E-healthcare solutions

E-healthcare solutions
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E-healthcare solutions
SectorMost major industry classification systems use sources of revenue as their basis for classifying companies into specific sectors, subsectors and industries. In order to group like companies based on their sustainability-related risks and opportunities, SASB created the Sustainable Industry Classification System® (SICS®) and the classification of sectors, subsectors and industries in the SDG Investor Platform is based on SICS.
Health Care
Health Care Providers
Business Model Description

Provide affordable e-health services, such as online consultations, telemedicine and self-diagnosis, together with a system for gathering and sharing medical data of patients with healthcare personnel.

Expected Impact

Reduce inequalities in health services accessibility between urban and rural communities.

Indicative ReturnDescribes the rate of growth an investment is expected to generate within the IOA. The indicative return is identified for the IOA by establishing its Internal Rate of Return (IRR), Return of Investment (ROI) or Gross Profit Margin (GPM).
20% - 25% (in ROI)
Investment TimeframeDescribes the time period in which the IOA will pay-back the invested resources. The estimate is based on asset expected lifetime as the IOA will start generating accumulated positive cash-flows.
Medium Term (5–10 years)
Market SizeDescribes the value of potential addressable market of the IOA. The market size is identified for the IOA by establishing the value in USD, identifying the Compound Annual Growth Rate (CAGR) or providing a numeric unit critical to the IOA.
USD 559 million total healthcare spending in the country.
Average Ticket Size (USD)Describes the USD amount for a typical investment required in the IOA.
USD 500,000 - USD 1 million
Direct ImpactDescribes the primary SDG(s) the IOA addresses.
No Poverty (SDG 1) Good health and well-being (SDG 3) Gender Equality (SDG 5)
Indirect ImpactDescribes the secondary SDG(s) the IOA addresses.
Decent Work and Economic Growth (SDG 8) Reduced Inequalities (SDG 10)
Country
Regions
  • Rwanda: Countrywide
SectorMost major industry classification systems use sources of revenue as their basis for classifying companies into specific sectors, subsectors and industries. In order to group like companies based on their sustainability-related risks and opportunities, SASB created the Sustainable Industry Classification System® (SICS®) and the classification of sectors, subsectors and industries in the SDG Investor Platform is based on SICS.
Health Care
HC

Development need: Important work remains in Rwanda for achieve on-track status in all targets for SDG 3 - Good Health and Well-being).(1) A child born in Rwanda today will be only 37% as productive as they could be if they enjoyed complete education and full health.(2)

Policy priority: Via the introduction of Mutualles de Danté in early 2000, known today as Rwanda Community-Based Health Insurance, Rwanda aims to give access to all the citizens not covered by other healthcare schemes.(3) The 4th Health Strategic Sector Plan 2018-2024 aims to ensure all Rwandan citizens have equal access to high quality maternal, neonatal, child and community health services.(4)

Gender inequalities and marginalization issues: A substantial investment has been made in healthcare human capital development. However, significant improvements are still needed for Rwanda to achieve sufficient health staff with all requisite human and technical skills, as well as to distribute the health providers in remote rural areas.(4)

Investment opportunities introduction: Increasing private sector participation in healthcare will increase overall access to health services and population wellbeing, and boost Rwanda's economic growth.(4)

Key bottlenecks introduction: Rwanda's healthcare sector faces a number of challenges, including a deficit of skilled personnel (only 1.3 physicians per 10,000 people), limited access to health services (only 16 hospital beds per 10,000 people), and financial and operational problems.(3)

SubsectorMost major industry classification systems use sources of revenue as their basis for classifying companies into specific sectors, subsectors and industries. In order to group like companies based on their sustainability-related risks and opportunities, SASB created the Sustainable Industry Classification System® (SICS®) and the classification of sectors, subsectors and industries in the SDG Investor Platform is based on SICS.
Health Care Providers
HC.3

Development need: Rwanda has approximately 15,000 villages, and about 45,500 community health workers spread throughout the country.(5) Most health workers lack any medical education and can provide only the most basic medical services.(6) The country needs access to diagnostic services and consultations with specialists, which in turn allows for more accurate treatments.

