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8/3/2019 Sizing Business Potential

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Wwwwww.mhealthalliance.orgwww.mhealthalliance.orgww.w

SizingtheBusinessPotentialofmHealthintheGlobalSouth:

APracticalApproach

ByVital

Wave

Consulting

www.mHealthAllianc


2/22

www.mHealthAlliance.orgSizing the Business Potential of

mHealth in the Global South 2009

Page 1

TableofContents

TableofContents......................................................................................................................................................................................................................... 1

Introduction................................................................................................................................................................................................................................. 2

Part1 MarketSizingOverview................................................................................................................................................................................................... 4

Part2

Definitions........................................................................................................................................................................................................................

6

eHealth,mHealth,andTelemedicine:DefinitionsandRelationships....................................................................................................................................... 6

mHealthApplicationSegmentation.......................................................................................................................................................................................... 7

DevelopingCountriesandtheGlobalSouth............................................................................................................................................................................. 8

Part3 MethodologiesOverview................................................................................................................................................................................................. 9

Methodology1TopdownfromHealthBudgetswithNeedsbasedSegmentation..............................................................................................................9

Methodology2TopdownfromHealthICToreHealthBudgets.......................................................................................................................................... 11

Methodology3:BottomupfromCostandVolumeData....................................................................................................................................................... 12

Part4 MethodologyComparison............................................................................................................................................................................................. 15

Appendix:Available

Data

and

Sources

.......................................................................................................................................................................................

16

HealthExpenditureandHealthCareServiceIndicatorsinSouthAfrica................................................................................................................................. 17

HealthExpenditureandHealthCareServiceIndicatorsinVietnam....................................................................................................................................... 19

HealthExpenditureandHealthCareServiceIndicatorsinTurkey..........................................................................................................................................19

References.................................................................................................................................................................................................................................. 21


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Page 2

Introduction

AcrosstheGlobalSouth,lowerincomepopulationsneedqualityeducationandhealthcaretohelpmeetbasichumanneeds.Asthenumberofmobile

servicesubscriberscontinuestoskyrocket,theinfrastructureandinstalledbasefordeliveringservicesviathemobilephonecontinuestoexpand.

Meanwhile, thedwindlingnumberofnewsubscribersnecessitatesashiftoffocusbythemobilecommunicationsindustrytonewsourcesofrevenue.To

justifytheinvestmentsneededforthedevelopmentandcommercializationofmobileservicessuchasmHealth(thedeliveryandmonitoringofhealthdata

by

mobile

devices),

it

is

necessary

to

gauge

the

market

opportunity

that

exists

for

these

services.

Thisreportbuildsonapreviousreport,mHealthintheGlobalSouth:

LandscapeAnalysis,preparedbyVitalWaveConsultingtoexaminethe

currentmHealthlandscapeandprovideanoverviewofthescopeand

impactofmobileinitiativesonhealthcareacrossdevelopingregions.The

LandscapeAnalysisalsoanalyzescriticalsuccessfactorsformakingmHealth

morewidelyavailablethroughsustainableimplementations.mHealth

programsrequiretheparticipationofstakeholdersfromacrossinternational

organizations,governments,NGOs,andprivatecompanies.

Tostimulatecrosssectorparticipationandpartnership,itisnecessaryto

sizeandlocatethemHealthmarketopportunitysothattheseorganizationscanprioritizetheirinvestments,alignmHealthinvestmentswithotherbusiness

programs,and

justify

these

expenditures

to

internal

and

external

stakeholders.

GiventhenascentcharacterofthemHealthindustry,competitiveindicatorsneededtodevelopamarketsizefromthebottomupareabsent,anddataon

healthexpendituresfromthetopdownlackdetailformostdevelopingcountries.Therefore,determiningacrediblemarketsizerequiresapproachesthat

maximizetheuseofimperfectsecondarydata,includingadditionalinputsfromexpertsinthehealthfieldinthedevelopingworld.Tomovetowardthe

developmentofacrediblemarketsizing,thisreportidentifiestheavailablesecondarydataandprovidesthreepossibleapproachesforassessingthemarket

size.

Part1MarketSizingOverviewexaminestheneedforsizingthemarketopportunityformHealthsolutionsintheGlobalSouthandtheavailability of

reliabledatatoexecutethesizing.Basedonanalysisofreadilyavailabledataonhealthcareexpendituresandhealthcareindicatorsinthreedeveloping

countries(Turkey,Vietnam,andSouthAfrica),VitalWaveConsultingidentifiesthemissingpiecesneededtoassessthepotentialhealthcareexpenditure

thatcouldbeshiftedtomHealth.

Part2

Definitions

clarifies

the

main

terms

used

in

this

paper.

These

definitions

were

originally

proposed

in

Vital

Wave

Consultings

report,

mHealth

in

theGlobalSouth:LandscapeAnalysis,createdfortheUNFoundation.

Part3MethodologyOverviewdescribesindetailthetopdownandbottomupapproachesforsizingthemHealthmarketsandthethreemethodologies

proposedasthemostviableforthisexercise.AllproposedmethodologiesestimatethemarketopportunityforeachofthemHealthapplicationareasbut

relyondifferentsetsofdata.

Methodology1:Topdownfromhealthbudgetswithneedsbasedsegmentation

Methodology2:TopdownfromhealthICToreHealthbudgets

Methodology3:Bottomupfromhealthcareprogramcostandvolumepotentialdata

Inadditiontodetailedstepbystepexplanations,eachofthemethodologiesisevaluatedforitsadvantagesanddisadvantages.

Part4MethodologyComparisoncontraststhethreeproposedmethodologiesandcommentsonthequalityoftheirresults.

TheAppendixprovidesanoverviewofthedataonhealthcareexpendituresandhealthcaresystemsofthethreecountriesresearchedindepthTurkey,

SouthAfrica,andVietnamandevaluatesitsquality.

ThisreportwasoriginallypreparedfortheMakingthe

eHealthConnectionconferenceagatheringofmobile

healthstakeholdersinBellagio,ItalyfromJuly31toAugust

8,2008.ItwasrevisedfortheGlobalmHealthAllianceto

formafoundationalbasefortheAlliancesthought

leadershiplibrary.


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Page 3

ThisreportprovidesprofessionalsfromacrosssectorsandindustrieswithmethodologiesforsizingthemarketopportunityformHealthsolutionsinthe

GlobalSouth.Asthesemethodologiesrelyonprimaryandsecondaryresearch,thisreportwaspreparedafterthoroughresearchforavailabledataand

identifiesgapswheresubjectmatterexpertinputisneeded.


