E-healthcare
E-healthcare
Business Model Description
Provide telemedicine and mobilise consultations as well as digital emergency response systems to rural communities
Expected Impact
Provide cost-effective access to healthcare services for remote communities.
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
- Ghana: Greater Accra
- Ghana: Western Region
- Ghana: Upper East
- Ghana: Ahafo Region
- Ghana: Eastern
Sector Classification
Health Care
Development need
Ghana's healthcare sector is characterized by insufficient financing. Healthcare expenditure is approximately USD 66 per capita, or 3.6% of gross domestic product (GDP), both below the already low regional Sub-Saharan average.(3) Another healthcare challenge is insufficient doctors, and nurses and midwives (1.1 and 9.8 for every 10,000 inhabitants respectively), numbers which are also below the regional average.(4a) Subjective wellbeing of Ghana's population is rated as mediocre, scoring 5.0 out of 10.0.(1)
Policy priority
The country's policy aims to achieve a resilient healthcare delivery system, achieve sustainable financing for health, reach universal health coverage and reduce the financial barriers to healthcare by developing a National Health Insurance Scheme.(4)
Key bottlenecks
The main sector challenges include: lack of medical infrastructure, inadequate equipment, low number of doctors and average level of knowledge among medical personnel, high regional disparities in access, low insurance penetration, poor access to birth control, and inadequate nutrition.
Health Care Distributors
Pipeline Opportunity
E-healthcare
Provide telemedicine and mobilise consultations as well as digital emergency response systems to rural communities
Business Case
Market Size and Environment
< USD 50 million
One key area where telehealth is highly used is maternal health (second after family planning). The total market size is estimated to rise from 0.95 million to 1.2 million people between 2014 and 2020.(V)
In 2016, Ghana had more than 8,300 health facilities, and more than 23 thousand hospital beds, 13% of which were provided by private companies.(I)
While more than half of the population live in urban areas,(3) the distribution of health facilities and health workforce is uneven among regions. Ashanti and Greater Accra, regions with Ghana's two major cities, had approximately 40% of the health workforce. This means rural populations may face obstacles in accessing health services.(8)
Indicative Return
20% - 25%
The estimated rate of return for investors is 23.2% - 27.2%. This rate is a benchmark calculated as a cost of equity that includes a country risk premium, reflecting an average return required by investors active in the subsector.(XI)
Based on a regional case study, implementing a telemedicine solution saved up to USD 500,000, when compared with health workforce travel costs incurred by a private medical company.(III)
Investment Timeframe
Short Term (0–5 years)
A small, standalone solution can achieve a positive return in less than 5 years, but often 5 years is required to achieve net profits. For a large-scale digital healthcare project, a payback period of up to 9 years should be expected.(VII)
Market Risks & Scale Obstacles
Business - Supply Chain Constraints
Capital - Limited Investor Interest
Market - uptake barriers
Impact Case
Sustainable Development Need
Achieving universal healthcare access is still a challenge in Ghana. Achieving it requires removing bottlenecks such as a poor transport network, underequipped medical centers and insufficient medical workforce. Many diseases that could be easily treated have a negative impact on morbidity rates.(II)
With limited access to health services, the focus should be on prevention. Ghana has only 9 hospital beds per 10,000 population, compared with the average of 19 beds per 10,000 population for medium development countries (according to the Human Development Index).(5)
Ghana has only 0.1359 doctors (in 2017) and 4.2 nurses (in 2018) per 1,000 population (6), compared with WHO recommended minimums of 0.217 doctors and 2.28 nurses per 1,000 people respectively.(7)
Given Ghana's limited medical personnel (6), e-medicine can help with identifying COVID-19 cases and reduce the burden on the overloaded healthcare system.