Policy priority: The Rwandan Government aims for a comprehensive health care system. The importance of improving the quality of services as well as expanding service coverage has been emphasized in many policy documents. Rwanda aims to deploy a digital-first universal primary care services system.(7),(8)

Gender inequalities and marginalization issues: In Rwanda, around 59% of women experience at least once a problem in accessing healthcare services.(9)

Investment opportunities introduction: According to case studies, the hospitals introducing telemedicine can increase their profit by USD 1-3 million by investing approximately USD 100,000.(10)

Key bottlenecks introduction: Rwanda offers an accelerated depreciation rate of 50% over the first year of operations.(16) Digital decision support tools and strategies helping with diagnosis and treatment, as well as clinical algorithms recognized as an important adjunct to healthcare quality, are often still in their infancy.(7),(8)

IndustriesMost major industry classification systems use sources of revenue as their basis for classifying companies into specific sectors, subsectors and industries. In order to group like companies based on their sustainability-related risks and opportunities, SASB created the Sustainable Industry Classification System® (SICS®) and the classification of sectors, subsectors and industries in the SDG Investor Platform is based on SICS.
Health Care Delivery
HC-DY
Investment Opportunity Area

E-healthcare solutions

Business Model

Provide affordable e-health services, such as online consultations, telemedicine and self-diagnosis, together with a system for gathering and sharing medical data of patients with healthcare personnel.

Critical IOA UnitDescribes a complementary market sizing measure exemplifying the opportunities with the IOA.
USD 559 million total healthcare spending in the country.

In 2016-17, approximately 67% of Rwandan households owned a mobile phone, translating to over 2.7 million households.(14)

Rwanda's community-based health insurance program (Mutuelle de Santé) covers over 90% of the population. The government aims to ensure universal healthcare access.(15)

Out-of-pocket payments currently constitute 18% of total expenditure on health.(16)

ROIDescribes an expected return from the IOA investment over its lifetime.
20% - 25%

Benchmark statistics for the e-healthcare sector estimate a return rate between 20.8% and 24.8%. This rate is a benchmark calculated as the cost of equity with a country risk premium, reflecting an average return required by investors.(17)

Available case studies indicate hospitals introducing telemedicine can increase profit by USD 1-3 million by investing around USD 100,000.(10)

TimeframeDescribes the time period in which the IOA will pay-back the invested resources. The estimate is based on asset expected lifetime as the IOA will start generating accumulated positive cash-flows.
Medium Term (5–10 years)

On average it takes 5 years to achieve return on telemedicine investment, but small standalone solutions can achieve returns within a shorter timeframe.(18)

A medium term timeframe is expected for large-scale digital healthcare project, with an expected payback period of up to 9 years.(18)

Average Ticket Size (USD)Describes the USD amount for a typical investment required in the IOA.
USD 500,000 - USD 1 million
Business - Supply Chain Constraints
Low availability of good infrastructure for general communications and information technology (19)
Capital - CapEx Intensive
Large-scale projects require an architecture supporting unique identifiers for patients, as well as open standards for data coding and exchange to integrate the new systems with existing databases and the future initiatives.(19)
Business - Supply Chain Constraints
Despite high internet coverage in the country, affordability may be an obstacle for future scalability.(20) However, the cost of internet is likely to decrease with further investment in the information and communications technology (ICT) sector.
Market - Volatile
Rising concerns about digital data privacy can limit the rapid pace of sector development.(21)
Sustainable Development Need

In 2019, the subjective wellbeing of Rwandans ranked only 3.3 on a 1-10 scale (1 being the worst and 10 being the best).(22)

In 2017, the universal health coverage (UHC) index of service coverage was 57.0 (out of 100), indicating less than two-thirds of coverage. This result highlights the need to improve access to healthcare services among the population, especially in rural areas.(22)

Rwanda's health system is constrained by limited staff, including a severe shortage of qualified medical personnel. The country has only 1.3 physicians per 10,000 people, compared with the recommended minimum of 2.5 healthcare providers per 10,000 people.

