by expert care services.
Gender inequality and/or marginalization risk: Pregnant women may require real-time access to physical healthcare facilities, which can not be substituted by online healthcare facilities.
Impact Classification
What
Digital solutions in healthcare to improve countrywide system efficiency by reducing costs incurred and time consumed in carrying out diagnosis and treatment.
Who
Underserved; at-risk patient groups such as pregnant women, senior citizens requiring at-home care services, as well as general population will benefit from accessible and affordable healthcare.
Risk
Implementation of telemedicine business models may exclude population segments that do not have the technical knowledge and digital capabilities required for accessing such digital platforms.
Contribution
NCDs kill ~60,000 Cambodians per year, and cost Cambodians USD 1.5 bn in health care costs and productivity losses (as of 2018).(9) Telemedicine can help address such issues.
How Much
Healthcare costs ~5% of the economic losses, while the remaining 95% are from the enormous burden NCDs impose on the Cambodian workforce.(9)
Impact Thesis
Digital solutions in healthcare to improve efficiency and accessibility of the healthcare system by communities and people that need them the most.
Enabling Environment
Policy Environment
Health Strategic Plan 2016-2020: outlines the framework for strengthening operations in the entire healthcare sector (both public and private) and addressing priorities. It also aims to mobilize adequate financial resources, inform fiscal allocation, and guide development assistance in the sector. (21)
Health Strategic Plan 2016-2020: Initiate the use of Tele-medicine services where appropriate to connect national hospitals and provincial referral hospitals to provide specialized services or manage diagnosis, treatment and care of complicated diseases. (21)
Strategic Framework and Programs for Economic Recovery 2020-2023: Increase the capability to provide quality and safe prevention, diagnosis, treatment and care services, especially, in the event of any large-scale COVID-19 outbreak. (22)
Cambodia's National Social Protection Policy (NSPP) Framework 2016–2025: aims to develop and expand social health protection schemes to achieve Universal Health Coverage (UHC) with a focus on the poor and vulnerable. (23)
H-EQUIP: targets particularly marginalized groups (poor, remote, rural population, women). The pro-poor approach aims to provide essential health packages to address inequities in distribution of essential health services. (23)
Financial Environment
Under the new investment law, health sector is eligible to get QIP incentives which include tax holiday, minimum tax exemption or exemption from prepayment of tax on income or export duty. (27)
Investment Law: Under article 24, health sector is among the sectors and activities which are entitled to investment incentives described under article 26 such as income tax exemption for 3 to 9 years, prepayment tax exemption and minimum tax exemption. (27)
Investment Law: Under article 27, besides the basic incentives above, QIP will receive additional incentives such as VAT exemption for the purchase of locally made inputs, deduction of 150 % from tax base for activities such as research development and innovation. (27)
Regulatory Environment
Article 72 of the Constitution provides that: 'The health of the people shall be guaranteed. The state shall give full consideration to disease prevention and medical care (1994) (24)
Law on Amendment of the Law on Management of Pharmaceuticals 2007: Both genders of Cambodian nationality or foreigner may have right to run a pharmaceutical manufacturing establishment, or importing/ exporting establishment and trade of pharmaceutical in Cambodia. (25)
Law on Management of Private Medical, Paramedical, and Medical Aide Profession 2000: The purpose of this Law is to define procedures and conditions of functioning for management of private medical, paramedical, medical aide profession in the Kingdom of Cambodia. (26)
Law on Management of Private Medical, Paramedical, and Medical Aide Profession 2000: A high and specialized foreign medical professional, paramedical professional, medical aide professional may be authorized to practice his or her profession in Cambodia. (26)
Marketplace Participants
Private Sector
Corporates: Pilltech, FWA (Peth Yoeung), Meetdoctor, Ssivix Lab Investors: IG Group
Government
Ministry of Health, Ministry of Commerce (for e-commerce platforms) and Ministry of Post and telecommunications (digital), Ministry of Education, Youth and Sports
Multilaterals
All multilaterals are involved in the health sector in Cambodia (Asian Development Bank, Worldbank, United Nation Office for Project Services, United Nation International Children Emergency's Fund)
Non-Profit
International Global Fund, Bill and Melinda Gates foundation, Hope worldwide, Clinton Health Access Initiative, MoPoTsyo
Public-Private Partnership
ICT for Development (ICT4D) Network Cambodia with Ministry of Education, Youth and Sports, CARE
Target Locations
Cambodia: Countrywide
References
- (1) Nuclear Threat Initiative and John Hopkins Center for Health Security. (2021). Advancing Collective Action and Accountability amid Global Crisis. https://www.ghsindex.org/wp-content/uploads/2021/12/2021_GHSindexFullReport_Final.pdf
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