Gender & Marginalisation
With solutions such as telemedicine and mobile consultation, Ghana's healthcare system will be better prepared and equipped to deal with gender-based violence. According to a report from 2016, more than 14% of young women in Ghana experienced sexual abuse and more than half of women experienced gender-based violence.(20)
Expected Development Outcome
Increased access to healthcare especially for remote places, reduced spread of illness
Broadened medical knowledge among people
Decreased cost of medical consultations, reduced commuting time for doctors
Gender & Marginalisation
Increased accessibility to reproductive health, and other subject matter consultations for women
Primary SDGs addressed
3.8.1 Coverage of essential health services
3.8.2 Proportion of population with large household expenditures on health as a share of total household expenditure or income
3.d.1 International Health Regulations (IHR) capacity and health emergency preparedness
5.6.1 Proportion of women aged 15–49 years who make their own informed decisions regarding sexual relations, contraceptive use and reproductive health care
Secondary SDGs addressed
Directly impacted stakeholders
People
Gender inequality and/or marginalization
Corporates
Public sector
Indirectly impacted stakeholders
Planet
Outcome Risks
Additional risk of medical data leaks (V)
People may lower their trust toward doctors due to lower quality consultations via mobile phones (X)
Teleconsultation may limit the doctor's ability to recognise a disease
Impact Classification
What
Investing in telemedicine is likely to have a positive impact because it reduces the barriers to healthcare access and provides new possibilities for medical consultations.
Risk
While the model is proven, telemedicine may diminish the quality of consultations due to a lack of personal contact.
Impact Thesis
Provide cost-effective access to healthcare services for remote communities.
Enabling Environment
Policy Environment
Medium-Term National Development Policy Framework: An Agenda For Jobs: Creating Prosperity and Equal Opportunity for All (First Step) 2018-2021: This policy aims to raise the quality and accessibility of medical services, as well as provide necessary social protection focusing on children, women, elderly and disabled people. One approach to achieving this objective is to expand the use of ICT (information and communications technology) and telemedicine in healthcare delivery.(9)
National Health Policy: This policy has 5 objectives: strengthen the healthcare delivery system to be resilient, encourage the adoption of healthy lifestyles, improve the physical environment, improve the socio-economic status of the population, and ensure sustainable financing for health.(VI)
Currently, the National Health Insurance Authority (NHIA) does not reimburse telemedicine consultations.(VI)
Financial Environment
Financial incentives: Ghana doesn't provide any incentives for this investment opportunity area because the government provides little regulation for e-health.
Regulatory Environment
The Ministry of Health is the main body responsible for overseeing the health sector.(X)
The Ministry of Health strategic plan aims at scaling-up telemedicine in Ghana. (11)
In 2010, Ghana introduced an e-Health strategy framework to improve access to healthcare and the overall wellbeing of its citizens by scaling telemedicine use.(X)
Marketplace Participants
Private Sector
Redbird, Vodafone Healthline, ReACH, MOTECH, mPEDIGREE, SATELLIFE, eHISS, Family Health, Sanford
Government
Ghana Health Service, Ministry of Health, Millennium Promise Alliance
Multilaterals
International Finance Corporation (IFC)
Multilaterals
Earth Institute, Columbia University, MoTeCH, Novartis, Bill and Melinda Gates Foundation
Target Locations
Ghana: Greater Accra
Ghana: Western Region
Ghana: Upper East
Ghana: Ahafo Region
Ghana: Eastern
References
- (1) Sachs, J., Schmidt-Traub, G., Kroll, C., Lafortune, G., Fuller, G., Woelm, F. 2020. The Sustainable Development Goals and COVID-19. Sustainable Development Report 2020. Cambridge: Cambridge University Press.
- (2) UN Office for the Coordination of Humanitarian Affairs (2020). West And Central Africa COVID-19 Digest, 26 July. https://reports.unocha.org/en/country/west-central-africa/card/6uLx4i1qIe/
- (3) World Bank database. https://data.worldbank.org/
- (4) Ghana Ministry of Health (2020). National Health Policy: Ensuring healthy lives for all. (4a) MedCOI (2019). Country policy and information note Ghana: medical and healthcare issues. UK Government. (4b) UN Development Programme (2019). Inequalities in Human Development in the 21st Century. Briefing note for countries on the 2019 Human Development Report.