Gender & Marginalisation

Approximately 59% of women experience at least once a problem in accessing healthcare services.(9)

The number of new Human Immune Virus (HIV) infections is a challenge, with 0.3 cases per 1,000 uninfected population.(22)

Expected Development Outcome

Improved healthcare delivery and access to healthcare for communities living in remote areas

Improved diagnosis of disease, access to medication and quality of human capital; increased access to preventive medicine and healthcare services, positively impacting the number of visits and need for secondary and tertiary healthcare services

Reduced number of non-emergency consultations in secondary and tertiary healthcare facilities due to online consultations, impacting positively the time and cost for healthcare facilities, workers and patients

Gender & Marginalisation

Investments can improve access to quality healthcare service provision for all segments of society, focusing on women and rural communities.

Primary SDGs addressed
1 - No Poverty
No Poverty (SDG 1)

1.a.2 Proportion of total government spending on essential services (education, health and social protection)

Current Level

Health: FRW 197,351,473,973 Education: FRW 240,486,878,694 Social protection: FRW 91,075,669,292 (38)

Target Level

N/A

3 - Good Health and Well-Being
Good health and well-being (SDG 3)

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.c.1 Health worker density and distribution

Current Level

57 (40)

1.15% (40)

1.34 per 10,000 (40)

Target Level

N/A

N/A

N/A

5 - Gender Equality
Gender Equality (SDG 5)

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

Current Level

84.2% (40)

Target Level

N/A

Secondary SDGs addressed
8 - Decent Work and Economic Growth
Decent Work and Economic Growth (SDG 8)
10 - Reduced Inequalities
Reduced Inequalities (SDG 10)
Directly impacted stakeholders
People
Populations inhabiting remote areas and society as a whole benefitting from better healthcare access
Gender inequality and/or marginalization
Women with better access to healthcare
Corporates
Pharmaceutical companies, healthcare employees
Public sector
National health system
Indirectly impacted stakeholders
Corporates
Secondary companies benefitting frem established e-healthcare systems
Outcome Risks

Possible systems fragmentation, poor communication and poor interoperability (23)

Security, privacy and confidentiality issues may arise (risk of data security and privacy breaches).(24),(25)

Impact Risks

Execution risk: Activities may not be delivered as planned and do not result in the desired outcomes in the absence of careful planning.

External risk: External factors may disrupt delivery of expected impact by distorting the supply chains in medical consumable manufacturing and distribution.

Stakeholder participation risk if services exclude certain regions

What

Investment in up-scaling the provision of e-health services e.g. online consultations, telemedicine and self-diagnosis, addressing the limited access to healthcare services in rural areas.

Who

Communities inhabiting remote areas, society as a whole, national health system, pharmaceutical companies, healthcare employees.

Risk

An inefficient, fragmented system and potential privacy and confidentiality issues may decrease trust in the deployed solutions.

Impact Thesis

Reduce inequalities in health services accessibility between urban and rural communities.

Policy Environment

Health Sector Policy: This policy identifies a need for improved access to and use of the Rwanda Health Information Management and its related systems.(26)

4th Health Sector Strategic Plan 2018-2024: This plan states e-health initiatives such as telemedicine shall be expanded nationwide, and contribute to improved efficiency in service delivery, better emergency management and expansion of the clinical outreach programs in peripheral health facilities.(27)

Health Sector Information and Communication Technology (ICT) Security Policy: This policy defines the healthcare sector ICT security policies and provides an communication and implementation framework to support these policies.(28)

Vision 2050: This policy outlines telemedicine and advanced health technologies as a means to universally accessible, high quality health services. According to the document, telemedicine should reduce operating and administrative costs.(29)

Financial Environment

Fiscal incentives: For investments equivalent to at least USD 50 million, investors receive with a corporate income tax holiday of up to 7 years.(36) IT equipment needed for establishing e-health operations is exempt from value added tax.(37)

Other incentives: Foreign enterprises that invest at least USD 250,000 can employ 3 foreign workers without performing a labor test.(36)

Regulatory Environment

Ministerial Instructions governing Private Health Facilities 2020: This regulatory document provides a framework for private health institutions, their obligations and requirements.(30)

Licensing Standards for Private Health Facilities: These standards provide a framework for obtaining a license by a private health facility and requirements that must be met.(31)

Health Post Management Manual: This document is a guideline to managing healthcare facilities in accordance with current laws and regulations in Rwanda.(32)