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Page 4

Part1 MarketSizingOverview

Marketsizingisgenerallymeasuredattwolevels:totalmarketandaddressablemarket.Totalmarketistheleastgranularmeasureofmarketopportunity

andusuallyrepresentsalargedemographicallyorcommerciallyidentifiablegroup.InthemHealthcontext,thetotalmarketcanbedefinedasgovernments

andorganizationsaroundtheworldthatarecurrentlyprovidinghealthrelatedservicesandprograms.Insomecases,theenduser(patientormessage

recipient)wouldalsopayformHealthservices,andmightbeconsideredpartofthetotalmarket.Thetotalmarketopportunityisthoughtofasthetotal

amount

of

funds

available

from

all

customers

for

health

care

programs.

Total

market

measures

are

normally

a

first

step

in

market

sizing,

but

they

are

rarely

usedbyorganizationaldecisionmakersbecausethetotalmarketdoesnotreflectthenumberofcustomerswhoarelikelytobuy.Forthis,onecalculatesan

addressablemarket.

Theaddressablemarketisasubsetofthetotalmarket.Putsimply,itisthenumberofindividualcustomerswhoarerealisticallywillingandabletopurchase

aproductorservice.Thewillingpartofthedefinitionconnotesthatthesolutionisappropriateforfulfillingacustomersneed,orsetofneeds.Theable

partindicatesthatthecustomerhastheresourcesnecessarytoacquireandeffectivelyusethesolution.Inotherwords,theyhavetherequisitefinancial

meanstopurchasethesolution,minimuminfrastructuretousethesolution,andtheycanacquirethesolutionthroughreasonablemeans.

TomeasuretheaddressablemarketofmHealth,onehastounderstandthesubsetofwillingandablecustomers.Thewillingwillbebasedontheimpact

ofmHealthprogramsandhowthatimpactcomparestootherpotentialinvestments.Thisisdifficulttomeasure,asmHealthiscurrentlyinitsinfancyand

verylimiteddataisavailabletomeasureitsimpact.InvestorstodaymakejudgmentsaboutthevalueofmHealthbasedontheirownexperience.Thisisa

validandnecessaryapproachforallnewindustriesortechnologyapplications,butitposeschallengestosizingthemarketonaglobalscale.

MeasuringtheablepartofanaddressablemarketgroupisbasedondatathatindicatehowmanycustomershavethemeanstopurchasemHealth

services.Thisisalsochallenging,asdatafordevelopingcountriesareoftenincomplete,unavailable,outdated,ortoolimitedtocapturethediversityand

nuanceofthecountryenvironmentforaparticularsolution.CompoundingthatchallengeisthefactthatbotheHealthandmHealthareintheirinfancyin

manydevelopingcountries,andestimatesofcurrentexpenditureonsuchsolutionsarenotsufficienttoextrapolatethemarketpotential.Inaddition,there

arelimiteddataabouthealthspendingatthesubaccountleveltoillustratehowcountriesallocatebudgetsacrossspecificprograms.Ifavailable, suchdata

couldbeusedasanindicatorofmHealthmarketpotential.

Theexerciseofmarketsizingissimilarlycomplex,asthereisnoonesizefitsallapproach.Somemarketsizingapproachesfollowatopdown

methodology,cuttingthemarketofalargerregionorindustryintosmallerpieces.Otherapproachesfollowabottomupmethodology,extrapolatinga

marketsizeforthegeographyorindustrybasedoncountrylevelorcompetitivedatapoints.However,allapproachesrelyoncredibleandcurrentdata.

ToinformanddevelopacrediblemethodologyformHealthmarketsizing,VitalWaveConsultingconductedathoroughsearchofavailabledatafromacross

internationalorganizations,

country

health

ministries,

press

and

journal

articles,

and

company

and

project

papers

and

documents.

The

data

search

covered

threedevelopingcountriesfromdifferentregionsoftheworld(SouthAfrica,Turkey,andVietnam)andincludeddocumentationofmHealthprojects

implementedworldwide.Thefollowingisasummaryoftheavailableandunavailabledatafoundinthisinvestigation:

Availabledata1

Totalhealthexpenditure(totalandpercentfromprivate,public,andexternalsources)

Healthworkforce(e.g.,thenumberandgeographicdistributionofnurses,physicians,dentists,pharmacists,beds,hospitals,healthcare

posts,andhealthcarecenters)

Healthserviceandcareindicators(e.g.,mortality,morbidity,disabilityadjustedlifeyearsperdisease,hospitaladmissions,HIVandTB

prevalence)

Drugexpenditure(totalandperdrugtype)

1More information about the data found and the documented sources can be found in the Appendix.


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Page 5

Informationontheorganizationofthehealthcaresystemsaswellastrendsandthelatestdevelopmentsintheseparticularcountries

Anecdotal,noncomprehensiveinformationaboutpotentialsavingsandimprovedoperationalefficiencyfromimplementedmHealth

solutions,coveringseveralsolutionsacrossselectedcountries

Limitedorunavailabledata

Healthbudgets

at

the

sub

account

level

by

function

or

activity

(e.g.,

ICT,

preventive

and

primary

health

care

service,

health

care

education,

andbehaviorchangecampaigns)

Healthbudgetsandhealthcareindicatorsbrokendownbyarea(urbanversusrural)orbyareaunit(province)

CrediblesystematicstudyofthepotentialimpactorcostsavingsfromimplementedmHealthsolutions

Dataaboutthehealthcaresystemsandexpenditureinthecountriesresearchedisabundant,butveryhighlevel,inhibitingestimatesoftheportionof

expendituresthatcouldbeshiftedtomHealth.Publiclyavailablesourcesofinformation(e.g.,theWorldHealthOrganizationandnationalministriesof

health)andpaiddatabasesprovidereliableinformationonthosetopics,butmoreindepthknowledgefromsubjectmatterexpertsatthecountrylevelis

needed.Forexample,inputfromthelatterwouldbecriticalwhenassessingthemHealthmarketopportunitiesforcountrieswithgreatdisparitiesin

spendingandavailabilityofhealthcareserviceinurbanandruralareas.SuchdisparitiesdeterminedifferentneedsformHealthsolutionsandarenot

alwaysreflectedinthereadilyavailabledata.