- (5) Conceição, P. (2019). Human Development Report 2019: Beyond income, beyond averages, beyond today: Inequalities in human development in the 21st century. UNDP, New York.
- (6) World Health Organization (2018). The 2018 update: Global Health Workforce Statistics. Geneva. http://www.who.int/hrh/statistics/hwfstats/
- (7) Masibo, R., Kiarie, H. and Bartilol, P. Policy brief: human resources for health – gaps and opportunities for strengthening. Kenya Ministry of Health.
- (8) Ghana Health Service (2017). Ghana Health Service Annual Report 2016. https://www.ghanahealthservice.org/downloads/GHS_ANNUAL_REPORT_2016_n.pdf
- (9) Medium-Term National Development Policy Framework: An Agenda for Jobs: Creating Prosperity and Equal Opportunity for All (First Step) 2018-2021.
- (10) Ghana Investment Promotion Centre (2017). Doing business in Ghana – to know and invest in Ghana.
- (11) Ministry of Health (2014). Health Sector Medium Term Development Plan 2014-2017.
- (12) Council on Foreign Relations (2016). Violence against Women in Ghana: Unsafe in the Second Safest Country in Africa. https://www.cfr.org/blog/violence-against-women-ghana-unsafe-second-safest-country-africa
- (I) Ghana Health Service (2018). The Health Sector in Ghana: Facts and Figures. (II) Ghana Telemedicine Program. https://globalhealthprogress.org/collaboration/ghana-telemedicine-program/ (III) Barbor, M. (2018). Building Improved and Sustainable Health-Care Systems Through Telemedicine. https://ascopost.com/issues/november-25-2018/building-improved-and-sustainable-health-care-systems-through-telemedicine/ (IV) GSMA (2020).The state of mobile in Ghana’s tech ecosystem. https://www.gsma.com/mobilefordevelopment/blog/the-state-of-mobile-in-ghanas-tech-ecosystem/#:~:text=There%20are%2013.1%20million%20active,million%20registered)%20mobile%20money%20accounts.&text=As%20of%20the%20third%20quarter,(as%20of%20Q3%202019) (V) GSMA (2014). Mobile for Development - mHealth Country Feasibility (Ghana). https://www.gsma.com/mobilefordevelopment/wp-content/uploads/2014/12/mHealth_Country_Feasibility_Report_Ghana_20141.pdf (VI) Novartis. Ghana Telemedicine Toolkit: Interactive Implementation Guide. https://www.novartisfoundation.org/sites/www.novartisfoundation.org/files/Interactive%20Implementation%20Guide.pdf (VII) Drury, P., Roth, S., Jones, T., Stahl, M. and Medeiros, D. (2018). Guidance for Investing in Digital Health. Asian Development Bank. https://www.adb.org/sites/default/files/publication/424311/sdwp-052-guidance-investing-digital-health.pdf (VIII) Osten, B. (2016). Cost-Effectiveness Analysis Of Telemedicine For Primary Healthcare In Amansie-West District. Kwame Nkrumah University of Science and Technology, Kumasi, Ghana., http://ir.knust.edu.gh/bitstream/123456789/9964/1/Final%20Project.pdf (X) Ogoe, H.A., Asamani, J.A., Hochheiser, H. et al. (2018). ‘Assessing Ghana’s eHealth workforce: implications for planning and training’. Human Resources for Health 16(65). (XI) PwC analysis based on Prof. A. Damodaran data, 2020. (X) Technology Advice (2015). Do Patients Trust Telemedicine? - 2015 Trends in Virtual Healthcare Services. http://telecareaware.com/wp-content/uploads/2015/07/technologyadvice-telemedicine-study-T46.pdf (XI) BMC Medical Informatics and Decision Making (2020). Lessening barriers to healthcare in rural Ghana: providers and users’ perspectives on the role of mHealth technology. A qualitative exploration. https://bmcmedinformdecismak.biomedcentral.com/articles/10.1186/s12911-020-1040-4