Ministerial Order N° 20/31 of 18/04/2012: This order determines the modalities for deploying medical staff in the health sector. It states that all doctors and other health professionals must be registered under appropriate health professional bodies.(33)

Rwanda's Ministry of Health provides laws, regulations and policies for the healthcare sector.(34) The Rwanda Biomedical Centre provides guidelines for healthcare operators to achieve the goals set out in the 4th Health Sector Strategic Plan 2018-2024.(35)

Private Sector

Babyl, E-Heza, VitalHealth Solutions BV

Government

Rwandan Ministry of Health (MOH), Rwanda Development Board (RDB)

Multilaterals

International Monetary Fund (IMF), European Union (EU), European Investment Bank (EIB), African Development Bank (AfDB), World Health Organization (WHO)

Non-Profit

World Economic Forum (WEF), United States Agency for International Development (USAID), German Corporation for International Cooperation (GIZ), KfW Development Bank, Agence Française de Développement (AFD)

country static map
semi-urban
Rwanda: Countrywide
The whole country focusing particularly on rural areas, which have limited access to healthcare facilities. The distance to healthcare facilities constitutes one of the major constraints to using healthcare services in Rwanda.(5)
Sector Sources
  • 1) Sachs, J., Schmidt-Traub, G., Kroll, C., Lafortune, G., Fuller, G. and Woelm, F. (2020). The Sustainable Development Goals and COVID-19. Sustainable Development Report 2020. Cambridge: Cambridge University Press. 2) United Nations Development Programme. Briefing note for countries on the 2019 Statistical Update: Rwanda. 3) Nyandekwe, M., Nzayirambaho, M. and Kakoma, J.B. (2020). 'Universal Health Insurance in Rwanda: Major Challenges and Solutions for Financial Sustainability Case Study of Rwanda Community-Based Health Insurance Part I', Pan African Medical Journal 37. 4) Ministry of Health. 4th Health Strategic Sector Plan 2018-2024. 5) Ministry of Health. 4th Health Strategic Sector Plan 2018-2024. 6) Schurer, J.M., Fowler, K., Rafferty, E., Masimbi, O., Muhire, J., Rozanski, O. and Amuguni, H.J. (2020). Equity for health delivery: Opportunity costs and benefits among Community Health Workers in Rwanda. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0236255 7) Mitchell, M. and Kan, L. (2019). Digital Technology and the Future of Health Systems. Health Systems and Reform. https://www.tandfonline.com/doi/pdf/10.1080/23288604.2019.1583040 8) Nawrat, A. (2020). 'Setting An Example: Rwanda As A Digital Health Success Story - Medical Technology', Medical technology, 28. https://medical-technology.nridigital.com/medical_technology_jun20/rwanda_digital_health 9) National Institute of Statistics of Rwanda (2015). Rwanda Demographic and Health Survey 2014-15. https://www.statistics.gov.rw/publication/demographic-and-health-survey-20142015-final-report 10) Marks, J., Augesnstein, J. et al. (2019). A Framework for Evaluating the Return on Investment of Telehealth. Manatt Health Strategies, LLC.
IOA Sources
  • 11) Barbor, M. Building Improved and Sustainable Health-Care Systems Through Telemedicine 12) Babyl (2020). Rwanda's ambitious aims for digital health. https://healthcare-in-europe.com/en/news/rwanda-s-ambitious-aims-for-digital-health.html 13) Educational Management Information Systems (EMIS) database. 14) National Institute of Statistics of Rwanda. The EICV5_Utilities and Amenities Thematic Report. https://www.statistics.gov.rw/publication/eicv5-thematic-report-utilities-and-amenities 15) Medical Technology (2020). Setting an example: Rwanda as a digital health success story. https://medical-technology.nridigital.com/medical_technology_jun20/rwanda_digital_health 16) World Health Organization (2017). Primary Health Care Systems (PRIMASYS). https://www.who.int/alliance-hpsr/projects/AHPSR-PRIMASYS-Rwanda-Abridged.pdf?ua=1 17) PwC analysis based on Prof. A. Damodaran data, 2020. 