AnotherimportantmissingpieceisacrediblestudyoftheimpactofmHealthsolutions.Informationaboutthebenefitscanbefoundinsomeproject

reportsandonthewebsitesofmobilephoneoperatorsandcompaniesdevelopingsuchsolutions,butthisinformationdoesnotsubstantiateimpact

beyondasinglesolutionorsmallgeographyortargetmarket,ifatall.Additionally,theimpactofaparticularsolutionwillnotnecessarilybethesamein

twodifferentcountries.Forexample,theSATELLIFEprojectestimatesthatowningaPDAdevicesavesamedicalofficerinUganda9.37hoursperweekon

average.iThesameproject,ifreplicatedinTurkey,couldhaveaverydifferentimpact.Untilcomprehensivestudiesaredone,onehastorelyonsubject

matterexpertsorfieldinterviewstoestimatetheimpactofdifferentmHealthapplications.

Below,VitalWaveConsultingproposesthreemethodologiesforassessingthemarketopportunityformHealthsolutionsintheGlobalSouthandits

individualregionsandcountries.ThisreportdoesnotexhaustallpossiblemethodsforsizingthemHealthmarket,butinsteadprovidesanoverviewofthe

threemethodologiesthatwouldgivethemostthoroughpictureofthemHealthinvestmentopportunities.

Given

the

above

mentioned

data

limitations

and

challenges,

all

three

proposed

methodologies

rely,

to

different

extents,

on

primary

research

in

addition

to

secondaryresearch.Also,giventhenascentcharacterofthemHealthindustry,theproposedmethodologiesconcentrateonestimatingthefutureor

potentialspendingonmHealth.


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Page 6

Part2 Definitions

Thissectionincludesexplanationsoftheimportanttermsusedinthispaper:

mHealthanditsdistinctionfromeHealthandtelemedicine

mHealth

application

segmentation

DevelopingcountriesandtheGlobalSouth

ThesedefinitionswereoriginallyproposedinVitalWaveConsultingsreport,mHealthintheGlobalSouth:LandscapeAnalysis.

eHealth,mHealth,andTelemedicine:DefinitionsandRelationships

ManyanddiversedefinitionsofthetermseHealth,mHealthandtelemedicineexist.However,thereisgeneralagreementthateHealthrepresentsa

supersetofmHealthandtelemedicine.eHealthistypicallyperceivedasencompassingtheuseofanyelectronictechnologiestoprovidehealthservices.Itis

independentofpatient/providerproximityortheuseofspecifictechnology.

Forthepurposesofthispaper,VitalWaveConsulting,relyingupontheinputofindustryexpertsandresearch,hasutilizedthefollowingdefinitions:

eHealth:thedeliveryofhealthrelatedservicesviainformationandcommunicationtechnology.

mHealth:asubsetofeHealthreferringtothedeliveryofhealthrelatedservicesviamobilecommunicationstechnology.

Telemedicine:asubsetofeHealthreferringtohealthrelatedservicesdeliveredremotelywithclinicalparticipationviaelectronic

communications.TelemedicinealsohasoverlapwithmHealthwhenmobilecommunicationstechnologiesareemployedinthedelivery

process.(Telemedicineisoftenassociatedwiththeterm"telehealth,"whichmayencompassabroaderdefinitionofremotehealthcare

thatdoesnotnecessarilyinvolveclinicalservices.)


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Figure1presentsthetermsdescribedaboveinthecontextofthecorrespondinghealthcareapplicationsegments.Thesegmentsshownatthetopofthe

tablereflectthegrowingsophisticationofapplicationandtechnologicalrequirementsastheymovefromeducationandpublicawareness, attheleft,to

diagnosisandconsultationonthefarright.Itismobiletechnologysuniquecharacteristicsofportabilityandaccessthatprovidecompletelynewsolutions

tohealthcareneedsacrossabroaderrangeofhealthcareapplications.

Figure1:PositioningeHealth,mHealthandTelemedicine

mHealthApplicationSegmentation

BysurveyingabroadrangeofmHealthprograms,initiatives,andapplications,VitalWaveConsultingcreatedanapplicationsegmentationmodelbasedon

targetedhealthcaregoals.Figure2liststhesesegments,withcorrespondingdescriptionsandexamplesofspecificmHealthprogramsintheGlobalSouth.

Readingthelistfromtoptobottom,theapplicationsegmentshaveincreasingtechnologyrequirementsandcomplexityofimplementation.These

applicationcharacteristicshaveaninverserelationshipwiththeirpotentialforscale.Therefore,educationandawarenessmHealthprogramshavethe

simplesttechnologyrequirementsandimplementationmethodswiththehighestpotentialforscale.Analysis,diagnosisandconsultationapplicationsvia

mobiletechnologyaremorecomplexanddifficulttoscale.


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Figure2:mHealthApplications,Descriptions,andPotentialBenefitsandSavings

Recognizingthedistinctionsbetweenthesesegmentsandunderstandingthecharacteristicsofrelatingtechnologiesisacriticalpartofbeingabletobuild

applicationsthatpromisesustainabilityandscale.Forsomehealthcareapplications,mobiletechnologyprovidesameanstoaddressspecifictasksbetter

andfaster.However,currentmobiletechnologyisnotidealforsomemHealthapplicationsthatrequiregreaterbandwidthorlowercosts.Mobile

technologysappropriatenesstoanygivenapplicationdependsonabalanceoftechnicalperformance,cost,andefficacyconditionsthatwillcontinueto

evolve.

DevelopingCountries

and

the

Global

South

Throughoutthispaper,thetermsdevelopingcountriesandGlobalSouthareusedinterchangeably.VitalWaveConsultingfollowsestablishedWorld

BankeconomicbenchmarkstodefinedevelopingcountriesorGlobalSouthascountriesthathaveagrossnationalincome(GNI)of$10,725orlessper

capita.Intheprivatesector,thetermemergingmarketsisfrequentlyusedinterchangeablywithdevelopingcountries.

Withindevelopingcountries,VitalWaveConsultingdistinguishesbetweenthreesubgroupsaccordingtopopulationsizeandeconomicstatus.More

informationaboutthesetermsandcategoriesmaybefoundintheInsightssectionoftheVitalWaveConsultingwebsite.

Application Description Potential Benefits & Savings Examples

Education &

Awareness

Primarily one-way communication programs to mobile subscribers via

SMS/text messaging in support of public health, behavior change

campaigns.

Improved awareness

Enhanced quality of care through education

Saved time and travel cost from distant learning

Decreased cost per impression

Data, Health Record

Access

Applications designed to use mobile phones, PDAs, or laptops to enter

and access patient data. Some projects may also be used by patients to

access their own records.

Improved data accuracy

Saved office supplies Reduced time for collecting and transcribing data by

medical personnel

Increased productivity within health system

Enhanced quality of care

Monitoring/

Medication

Compliance

One-way or two-way communication to patient to monitor health

conditions, maintain care giver appointments, or ensure strict

medication regimen adherence. Some applications may also include

inpatient and outpatient monitoring sensors for monitoring of multipleconditions (such as diabetes, vital signs, or card iac.)

Improved medication adherence and reduced DALYs,

medication cost, general health care cost Improved service because of better monitoring

Saved travel time (both doctors and patients)

Reduced expense for hospital stays

Saved time for doctors through access to automated

medical history

Saved resources from fewer missed appointments

Disease/ Emergency

Tracking

Applications using mobile devices to send and receive data of disease

incidence, outbreaks, geographic spread of public health emergencies,

often in association with GPS systems and backend applications for

visualization.

Enhanced disease surveillance and control

Health/

Administrative

Systems

Applications developed for back office or central health care IT

systems allowing for access by and integration with mHealth

application. Such applications often tie in to regional, national, or

global systems.

Reduced IT/MIS cost

Reduced cost from better IT integration, reduced

compatibility problems, ease of upgrades

Analysis, Diagnosis,

and Consultation

Applications developed to provide support for diagnostic and treatment

activities of remote care givers through internet access to medical

information data bases or to medical staff.

Increased productivity within health system

Enhanced quality of care


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Market Opportunity(by application)

Total HealthExpenditure

% of Health

Expenditures forApplication Area

% of Health ApplicationSpending that can be

converted to mHealth= x x

Part3 MethodologiesOverview

BasedonavailableinformationandextensiveresearchonhealthcaremarketsindevelopingcountriesperformedbyVitalWaveConsulting,bothtopdown

andbottomupapproachesarefeasibleforestimatingthemarketsizeformHealthsolutions.Threepossiblemethodologiesaredescribedindetailbelow.

Thetwotopdownapproachmethodologies(Methodology1andMethodology2)startfromthetotalhealthcareorHealthICT/eHealthexpendituresper

country

and

estimate

the

portion

of

this

expenditure

that

can

be

shifted

to

mHealth

solutions.

The

bottom

up

approach

(Methodology

3)

starts

with

the

differentmHealthapplicationareasidentifiedinFigure2andestimatesthepotentialsavingsfromtheirimplementation.Allproposedmethodologies

estimatethemarketopportunityforeachmHealthapplication.Theaddressablemarketsize,inthiscase,isthesumofthemarketsizesperapplication.

Choosingthemostappropriatemethodologydependsonpreferencesforspecificapproaches,geographicareasofinterest,time,andbudget.

Methodology1TopdownfromHealthBudgetswithNeedsbasedSegmentation

Methodology1estimatesthemarketopportunityformHealthsolutionsasaportionoftotalhealthexpenditureforeachapplicationarea.Thetotalmarket

sizeisequaltothesizeofallmarketsperapplicationcombined.

Step1:DetermineTotalHealthExpenditure

Collectinformationabouttotalhealthexpenditureineachcountry,accessibleviapublicsourcesofinformation,suchastheWorldHealthOrganization.

Step2:EstablishGeographic SegmentsBasedonHealthNeed

SegmentthedevelopingcountriesaccordingtotheirneedsforthesixmHealthapplicationareasusingavailablesecondarydata(e.g.,disabilityadjustedlife

years,healthexpenditurespercapita,landarea,ruralandurbanpopulations,andnumberofdoctorsandhospitals).Determinecountrysegmentswith

similarneedlevels(low,mediumandhigh)foreachapplication.Forinstance,countrieswithhighinstancesofinfectiousdiseasesandstressedhealth

systeminfrastructure(e.g.,nationsinsubSaharanAfrica)mayhavegreaterneedsforeducationandawarenessandmonitoring/medicationcompliance

applicationsthancountrieswithalowerincidenceofinfectiousdiseasesandmoreadvancedhealthsystems(e.g.,nationsinEasternEurope).

Therequireddatacanbeobtainedfrompublicsourcesofinformation,suchasWHO,theUnitedNations,andtheWorldBank.Morespecificinformation

canbefoundinpaiddatabasessuchasBusinessMonitorInternational.Availabledatawillbevalidatedthroughandaugmentedbyexpertopinion.Asample

needsbasedsegmentationisshowninFigure3.


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Figure3:NeedsbasedSegmentation(sampleoutput).Tableforillustrativepurposesonly.

Step3:DetermineTotalHealthExpenditureperDetermineTotalHealthExpenditureperApplicationArea(asPercentageofTotalHealthExpenditure)

UsinginputsfromsubjectmatterexpertsacrossthesixmHealthapplicationareascombinedwithanyanecdotaldatafoundforrepresentativecountries

withinthesegmenttovalidatetheexpertsopinions,theportionoftotalhealthspendingallocatedtoeachapplicationareaforeachsegmentcanbe

estimated.ThisprocessisdemonstratedinFigure4.

Step4:ConvertTotalHealthExpenditureperApplicationAreatomHealthspecificExpenditures

Usinginputsfromsubjectmatterexpertsacrosstheapplications,onecandeterminetheportionoftotalhealthspendingbyapplicationthatcouldbe

transferredtomHealthinthedifferentgeographicsegments.Thisstepincorporatesacountrysneedandthepotentialimpactofaparticularsolution,as

wellasthecosttradeoffbetweenthemHealthapplicationandtraditionalservices.Forinstance,mHealtheducationandawarenesscampaignsinsub

SaharanAfricacouldcommandahigherpercentoftheoverallbudgetiftheydirectlyreplaceradio,print,andtelevisioncampaigns.Thepenetrationof

mobileservicesacrossthepopulationandcoverageofdifferentgeographicareaswouldalsofigureintothiscalculation,takingintoconsiderationthe

increasedimpactaprogramcouldhavewithexpandedmobilecoverage.Asamplecalculationofthepotentialimpactinanapplicationareaforvarying

segments(suchascountriesorregions)isshowninFigure5.

Figure5:PortionofHealthApplicationAreaSpendingthatisConvertibletomHealthTableforillustrativepurposesonly.

Step5:CalculatetheMarketOpportunity

mHealth Application Area Segment 1 Segment 2 Segment 3

Education & Awareness

Data Entry, Health Records Access

Monitoring/ Medication Compliance

Disease/ Emergency tracking

Health/ Administrative System

Analysis, Diagnosis, and Consultation

High Need Medium Need Low Need

mHealth Application Area Segment 1 Segment 2 Segment 3

Education & Awareness 25% 10% 5%

Data Entry, Health Records Access 10% 15% 18%

Monitoring/ Medication Compliance 13% 7% 7%

Disease/ Emergency tracking 13% 7% 5%

Health/ Administrative System 5% 5% 8%

Analysis, Diagnosis, and Consultation 3% 3% 5%



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Total Health ICT/eHealthExpenditure

% of Health Application Spendingthat can be converted to mHealth

Market Opportunity(by application) = x

Giventheoutcomesfromtheprevioussteps,onecancalculatethemarketopportunityformHealthsolutionsforeachoftheapplicationareaspercountry

andapplication.ThetotalmarketsizeformHealthinagivencountrywillbethesumoftheseapplicationspecificmarkets.