18) Drury, P., Roth, S., Jones, T., Stahl, M. and Medeiros, D. (2018). Guidance for Investing in Digital Health. Asian Development Bank. 19) Piette, J., Moura, L. and Lun, K. (2012). Impacts Of E-Health On The Outcomes Of Care In Low- And Middle-Income Countries: Where Do We Go From Here? World Health Organization. https://www.who.int/bulletin/volumes/90/5/11-099069/en/ 20) Rwanda Development Board (2013). Broadband for an inclusive digital society. https://unctad.org/system/files/non-official-document/Broadband%20for%20an%20inclusive%20digital%20society%20-%20Rwanda.pdf 21) European Union Agency For Network And Information Security (2015). Security and Resilience in eHealth https://www.enisa.europa.eu/publications/security-and-resilience-in-ehealth-infrastructures-and-services/at_download/fullReport 22) United Nations Development Programme (2020). Sustainable Development Report 2020. https://unstats.un.org/sdgs/report/2020/The-Sustainable-Development-Goals-Report-2020.pdf 23) Piette, J., Moura, L. and Lun, K. (2012). Impacts Of E-Health On The Outcomes Of Care In Low- And Middle-Income Countries: Where Do We Go From Here? World Health Organization. https://www.who.int/bulletin/volumes/90/5/11-099069/en/ 24) Zriquat, I. and Altamimi, A. (2016). 'Security And Privacy Issues In Ehealthcare Systems: Towards Trusted Services', International Journal of Advanced Computer Science and Applications, vol. 7. https://www.researchgate.net/publication/308803282_Security_and_Privacy_Issues_In_eHealthcare_Systems_Towards_Trusted_Services 25) Sahama, T. and Simpson, L. (2013). Security And Privacy In Ehealth: Is It Possible? https://www.researchgate.net/publication/269329631_Security_and_Privacy_in_eHealth_Is_it_possible 26) Ministry of Health (2015). Health Sector Policy. Republic of Rwanda. http://moh.gov.rw/fileadmin/templates/policies/Health_Sector_Policy___19th_January_2015.pdf 27) Ministry of Health (2017). 4th Health Sector Strategic Plan 2018-2024. Republic of Rwanda. http://moh.gov.rw/fileadmin/templates/Docs/FINALH_2-1.pdf 28) Ministry of Health (2016). Health Sector Information And Communication Technology (ICT) Security Policy. Republic of Rwanda. http://moh.gov.rw/fileadmin/templates/policies/Aproved_ICT_Security_Policy_forMOH.pdf 29) Ministry of Finance and Economic Planning (2015). Vision 2050. http://www.minecofin.gov.rw/fileadmin/templates/documents/NDPR/Vision_2050/Vision_2050_-Full_Document.pdf 30) Republic of Rwanda (2020). Ministerial Instructions governing Private Health Facilities 2020. http://moh.gov.rw/fileadmin/Publications/Policies/MINISTERIAL_INSTRUCTIONS_2020.pdf 31) Republic of Rwanda. Licensing Standards for Private Health Facilities. http://moh.gov.rw/fileadmin/Publications/Policies/Licensing%20Standard%20for%20PHF.pdf 32) Republic of Rwanda. Health Post Management Manual. http://moh.gov.rw/fileadmin/templates/Guidelines_Protocols/HPs_Procedure_Manual.pdf 33) Republic of Rwanda (2012). Official Gazette nº 25 of 18/06/2012. http://moh.gov.rw/fileadmin/templates/HLaws/Appoinntment-of-medical-staff-AM.pdf 34) Ministry of Health. About Ministry. https://www.moh.gov.rw/about 35) Rwanda Biomedical Centre. Who We Are. https://www.rbc.gov.rw/index.php?id=629 36) Rwanda Development Board. Incentives to support Health sector. https://rdb.rw/investment-opportunities/health-services/#tab-1-3 37) Rwanda Development Board. Special incentive packages provided to ICT firms. https://rdb.rw/investment-opportunities/ict/#tab-1-3 38) Republic of Rwanda (2019). Voluntary National Review Rwanda 2019. https://sustainabledevelopment.un.org/content/documents/23432Rwanda_VNR_Document__Final.pdf 39) 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. https://dashboards.sdgindex.org/profiles/RWA 40) United Nations. SDG indicators. https://unstats.un.org/sdgs/indicators/database/