AdvantagesandDisadvantagesofMethodology1

Methodology2TopdownfromHealthICToreHealthBudgets

SimilartoMethodology1,Methodology2estimatesthemarketopportunityperapplicationasaportionofexistingtechnologyexpenditures.

Step1:TotalHealthICToreHealthExpenditure

CollectallavailabledataforhealthICTandeHealthexpendituresforapproximately40to50countries.Suchdataisavailablethroughpublishedreports

(suchasthosebyFrostandSullivan),pressreports,governmentpapersorspeeches,andstudiesbyacademicsandtheinternationaldevelopment

community.TotalspendingforICTinhealthcareworldwideisestimatedat34%oftotalhealthcarespending.However,fortheGlobalSouth,this

percentagewillbelower.

Step2:EstablishGeographic SegmentsBasedonHealthCareInfrastructure

Itispossibletosegmentcountriesbasedonhealthsysteminfrastructureandcoverageprofiles.However,comprehensiveresearchisneededforthis

segmentationbecausecountriesvarygreatly,notonlyinthelevelofdevelopmentoftheirhealthsysteminfrastructure,butalsointheirbudgetsources.

Forinstance,somecountriesallocatehigherportionsofthegovernmentbudgetandgrossdomesticproducttohealththanothers,andsomecountriesrely

muchmoreheavilyonprivateentitiesforhealthcareprovision.Inaddition,countrieshavevaryinglevelsofwirelessinfrastructureandmobilecapacityfor

mHealthservices.Countrieswithlimitedwirelessinfrastructureandlargepopulations(suchasEthiopiaandMyanmar)couldpresentalongtermmarket

opportunitybut

require

additional

reforms

before

widespread

mHealth

services

can

be

offered.

Step3:ConvertHealthICToreHealthExpendituretomHealthspecificExpenditure

Advantages of Methodology 1 Disadvantages of Methodology 1

Incorporates an evaluation of needs intothe analysis

Spending data are directional becausethey are based on expert opinion

Captures market opportunities beyond

current/potential IT expenditure

Requires primary research resources

(subject matter experts) that areknowledgeable of health expenditures by

application area and mHealth potential


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Average spending per person formHealth-related applications

Volume potential perapplication

Market Opportunity(by application)

= x

UsinginputsfromsubjectmatterexpertsacrossthesixmHealthapplicationareasandanyavailableanecdotalevidence,identifytheportionoftotalhealth

ICTandeHealthspendingthatcanbeconvertedtomHealthspendingacrossapplicationareasandsegments.CountriesthatareinvestinginICTforhealth

andhavestrongmobilecoveragecouldbebettercandidatestoconvertbudgetallocationstomHealthintheshortterm.

Step4:CalculateMarketOpportunity

Onecancalculatethemarketopportunityperapplicationareaandpercountryforthosewherereliabledataareavailable.Thefinalstepistoextrapolate

thisprocess

to

other

countries

using

the

same

coefficients

for

countries

in

the

same

geographic

segment.

AdvantagesandDisadvantagesofMethodology2

Methodology3:BottomupfromCostandVolumeData

Methodology3followsabottomupapproachtocalculatethemarketopportunityperapplicationareaastheproductofaveragespendingperpersonand

thevolumepotentialofanapplication.

Step1:EstablishGeographicSegmentsBasedonHealthNeed

AsinMethodology1,aneedsbasedsegmentationisrequired.OnecansegmentthedevelopingcountriesaccordingtotheirneedsforthesixmHealth

applicationareasusingavailablesecondarydata(suchasdisabilityadjustedlifeyears,healthexpenditurespercapita,landarea,ruralandurban

populations,andthenumberofdoctorsandhospitals).Then,determinecountrysegmentswithsimilarneedpatterns(low,mediumandhigh)foreach

application.

Further,onecanselect10to14representativecountriesacrossthesegmentsfordeeperinvestigation.Later,thefactorscalculatedforthesecountriescan

beappliedtoallcountriesintheparticularsegment.IllustrativeoutputoftheneedbasedsegmentationisshowninFigure3,above.

Step2:IdentifyPotentialCostSavingsfrommHealthApplicationsperArea

UsinginputsfromsubjectmatterexpertsacrossthesixmHealthapplicationareasandanyapplicableanecdotaldatafromsecondarysources,onecan

expand,refineandensuretheaccuracyandcomprehensivenessofthelistofpotentialbenefitsandsavingsoutlinedinFigure2.

Step3:ConductCountryResearch

Advantages of Methodology 1 Disadvantages of Methodology 1

Incorporates an evaluation of needs into

the analysis

Spending data are directional because

they are based on expert opinion

Captures market opportunities beyondcurrent/potential IT expenditure

Requires primary research resources(subject matter experts) that are

knowledgeable of health expenditures by

application area and mHealth potential


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Usingsecondarydatafrom10to14countriesselectedfromacrossthesegments,aswellasexpertopinion,onecandeviseanaveragecostperunitforeach

oftheapplicationareas(Figure6)ineachgeographicsegment.Additionally,onecancreatecoefficientstoadjustthoseaveragecostsfordifferentsegments

containingcountrieswithvaryingincomelevelsandhealthinfrastructure.

Forinstance,SouthAfricaandLesothocouldbeinthesamegeographicsegmentaccordingtotheirhealthneeds,butcostsforconductingepidemiological

surveysinSouthAfrica,withitslargerrurallandarea,maybemoreexpensiveperfieldworkerthaninLesothobecauseoftheneedforadditionaltravel.

Figure6:

mHealth

Per

capita

Unit

Cost

and

Volume

Potential

by

Segment

Table

for

illustrative

purposes

only.

Final

variables

to

be

adjusted

based

on

precisedataavailability.

Next,onecanidentifythevolumepotentialbyapplicationandbysegment(suchasthenumberoffieldsurveyorsneededperpopulationof1,000,the

numberofrecipientsofbehaviorchangecampaignsperpopulationof1,000,andthenumberofimpressionsneededtoinvokebehaviorchangeineach

person). Thestepsabovewilldemandbothsecondaryresearchandexpertopinion.

Step4:CalculatetheMarketPotential

Withthefindingsgeneratedfromstepsdescribedabove,onecancalculatethesumofthemarketopportunityperapplicationarea.Thebenefitofthis

approachisthatitismorecomprehensiveacrossallmHealthsavingsareasbeyondtechnology.However,italsorequiresveryknowledgeableprimary

sourcesandpresentsthemostchallengingdatarequirementsofthethreeapproaches.


mHealth Per-capita Unit Cost Base Multiplied By Volume Potential Base

Segment 1 Segment 2 Segment 3 Segment 1 Segment 2 Segment 3

Education &Awareness

Cost per

impression;

Costs per

individual

behaviorchange

Cost per

impression;

Costs per

individual

behaviorchange

Cost per

impression;

Costs per

individual

behaviorchange

Number of

impressions

(per 100)

Number of

impressions

(per 100)

Cost per

impression;

Costs per

individual

behaviorchange

Data Entry, Health

Records AccessCosts per

record accessCosts per

record accessCosts per

record access

Volume of

record access

transactions(per 100)

Volume of

record access


Number of

impressions(per 100)

Monitoring/

Medication

Compliance

Cost per

patient

Cost per

patient

Cost per

patient

x

Number of

patients to be

monitored (per100)

Number of

patients to be

monitored (per100)

Volume of

record access


Disease/ Emergencytracking

Cost per survey Cost per survey Cost per surveyNumber of

surveys (per100)

Number of

surveys (per100)

Number of

patients to be

monitored (per

100)

Health/

AdministrativeSystem

Cost per 100population



Population

served (per

100)

Population

served (per

100)

Number of

surveys (per

100)

Analysis, Diagnosis,

& ConsultationCost per

interactionCost per

interactionCost per

interaction

Number of

interactions(per 100)

Number of

interactions(per 100)

Population

served (per100)


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Page 14

Advantagesand

Disadvantages

of

Methodology

3

Average spending per person for

mHealth-related applications

Volume potential per

application

Market Opportunity

(by application)= x


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Page 15

Part4 MethodologyComparison

EachofthethreemethodologiespresentedinthispaperprovidesarealisticandcredibleapproachforestimatingthemarketopportunityformHealth

solutionsintheGlobalSouth.Allofthemincludeprimaryresearchandinputfromsubjectmatterexpertsinthedatagatheringphase.Foreffective

executionandresultsthataccuratelygaugethemarketopportunity,ateamofresearchersandanalystsworkingwithateamofexpertsoverseveral

monthswillbeneeded.

Eachmethodology,however,differsinitsapproachtowardtheexistingandreadilyavailabledata,asillustratedinFigure7.

Figure7:MethodologiesComparison

Methodology3withitsbottomupapproachprovidesthebestcombinationofcomprehensiveanddefinitiveresults.Thismethodologyis,however,the

mosttime andlaborconsumingofthethree.Ingeneral,bottomupapproachesaretimeandresourceintensiveandthereforechallengingtoimplement

globally.Butinamanageable setofcountries,itisacompellingapproach.

Methodology1ismoredirectionalthandefinitiveinitsresultswhencomparedtoMethodology3.Itreliesonsubjectexpertopinionsratherthanondata

fromglobalfieldsurveys,andislesstime andcostintensivetoimplement.

Methodology2istheleasttimeandlaborconsumingamongallthreeapproaches.Theresultswillbemoredirectionalthanwiththeothermethodologies.

ThisapproachestimatestheportionofHealthICTandeHealthbudgetsthatcouldbeshiftedtowardmHealthsolutionsandomitstheotherareaswhere

mHealthwillhaveimpact(e.g.,augmentingorreplacingtraditionalmediainawarenessandbehaviorchangecampaigns).Thisapproachisbestusedin

caseswithlimitedbudgetsandtheneedforaglobalestimateofthemarketsize.

AllthreeproposedmethodologiesanalyzeeithercurrentexpendituresorthosethatcouldbeavailabletomHealthsolutionsthroughshiftingbudgetline

items(justifiedbycostsavingsresultingfrommHealthservices).TwootherimportantaspectsofimplementingmHealthsolutionsaretheimproved

efficiencyandimprovedservicethataremoredifficulttomeasureortoexpressinmonetaryterms.Undoubtedly,measuringtheoutcomesshouldbepart

ofthemarketsizingaswell,butcredibleinformationforthisisnotyetavailable.Itisalsoimportanttonotethatameasurement oftheresultsofmHealth

solutionswill

draw

additional

investments

in

this

field.

Directional

Comprehensive

Narrow

Methodology1

Definitive

Methodology2

Methodology3


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Page 16

Appendix:AvailableDataandSources

Theinformationbelowsummarizesavailabledata,illustratingthelevelofdetailandprovidingguidelinesforfurtherresearch.Itisnotacomprehensive

overviewoftherespectivehealthcaremarkets.

WorldHealthOrganization StatisticalInformationSystem

ThemostimportantsourceofhighlevelstatisticaldataonhealthcarepercountryisthedatabaseoftheWorldHealthOrganization,theWHOStatistical

InformationSystem(WHOSIS).WHOSIScontainshistoricalvaluesformanyindicators,allowingtheidentificationoftrendsandforecasting.Thedatabase

containsdatafor164indicatorsinthefollowingsixcategories:

Demographicandsocioeconomicstatistics

Healthservicecoverage

Healthsystemsresources

Inequitiesinhealthcareandhealthoutcome

Mortalityand

burden

of

disease

Riskfactors

Fordevelopingcountries,however,andforthecountriessurveyedbyVitalWaveConsultinginparticular,dataformanyofthe164WHOSISindicatorsare

notavailable.Themostrelevantandavailabledatacoverthefollowingindicators:

Totalhealthcareexpenditureinabsolutevalue,asapercentageofGDP,percapita,inrealdollars,internationaldollars,andnational

currencyunits.

Breakdownofthetotalhealthcareexpenditureinto:

Privatespendingsuchasoutofpocketpayment,prepaidandriskpoolingplans,andNGOs

PublicspendingsuchasMinistryofHealth,socialsecurityfunds,andothergovernmentspending

Externalsourcessuchasinternationaldonorprograms.

Healthworkforceandresources(nurses,midwives,physicians,dentists,pharmacists,hospitals,hospitalbeds)inabsolutevalueandpera

populationof1,000.

SomeoftheWHOSISindicatorsthatwouldbehelpfulinthemarketassessmentandforwhichdatafortheresearchedcountriesarenotavailableare:

Expenditureoninpatientcurativecare

Expenditureonpreventionandpublichealthservices

Expenditureonhospitals

Expenditureonhumanhealthresources


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Page 17

AlthoughtheWHOSISdatabaseisprobablythebestsourceforhighlevelhealthcaredatapercountry,somenationalgovernmentsprovidedmuchmore

detailedanduptodatedataonhealthcareintheircountry.

HealthExpenditureandHealthCareServiceIndicatorsinSouthAfrica

SouthAfrica,forexample,hasawelldocumentedhealthcaresystemanddatabasewithcomprehensivestatisticalinformationoncountryandprovince

levels.TheNationalDepartment ofHealth(www.doh.gov.za)issuesaDepartmentofHealthAnnualReportgivingdetailsonlegislativechanges,

departmentalrevenueandexpenditure,strategichealthprograms,andprogressmadetowardachievingestablishedgoals.TheroleoftheNational

Department ofHealthismainlystrategicanditsparticipationinSouthAfricashealthcareexpenditureislessthan1percent.

MoredetaileddataabouthealthcarethanthatfoundthroughWHOSISandtheNationalDepartment ofHealthareavailableontheProvincialDepartments

ofHealthwebsites(http://www.doh.gov.za/links/index.html).Thesedepartmentsareresponsiblefortheallocationofmorethan95percentofgovernment

healthspending.Eachofthedepartmentsissuesanannualreportwithdetailsonitsfinancialspending,humanresources,andthefollowingprograms:

Program1:HealthAdministration

Program2:DistrictHealthServices

Program3:EmergencyMedicalServices

Program4:ProvincialHospitalServices

Program5:HealthSciencesandTraining

Program6:HealthCareSupport

Program7:HealthFacilitiesManagement

Besidespurelyquantitativeinformationonagreatnumberofhealthindicators,thesereportsincludethequalitativeinformationneededforabetter

understandingofthelocalhealthcaresystemandanassessmentofthepotentialbenefitsofmHealthsolutionsanoverviewofthecurrentsituation,

discussionsofproblems(suchasdisparitiesindifferentregionswithinaprovince)andprojectionsforthefuture.Thelevelofdetailsurpassesthedetailsin

apubliccompanysannualreport.

WhiletheNationalandProvincialDepartmentsofHealthsdocumentationcontaindatamainlyaboutpublichealthexpenditureandgovernmentprograms,

theHealthSystemTrust(www.hst.org.za)andStatisticsSouthAfrica(www.statssa.gov.za)provideinformationonSouthAfricashealthcareasawhole.

HealthSystemTrustsannualreportSouthAfricanHealthReview2007(http://www.hst.org.za/publications/711)focusesonbroadareaswithrespectto

theroleoftheprivatehealthsector.Theseareasincludeoversight,poolingofresources,purchasingofhealthcare,deliveryofhealthcareservicesand

healthrelatedindicators.Criticalissuescoveredinthe2007reviewinclude:

Assessmentoftheroleofthegovernmentintheoveralltransformationprocessofthehealthsector.

Policyandlegislativereviewontheprovisionandfundingofprivatehealthcare.

Reviewandanalysisofhealthcarefinancingandexpenditureaswellasrecenttrendsinspendinginthepublicandprivatehealthsectors.

Overviewofhealthinformationsystemsandtheroleplayedbyintermediariesinfacilitatingtheflowofpatientinformation.

AnalysisofthehealthstatusoftheSouthAfricanworkforceandhealthcareprovisionintheworkplace.

Analysisanddevelopmentsinthemarketandregulatoryenvironmentimpactingmedicinepricingandaccesstomedicines.


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Page 18

Reviewoftheimpactofpublicprivatepartnershipsonaccesstohealthcareandhealthoutcomes.

Analysisoftheprivatehospitalindustrywithspecificfocusonstructure,ownership,andmarketsharepergeographicalregionandthe

natureofrelationshipsbetweenprivatehospitalsandproviders.

AnalysisoftheprivatesectorsresponseforHIV/AIDS,sexuallytransmittedinfections,andtuberculosis.

Inbrief,

the

report

summarizes

the

most

relevant

data

from

the

sources

described

above,

and

compares

the

health

care

systems

across

provinces

on

both

thepublicandprivatelevel.SeeReferencesforsourcedata.


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Page 19

HealthExpenditureandHealthCareServiceIndicatorsinVietnam

Whiledetaileddataonhealthcareexpenditure,allocation,andindicatorsforSouthAfricaareabundant,readilyavailableandeasilyaccessiblethrough

governmentagenciesorpublicinstitutionswebsites,thisisnotthecaseformanyotherdevelopingcountries,suchasVietnam.ForVietnam,WHOSIS

provestobethebestsourceforquantitativedata,eventhoughitgivesdatathataretoohighleveltobedirectlyusefulfordetermininghowmoniesare

spent.

TheEnglish

version

of

the

Vietnamese

Ministry

of

Healths

website

(www.moh.gov.vn)

contains

little

qualitative

or

quantitative

information,

while

the

HealthPolicyandStrategyInstitute(www.hspi.org.vn)referstodocumentspreparedbytheUnitedNationsandWHO.TheVietnameseversionofthe

MinistryofHealthswebsitecontainssomequantitativedata,butinmuchlessdetailthanthedataavailableintheWHOStatisticalInformationSystem.

UptodatequantitativedataonhealthcareindicatorsareavailableonthewebsiteoftheGeneralStatisticsOfficeofVietnam(www.gso.gov.vn).However,

theindicatorscoveredlargelyoverlapwiththoseintheWHOSISandgivelittlenewinformation.Additionally,mostofthedataexcludetherapidlygrowing

privatesectorandaresummarizedatthecountrylevel.

TwoadditionalfactsmakefindingindepthinformationinVietnamdifficult:

Vietnams64provinceshavesignificantbudgetandinvestmentautonomy.

Privateoutofpocketspendingrepresentsasmuchas80percentoftotalspendingonhealthcareinVietnam.

Inbrief,asystematicstudyonthehealthcareexpenditureinVietnamatalevelofdetailthatwouldaddtothemarketassessmenteffortsisnotavailable.

Mostoftheexternaldatasources(suchastheUnitedNations,UnitedNationsPopulationFund,WHO,WorldBank,InternationalMonetaryFund,andthe

AsiaPacificActionAllianceonHumanResourcesforHealth)usethequantitativedataalreadyavailable.Thesesources,however,containqualitative

descriptionsoftheorganizationofthehealthcaresysteminVietnam,whichprovidesusefulbackground.SeeReferencesforsourcedata.

HealthExpenditureandHealthCareServiceIndicatorsinTurkey

WhileSouthAfricaandVietnamrepresenttheextremesofreadilyavailableandeasilyaccessiblehealthdata,Turkeyprovidesasatisfactory,ifnot

thorough,quantityofdata.InformationabouttheTurkishhealthcaresystemisnotasstructuredascorrespondinginformationforSouthAfrica,butitisstill

abundantandcontainsusefuldetails.

RelevantandinformativedocumentationaboutthehealthcaresysteminTurkeyisavailableontheMinistryofHealthwebsite(www.saglik.gov.tr).The

TurkeyHealthTransformationProgramdocumentdescribesthelatestdevelopments,ongoingprojectsandfuturegovernmentplanstoaddresstopics

suchashealthcareorganizations,currentandfutureexpenditures,hospitalsandhospitalservices,humanresourcesavailabilityandtrainingand

geographicaldisparities.TurkeysprofileontheWHOwebsite(www.euro.who.int/document/e79838.pdf)addstothesetopics,butdatainthedocument

areoutdated.

TurkeysprofileontheOECDwebsite(www.oecd.org/turkey)providesbasichealthcareindicatorsforTurkeyincomparisontoothermembers.OECDalso

breaksdowndetailsofhealthcareexpenditures(http://www.oecd.org/dataoecd/7/49/33696739.pdf)bymainfunction,financingagentandhealthcare

provider.

Someofthequantitativedatainthisdocumentisoutdated,butitstillgivesasolidstartingpointforfurtherexplorationofhealthcareexpendituresin

Turkey.

Inbrief,

the

public

sources

of

information

provide

good

documentation

for

one

to

get

acquainted

with

the

health

care

system

and

expenditure

on

acountry

level.However,quantitativedataandprofilesofthe81provinces,oratleasttheregionswithgreatdisparitiesinhealthcarespendingandservices,will

requireinputfromasubjectmatterexpert.SeeReferencesforsourcedata.

PaidDatabasesforHealthcareData


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Page 20

Paiddatabases(e.g.,ISIEmergingMarketsandBusinessMonitorInternational)mainlyusehealthcareexpendituredataandcountryprofilesfromWHO,

therespectivehealthministrywebsitesandstatisticsofficesandextrapolatethem.However,furtherbreakdownofhealthcareexpendituresatasub

accountlevelisusuallymissing.

AnimportantdatapointaboutdisabilityadjustedlifeyearsperdiseasecanbefoundintheBusinessMonitorInternationaldatabases.Asdescribedin

Methodology1above,thisinformationisusefulinsegmentationofthecountriesintheGlobalSouth.

Dataon

the

Impact

from

mHealth

Solutions

AcrediblestudyoftheimpactofmHealthsolutionsisnotavailable,andimpactisakeyindicatorindeterminingthemarketthatiswillingtopurchase.

Informationaboutthebenefitscanbefoundinsomeprojectpapersandonsomewebsitesofmobilephoneoperatorsandcompaniesdevelopingsuch

solutions,butthisinformationisanecdotalratherthancomprehensive.Subjectmatterexpertscanhelpaugmenttheanecdotaldatatoalevelthatis

quantifiableandcredibleforthemarketsizingmodel.However,thiswouldnotbearigorousimpactstudy,butanestimationbasedonexpertopinion


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Page 21

References

SouthAfricahealthexpenditureandhealthcareserviceindicators:

CountryProfileSouthAfrica.(2007).WHOReport2007GlobalTuberculosisControl.WorldHealthOrganization.Retrievedon15May2008fromhttp://www.who.int

EvaluationoftheOnCueComplianceServicePilotTestingtheuseofSMSremindersinthetreatmentofTuberculosisinCapeTown,SouthAfrica.

(March2005).

bridges.org.

Retrieved

on

14

May

2008

from

http://www.bridges.org/files/active/0/Cmplnc_EvlRpt_FIN_29Mar05.pdf

SouthAfricanHealthReview,2007.(2007).Durban:HealthSystemsTrust.Retrievedon18May2008from:http://www.hst.org.za/publications/711

Vietnamhealthexpenditureandhealthcareserviceindicators:

AdamsSJ.VietnamsHealthCareSystem:AMacroeconomicPerspective,InternationalMonetaryFund.2005.Retrievedon19May2008from:

http://imf.org/external/country/VNM/rr/sp/012105.pdf

HuongP,HueV.VietnamHITCaseStudy.CenterforHealthandAgingHealthInformationTechnologyandPolicyLab,TheNationalBureauofAsianResearch.2007.RetrievedonMay18,2008from:http://pacifichealthsummit.org/downloads/HITCaseStudies/Economy/VietnamHIT.pdf

NguyenT,LofgrenC,NguyenT,JanlertU,LindholmL.Householdoutofpocketpaymentsforillness:EvidencefromVietnam.BMCPublicHealth.

2006;vol.6:p.283.RetrievedonMay12,2008fromhttp://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1660562

WHOCountryCooperationStrategy,Vietnam,20032006.WorldHealthOrganization,VienamCountryOffice.WorldHealthOrganization;2007.RetrievedonJune1,2008fromwww.un.org.vn/who/docs/whoccs.pdf

Turkey

health

expenditure

and

health

care

service

indicators:

AkdagR.TheProgressSoFarTurkeyHealthTransformationProgram,November2002June2007.RepublicofTurkey,MinistryofHealth.2007.

RetrievedonMay10,2008fromhttp://www.saglik.gov.tr/EN/dosyagoster.aspx?DIL=2&BELGEANAH=466&DOSYAISIM=TurkeyHea

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ChartingtheWayForward:HealthCareReforminTurkey.TurkishIndustrialistsandBusinessmensAssociation(TUSAID).2005.

eTransformationinHealth.RepublicofTurkey,MinistryofHealth,Department ofInformationProcessing.2007.RetrievedonMay13,2008from

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HealthCareandHealthCareEquipments.TurkishUSBusinessCouncil,2007.RetrievedonMay12,2008from:http://www.turkeynow.org/db/Docs/A%20Healthcare%20May%202006.pdf

Mandil,S.TurkeyeHealthStrategyTowardsthestartofImplementation.RepublicofTurkey,MinistryofHealth.2007.Retrievedon10May2008

from:http://www.saglik.gov.tr/EN/Tempdosyalar/247__Turkey_Towards_start_of_Implementation_eng.pdf

NinthDevelopment

Plan

(2007

2013).

2008

Annual

Program.

Republic

of

Turkey,

Undersecretariat

of

State

Planning

Organization.

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